An RN/CHW Exemplar: Managing Hypertension in an Urban Community

Zha, Peijia; Sickora, Cindy; Chase, Sabrina M.; Erlewein, Meaghan

doi:10.4172/2471-9846.1000135

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…This study demonstrates that a culturally-adapted CHWled intervention among hypertensive South Asians delivered in community-based primary care practice settings can achieve significant improvements in BP control after 6 months. Previous research has focused on minority groups such as African Americans and Filipinos, 3,[22][23][24] but this is the first study designed to improve BP management among South Asian Americans. This is significant because although changes in overall BP control have been examined in community-based lifestyle interventions targeting heart disease and diabetes risk factors among South Asian Americans, [25][26][27]36 to our knowledge this is the first study to examine the impact of implementation of such models in small, community-based primary care practices.…”

Section: Discussionmentioning

confidence: 99%

“…predominantly focused on low-income Black or Latino communities. [22][23][24] However, a CHW-led randomized controlled trial among Filipino Americans observed 3.2 times greater adjusted odds of BP control for the treatment group versus the control group. 3 While CHWbased interventions have been effective in improving chronic disease outcomes in South Asian American communities, [25][26][27] no studies have investigated the impact on hypertension management.…”

Section: What Is Known?mentioning

confidence: 99%

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Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial

Islam

Wyatt

Ali

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Blood pressure (BP) control is suboptimal in minority communities, including Asian populations. We evaluate the feasibility, adoption, and effectiveness of an integrated CHW-led health coaching and practice-level intervention to improve hypertension control among South Asian patients in New York City, Project IMPACT (Integrating Million Hearts for Provider and Community Transformation). The primary outcome was BP control, and secondary outcomes were systolic BP and diastolic BP at 6-month follow-up. METHODS: A randomized-controlled trial took place within community-based primary care practices that primarily serve South Asian patients in New York City between 2017 and 2019. A total of 303 South Asian patients aged 18–85 with diagnosed hypertension and uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) within the previous 6 months at 14 clinic sites consented to participate. After completing 1 education session, individuals were randomized into treatment (n=159) or control (n=144) groups. Treatment participants received 4 additional group education sessions and individualized health coaching over a 6-month period. A mixed effect generalized linear model with a logit link function was used to assess intervention effectiveness for controlled hypertension (Yes/No), adjusting for practice level random effect, age, sex, baseline systolic BP, and days between BP measurements. Results: Among the total enrolled population, mean age was 56.8±11.2 years, and 54.1% were women. At 6 months among individuals with follow-up BP data (treatment, n=154; control, n=137), 68.2% of the treatment group and 41.6% of the control group had controlled BP ( P <0.001). In final adjusted analysis, treatment group participants had 3.7 [95% CI, 2.1–6.5] times the odds of achieving BP control at follow-up compared with the control group. CONCLUSIONS: A CHW-led health coaching intervention was effective in achieving BP control among South Asian Americans in New York City primary care practices. Findings can guide translation and dissemination of this model across other communities experiencing hypertension disparities. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03159533

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Section: Discussionmentioning

confidence: 99%

Section: What Is Known?mentioning

confidence: 99%

Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial

Islam

Wyatt

Ali

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…6 20 One strategy to improve the hypertension care cascade and bridge the gap between the community and the health system in other contexts is task-sharing, in which specific tasks are shared from a more qualified healthcare cadre to a less trained cadre such as community health workers. 21 22 Community-based health education and healthy lifestyle counselling interventions implemented by community health workers, for example, have shown promising results in early detection of hypertension, linkage to the health facilities, [23][24][25] medication adherence, [26][27][28][29] mean blood pressure reduction [30][31][32] and blood pressure control. 30 33 34 While Ethiopia has a health extension programme for certain communicable diseases, maternal and child health, hygiene and sanitation, health extension workers (HEWs) currently do not provide hypertension care and thus there is no evidence on how effective it will be in this context.…”

Section: Introductionmentioning

confidence: 99%

Effect of health extension workers led home-based intervention on hypertension management in Northwest Ethiopia, 2021: study protocol for a cluster randomised controlled trial

et al. 2022

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IntroductionAlthough hypertension is highly prevalent in Ethiopia, it is poorly diagnosed, treated and controlled. Poor access to care and a shortage of healthcare providers are major barriers. This study aims to evaluate the effects of health extension workers’ led home-based intervention on hypertension management in patients with hypertension in rural districts of northwest Ethiopia.Methods and analysisA two-arm cluster randomised controlled trial will be conducted among 456 hypertensive patients. Adults aged ≥25 years who have a diagnosis of hypertension both in the home-based hypertension screening study and at another measurement prior to recruitment will be eligible for the study. Randomisation will be done at the kebele level. In the intervention clusters, trained health extension workers will provide home-based intervention for hypertensive patients every 2 months for 9 months. The primary outcomes of the trial will be clinical linkage and blood pressure changes, whereas the secondary outcomes will be lifestyle modification, medication adherence and blood pressure control. Intention-to-treat analysis will be used for all primary analyses. A linear mixed-effect regression model will be used to model the change in blood pressure, while a mixed effect logistic regression model will be used to evaluate the intervention’s effect on the binary outcomes. Effect sizes such as mean difference for the continuous outcomes and relative risk, attributable risk and population attributable risk for binary outcomes will be used. All statistical analyses are two sided and a p<0.05 will be used.Ethics and disseminationThis study has been approved by institutional review board of the University of Gondar (Ref. No: V/P/RCS/05/2293/2020). The district’s health office will grant permission for cluster randomisation, and each participant will provide written informed consent for participation. The findings will be presented at scientific conferences and published in peer-reviewed scientific journals.Trial registration numberPACTR202102729454417.

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“…skills, outreach, and education (University of Arizona, 1998;Zha, Sickora, Chase, & Erlewein, 2016). As per county-level data, regular physical exercise has declined and the obesity rate increased from 2006 to 2010 (Boseman et al, 2013).…”

mentioning

confidence: 99%

“…The J&HCHC has offices in four public housing facilities. Seven CHWs were trained to improve health care access through a set of core skills, outreach, and education (University of Arizona, 1998; Zha, Sickora, Chase, & Erlewein, 2016). As per county-level data, regular physical exercise has declined and the obesity rate increased from 2006 to 2010 (Boseman et al, 2013).…”

mentioning

confidence: 99%

The Feasibility of an Exergaming Program in Underserved Older African Americans

et al. 2017

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The study tested the feasibility and efficacy of an exergaming program in underserved older African American communities. The study is a single-group with pre- and posttest design. Twelve female participants ( M age = 64.17 ± 6.74 years) completed an exergaming program once or twice a week for 24 sessions over 14 weeks. Community health workers implemented the program through coaching and supporting mechanisms to motivate participants to exercise. A mixed-methods analysis was used to assess the intervention. After the program, participants showed significant improvements in lower body flexibility ( p = .012), and physical health-related quality of life ( p = .005). Four themes were identified related to the self-reported benefits of the exergaming program: (a) improving health, (b) feeling enjoyment, (c) getting connected, and (d) knowing you. The exergaming program provides an easy-to-implement and potentially effective intervention that can be used in community-directed centers to improve health and well-being in the underserved population.

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An RN/CHW Exemplar: Managing Hypertension in an Urban Community

Cited by 4 publications

References 18 publications

Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial

Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial

Effect of health extension workers led home-based intervention on hypertension management in Northwest Ethiopia, 2021: study protocol for a cluster randomised controlled trial

The Feasibility of an Exergaming Program in Underserved Older African Americans

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