The heart healthy lenoir project-an intervention to reduce disparities in hypertension control: study protocol

Abstract

BackgroundRacial disparities in blood pressure control are well established; however the impact of low health literacy (LHL) on blood pressure has garnered less attention. Office based interventions that are created with iterative patient, practice and community stakeholder input and are rolled out incrementally, may help address these disparities in hypertension control. This paper describes our study protocol.Methods/designUsing a community based participatory research (CBPR) approach, we designed and implemented a cohort study that includes both a practice level and patient level intervention to enhance the care and support of patients with hypertension in primary care practices in a rural region of eastern North Carolina. The study is divided into a formative phase and an ongoing 2.5 year implementation phase. Our main care enhancement activities include the integration of a community health coach, using home blood pressure monitoring in clinical decision making, standardizing care delivery processes, and working to improve medication adherence. Main outcomes include overall blood pressure change, the differential change in blood pressure by race (African American vs. White) and health literacy level (low vs. higher health literacy).DiscussionUsing a community based participatory approach in primary care practice settings has helped to engage patients and practice staff and providers in the research effort and in making practice changes to support hypertension care. Practices have engaged at varying levels, but progress has been made in implementing and iteratively improving upon the interventions to date.Trial registrationClinicalTrials.gov NCT01425515.

Blood pressure–associated polymorphism controls ARHGAP42 expression via serum response factor DNA binding

“…exhibited hypertension trended lower in subjects who had copies of the minor allele (69%, 64%, and 60% for the C/C, C/T, and T/T genotypes, respectively). Finally, the MAF of the protective T allele in this cohort was dramatically lower in African Americans than in subjects of mixed European descent (6.5% vs. 26.6%; P < 0.001), and sequencing of over 1,000 individuals from this and additional University of North Carolina cardiovascular cohorts (17)(18)(19)(20) confirmed this result (Supplemental Table 2). Identification of regulatory elements within the ARHGAP42 gene.…”

The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial

“…Focus groups and other stakeholder engagement activities were held in the formative year to adapt and design our intervention [18, 19]. Stakeholders included people representing patients, clinicians, local government, educational systems, faith communities, health advocacy groups and many others.…”

“…As an overarching framework, we reasoned that implementing activities such as 1) enhancing and standardizing team based care, 2) providing patient self-management support (to improve intermediary measures such as patient activation, medication adherence, disease knowledge), 3) facilitating the provision of clinical data to providers [20, 21] and infusing the principles of health literacy throughout, that blood pressure will be lowered. Further details of the trial design, conceptual framework, and methods have been published [18], (Cene C, Journal of Clinical Hypertension, in press).…”

“…Table 3 includes the main topics covered. Further details of the curriculum and coaching process are available [18]. The coaches guided participants in goal setting, reviewed accurate BP measurement technique, and addressed BP target values on each phone call.…”

Calling for a Bold New Vision of Health Disparities Intervention Research

“…However, evidence for the effectiveness of multilevel interventions in reducing disparities is limited. 5 Current CPHHD multilevel interventions include a corner store intervention project in East Los Angeles, California 6 ; health system quality improvement projects to reduce hypertension disparities in Baltimore, Maryland, and rural North Carolina 7,8 ; a media training program for community-based organizations and toolkit for journalists to influence the public agenda on tobacco-related health disparities in Lawrence, Massachusetts; and a reservation-wide, multimedia campaign to increase colorectal cancer screening in the Northern Plains. Issues that need to be addressed in multilevel intervention research range from the very definition of what constitutes a multilevel intervention to identifying the best methodologies for intervention design, implementation, analyses, and optimizing translation, dissemination, and sustainability.…”