Racial and ethnic disparities in hypertension (HTN) prevalence and control are well-documented and persist despite targeted initiatives aimed at their reduction. The use of Community Health Workers (CHWs) has been endorsed as a best practice to reduce HTN disparities among members of vulnerable communities. Despite the strength of the evidence linking exposure to CHW-delivered interventions with improved HTN-related outcomes among vulnerable populations, the sub-optimal uptake of CHW interventions across healthcare systems at large, and barriers to CHWs? full integration in healthcare teams in particular, may threaten efforts to utilize them in support of patients whose psychosocial and socioeconomic circumstances require CHWs? qualities and skillsets. Dr. Chidinma A. Ibe is a social behavioral scientist and an Assistant Professor of General Internal Medicine at the Johns Hopkins University School of Medicine. She seeks to support the translation and diffusion of this innovative, effective workforce into routine care by conducting a theory-driven, systematic appraisal of the factors contributing CHWs? integration into care teams. She is applying for a K01 Mentored Career Development Award in order to acquire the skills, experience, and pilot data necessary to lay the foundation for an R01 that will apply the lessons learned in the K01 research and training period to develop interventions that optimize CHW uptake across diverse healthcare systems. Her proposed study will examine contextual barriers to the diffusion of a CHW intervention that formed the crux of a stepped collaborative care intervention. She will leverage the RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvements for Everyone) Project, a pragmatic, cluster randomized trial aimed at reducing disparities in HTN control featuring the use of CHWs embedded in collaborative care teams, to: 1) illuminate the complement of intrapersonal, interpersonal, and structural factors associated with the CHWs? integration into care teams; 2) develop a theoretically-rooted measure of CHW care team integration; 3) explore the extent to which CHWs? integration into healthcare teams is related to patients? cardiovascular, behavioral, care management, and process of care outcomes; and 4) use human-centered design methods to co-develop, in partnership with key stakeholders, an organizational change intervention to promote CHWs? integration into care teams. Her career development plan is characterized by a blend of didactic and experiential training in implementation science, qualitative and mixed methods, and advanced statistical strategies, including psychometric testing. This proposed research, in combination with an exceptional mentoring team (Primary Mentor: Dr. Lisa A. Cooper; Co-Mentor, Dr. Jill Marsteller), coursework, and participation in relevant working groups, professional development programs, and scientific meetings, will position Dr. Ibe to achieve her goal of becoming an independent investigator with expertise in the application of implementation science theories and models to strengthen the development, implementation, and translation of CHW interventions in healthcare settings.
The use of Community Health Workers has been found to be an effective strategy in reducing hypertension disparities, but there are barriers to their utilization in primary healthcare settings. Implementation science theories, frameworks, and methods may improve our understanding of how best to overcome these obstacles.
