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

Abstract

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

Community Health Workers as Key Allies in the Global Battle Against Hypertension: Current Roles and Future Possibilities

“…8 They also found a doubling in the odds for diabetes, the highest of any race or ethnicity. This highlights the importance of trials like that by Islam et al 7 aiming to reduce cardiometabolic risk in South Asians. Moreover, it has been increasingly recognized that negative social determinants health are barriers to the success of health care in many (particularly immigrant) South Asian communities.…”

“…There were also a few limitations, most of which were adequately discussed by the investigators (eg, unblinded trial). 7 It is unfortunate that data regarding medication intensification or adherence were not collected. While theoretically due to lifestyle changes, the degree of systolic BP lowering (~7 mm Hg) suggests that some portion was due to improved drug treatment.…”

“…In this background, the current trial by Islam et al 7 is a welcome and important addition to the scientific literature. Potentially eligible South Asian (ie, India, Bangladesh, Pakistan, Nepal, Sri Lanka, or the Indo-Caribbean) adults were identified from the electronic medical records of 14 small community-based primary care practices in New York city.…”

Strategies to improve the implementation of intensive lifestyle interventions for obesity

“…Environmental change often necessitates local policy intervention and cross-sectoral partnerships, which should be incorporated to a greater extent in the next generation of ILIs ( 34 ). The use of community health workers (CHWs) or patient navigators may also help patients address social determinants of health by linking patients to clinical and social services ( 35 ).…”

“…Given these cultural nuances, ILIs developed in predominantly white populations may not be as effective with newly immigrant Chinese American families if interventions fail to engage grandparents in the U.S. or China ( 37 ). The use of culturally and linguistically concordant CHWs may help to bridge this cultural divide ( 35 ). In addition, the need for ILI adaptations is increasingly recognized in implementation science; however, how to optimally effect these adaptations is the next frontier of research ( 38 ).…”