South Carolina has some of the largest health disparities in the nation, and these are invariably more extreme in African Americans (AA) compared to European Americans. The chronic diseases that present the greatest public health challenges are now known to be inflammation related, and AAs tend to have greater inherent sensitivity to inflammation modulators. The proposed dissemination and implementation research is based on our efficacious intervention trial, Diet & Activity Community Trial: High-Risk Inflammation [R24 MD002769- 01], which focused on diet, physical activity, and stress reduction in collaboration with the AA faith community to reduce inflammation (referred to as the HEALS intervention). Extraordinary success in engaging the AA faith and greater AA community allows us to propose to disseminate and implement this intervention. We will ensure that the proposed dissemination and implementation research contributes to achieving our overall goal of reducing health disparities among AAs through the following specific aims: (1) Disseminate and implement the successful HEALS intervention in the AA faith community; (2) Evaluate and monitor the dissemination process for adoption, recruitment, retention, and fidelity to the HEALS intervention trial including testing the effect of the disseminated intervention using a variety of non-invasive measures that are relevant to overall health status, proven to be related to chronic inflammation in the intervention-phase trial, and that can (and will) be employed in a community setting; (3) Conduct a cost-effectiveness analysis of intervention dissemination and implementation to reduce health disparities in parameters associated with inflammation, from both budgetary and societal perspectives; and (4) Enhance the capacity of the target community to sustain the delivery of the evidence-based intervention and for community partners to engage in future research and programming to address health disparities through cultivation of a network of active church and community educators and leadership development activities. We will utilize a community-based participatory research approach to recruit 30 churches and 450 participants using a lay health, train-the-trainer model that decentralizes the research process and is suitable for dissemination and implementation research. We also will engage 30 mentor lay health educators (members of church education teams) who participated in the intervention trial phase to mentor and train newly recruited lay health educators for church education teams for the proposed dissemination and implementation research. We propose to use non-invasive approaches to measure key variables during dissemination and implementation. Cost-effectiveness analysis is an important component and will yield information on required inputs and outputs. The proposed research offers an opportunity to build upon a history of successful collaboration by disseminating and implementing evidence- based intervention with a focus on sustainability of efforts through capacity-building and leadership development to address health disparities in the AA community to address health disparities.

Public Health Relevance

African Americans (AA) in South Carolina have some of the most extreme health disparities in the nation and most of these can be traced to the effects of poor diet, low levels of physical activity, and stress in increasing chronic inflammation. We have developed an efficacious intervention for dissemination and implementation in partnership with and by our community stakeholders in the AA community to stem the high rates of inflammation rising tide of chronic disease rates in this community. The proposed research also will include assessing the costs associated with dissemination and implementation and focus on enhancing sustainability through capacity building and leadership development activities.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Stoney, Catherine
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University of South Carolina at Columbia
Schools of Arts and Sciences
United States
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Hébert, James R; Frongillo, Edward A; Adams, Swann A et al. (2016) Perspective: Randomized Controlled Trials Are Not a Panacea for Diet-Related Research. Adv Nutr 7:423-32
Hébert, James R; Hurley, Thomas G; Steck, Susan E et al. (2015) Reply to E Archer and SN Blair. Adv Nutr 6:230-3