Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: a Narrative Review of Recent Developments and Suggestions for Programmatic Efforts

Ali, Shahmir H.; Islam, Nadia; Commodore‐Mensah, Yvonne; Yi, Stella S.

doi:10.1007/s11906-020-01121-6

Cited by 10 publications

(12 citation statements)

References 52 publications

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“…Strategies to help overcome these barriers include providing Latinx patients and their family/caregivers with information describing how the research team will maintain confidentiality, and establishing partnerships with community-based organizations to increase public trust in research processes [ 41 ]. Structural barriers include financial concerns, time constraints due to work or caregiving responsibilities, lack of transportation, and communication issues [ 7 , 12 , 15 , 16 ]. Many of these structural barriers are remediable.…”

Section: Discussionmentioning

confidence: 99%

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research

et al. 2023

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Background Latinx individuals are disproportionally burdened by kidney diseases compared to non-Latinx White individuals and are underrepresented in kidney-related research. We aimed to describe stakeholder perspectives on Latinx patient engagement in kidney-related research. Methods We conducted a thematic analysis of two online moderated discussions and an interactive online survey with open-text responses involving participants (i.e. stakeholders), with personal and/or professional experiences with Latinx patients with kidney diseases and their families/caregivers. Results Among the eight stakeholders (Female:75%; Latinx ethnicity:88%), there were three physicians, one nurse, one patient with kidney disease who received a kidney transplant, one policy maker, one Doctor of Philosophy, and one executive director of a non-profit health organization. We identified five themes. The majority of themes and their respective subthemes (in parentheses) reflected barriers to engagement: Lack of personal relevance (unable to relate to research staff and marketing resources, and unclear benefit of research to self, family, and community); fear and vulnerability (immigration concerns, stigma with seeking care, skepticism of Western medicine); logistical and financial barriers (limited opportunities to enroll in clinical trials, out-of-pocket costs, transportation issues); and distrust and asymmetry of power (related to limited English proficiency or health literacy, and provider bias). The last theme centered on stimulating interest and establishing trust in the research process. Conclusions To overcome barriers to engagement in kidney-related research and establish trust among potential Latinx research participants, stakeholders recommended employing cultural responsiveness and community-based strategies. These strategies can help identify local health priorities, enhance research recruitment and retention strategies, and establish partnerships that continue to elevate research endeavors aiming to enhance the health of Latinx individuals with kidney diseases.

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Section: Discussionmentioning

confidence: 99%

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research

et al. 2023

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“…Frameworks can also be leveraged to describe intervention design aspects and propose adaptations needed for widespread implementation. In a narrative review of community-based behavioral and educational interventions to promote hypertension control in immigrant populations, Ali and colleagues 70 used the Consolidated Framework for Implementation Research to propose key innovations, including adapting to a unique sociodemographic and acculturation level of immigrant communities, exploring new intervention designs (both shorter and longer, culturally sensitive activities), employing different types of intervention delivery agents from the community, collaborating with diverse stakeholders at multiple stages of the research process, and using mixed methods to efficiently adapt the intervention. Future work should consider how these innovations might target SDOH like education, income, and housing.…”

Section: Application Of Roadmap Step 4: Evaluating Implementation Suc...mentioning

confidence: 99%

Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association

Moise¹,

Cené²,

Tabak³

et al. 2022

Circulation

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Reducing cardiovascular disease disparities will require a concerted, focused effort to better adopt evidence-based interventions, in particular, those that address social determinants of health, in historically marginalized populations (ie, communities excluded on the basis of social identifiers like race, ethnicity, and social class and subject to inequitable distribution of social, economic, physical, and psychological resources). Implementation science is centered around stakeholder engagement and, by virtue of its reliance on theoretical frameworks, is custom built for addressing research-to-practice gaps. However, little guidance exists for how best to leverage implementation science to promote cardiovascular health equity. This American Heart Association scientific statement was commissioned to define implementation science with a cardiovascular health equity lens and to evaluate implementation research that targets cardiovascular inequities. We provide a 4-step roadmap and checklist with critical equity considerations for selecting/adapting evidence-based practices, assessing barriers and facilitators to implementation, selecting/using/adapting implementation strategies, and evaluating implementation success. Informed by our roadmap, we examine several organizational, community, policy, and multisetting interventions and implementation strategies developed to reduce cardiovascular disparities. We highlight gaps in implementation science research to date aimed at achieving cardiovascular health equity, including lack of stakeholder engagement, rigorous mixed methods, and equity-informed theoretical frameworks. We provide several key suggestions, including the need for improved conceptualization and inclusion of social and structural determinants of health in implementation science, and the use of adaptive, hybrid effectiveness designs. In addition, we call for more rigorous examination of multilevel interventions and implementation strategies with the greatest potential for reducing both primary and secondary cardiovascular disparities.

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“…8,9 While a sizeable literature has examined the impact of hypertension interventions for Black communities, 10 few have been implemented in South Asian populations. 11 South Asians Americans, individuals tracing their heritage to India, Pakistan, Bangladesh or other parts of the South Asian diaspora, experience a disproportionally high burden of CVD, diabetes, and hypertension. Results from a national longitudinal study of South Asians in the United States found that 43% of men and 35% of women between 40 and 84 years of age had hypertension.…”

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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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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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Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: a Narrative Review of Recent Developments and Suggestions for Programmatic Efforts

Cited by 10 publications

References 52 publications

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research

Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association

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

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