Outcomes of a multi‐community hypertension implementation study: the American Heart Association's Check. Change. Control. program

Abstract

Single-site, intensive, community-based blood pressure (BP) intervention programs have led to BP improvements. The authors examined the American Heart Association's Check. Change. Control. (CCC) program (4069 patients/18 cities) to determine whether BP interventions can effectively be scaled to multiple communities, using a simplified template and local customization. Effectiveness was evaluated at each site via site percent enrollment goals, participant engagement, and BP change from first to last measurement. High-enrolling sites frequently recruited at senior residential institutions and service organizations held hypertension management classes and utilized established and new community partners. High-engagement sites regularly held hypertension education classes and followed up with participants. Top-performing sites commonly distributed BP cuffs, checked BP at engagement activities, and trained volunteers. CCC demonstrated that simplified community-based hypertension intervention programs may lead to BP improvements, but there was high outcomes variability among programs. Several factors were associated with BP improvement that may guide future program development. Pivotal to this goal is the development of prevention strategies that are simple, cost-effective, sustainable, and scalable.The AHA has recently supported two large-scale, multifaceted, quality improvement efforts designed to assess the impact of pharmacists and/or community health workers, as well as the signature Heart360 information health technology, on lowering people's blood pressure (BP).3,4 Both of these academic-community partnership initiatives were effective; however, they were also resource-intensive in terms of cost and staffing, raising the question of whether such programs could be effective and scalable with less academic and financial support. Furthermore, it was unclear whether the findings from these initiatives could be generalized to other regions of the United States.

Nursing students serve and learn how to check, change, and control blood pressure in the local community

“…Several prior studies have demonstrated that the use of screening, health education and self-monitoring can promote improved hypertension control. [5,[7][8][9][10]14] In 2013, The AHA launched CCC program as an evidencebased hypertension management program that utilizes blood pressure self-monitoring to empower patients/participants to take ownership of their cardiovascular health. The CCC programs depends on volunteer health mentors to carry out the programs and interact with program participants; these volunteer health mentors were from both healthcare and nonhealthcare backgrounds.…”

“…The positive results of this study support the findings of previous studies that investigated the CCC program. [12,13] The extremely positive effects of this project are an eyeopening on the need of applying the program on a larger scale and invite other nursing programs in the region and US to participate in CCC program. To apply this program on a larger scale, partnerships with community organizations such as community health and wellness centers are needed.…”

“…[11] Few studies evaluate the impact of AHA CCC program. [12,13] The result of these studies showed that CCC as a simplified and cost-effective community-based hypertension intervention programs may lead to BP improvements. One study showed that CCC demonstrated significant BP reduction among 2,000 participants from eight Durham, NC outpatient clinics over a 6-month period.…”

“…[12] In another study 4,069 adults were enrolled into the CCC program at 18 US sites and the results showed that CCC program was associated with improved BP control (13.7 mmHg average reduction in BP) in a diverse community-based population. [14] Check. Change.…”

“…These sites trained volunteer health mentors to carry out CCC programs and interact with program participants; these volunteer health mentors were from both healthcare and nonhealthcare backgrounds. [11,14] The literature showed that community health promotion and disease prevention interventions conducted by nursing students have positive impact on the local communities. [15,16] These interventions also can serve as an effective strategy for teaching nursing student competencies and facilitating engagement with the community.…”