RESEARCH PROJECT #1 Hypertension disproportionately affects and is inadequately controlled among African American and poor populations. Health providers generally lack the skills and resources to address social contextual factors (i.e. health and community services, social networks, social stressors, physical environment, and economic resources) that influence management of hypertension. In prior work, we found that patients identify such social contextual factors as barriers to management of hypertension and are interested in working with lay health advisors to address these factors. We also developed and pilot tested culturally competent methods to train lay health advisors about hypertension and social contextual factors. We now propose to determine the impact of using trained lay health advisors to help patients address social contextual factors that influence hypertension management. Specifically, we propose a cluster randomized controlled trial involving 312 African American patients with poorly controlled hypertension at 8 clinics. Intervention patients will meet monthly in small groups with a trained lay health advisor. Lay health advisors will use an African American heritage theme as a framework to educate patients about blood pressure and hypertension treatment, will help patients better utilize their social networks or access health and social services, and will teach patients how to communicate more effectively with primary care physicians about barriers to hypertension management. Intervention patients within each group will also support each other in accomplishing these tasks. While our intervention is unlikely to eliminate fundamental causes of health disparities such as economic deprivation, segregated housing, or lack of affordable health care, our pilot work suggests that lay health advisors can help patients become more adept at taking advantage of the personal and community resources available to them. Control patients will continue to receive usual care for hypertension. Major outcomes after 12 months will include changes in blood pressure, hypertension knowledge and perceptions, medication adherence, health care interactions, and quality of life. We will also explore mechanisms that explain the relationship between intervention and changes in blood pressure, including the role of hypertension knowledge and perceptions (e.g. self-efficacy), specific health behaviors (e.g. medication adherence), and health care interactions (e.g. patient-provider communication) as mediators. The proposed project is a novel and promising approach to help patients address the social contextual factors that affect their hypertension management. Helping patients address these barriers may lead not only to improved blood pressure but also to increased survival, reduced organ damage, and decreased health care costs. The proposed project may also serve as a model for addressing other health disparity conditions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54MD002265-14
Application #
9932823
Study Section
Special Emphasis Panel (ZMD1)
Project Start
Project End
Budget Start
2020-05-01
Budget End
2021-04-30
Support Year
14
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Case Western Reserve University
Department
Type
DUNS #
077758407
City
Cleveland
State
OH
Country
United States
Zip Code
44106
Tarabichi, Yasir; Kats, Daniel J; Kaelber, David C et al. (2018) The Impact of Fluctuations in Pack-Year Smoking History in the Electronic Health Record on Lung Cancer Screening Practices. Chest 153:575-578
Merker, Julie M; Dolata, Jacqueline; Pike, Earl et al. (2017) Prevalence of Chronic Illness among Youth with DSM-IV-TR Axis I Diagnoses at a Large Mental Health Agency in Northeast Ohio. Child Welfare 95:79-95
Sehgal, Ashwini R (2017) Should Transplant Referral Be a Clinical Performance Measure? J Am Soc Nephrol 28:721-723
Sullivan, Catherine M; Pencak, Julie A; Freedman, Darcy A et al. (2017) Comparison of the Availability and Cost of Foods Compatible With a Renal Diet Versus an Unrestricted Diet Using the Nutrition Environment Measures Survey. J Ren Nutr 27:183-186
Pelfrey, Clara M; Cain, Katrice D; Lawless, Mary Ellen et al. (2017) A Consult Service to Support and Promote Community-Based Research: Tracking and Evaluating a Community-based Research Consult Service. J Clin Transl Sci 1:33-39
Pike, Stephanie N; Trapl, Erika S; Clark, Jill K et al. (2017) Examining the Food Retail Choice Context in Urban Food Deserts, Ohio, 2015. Prev Chronic Dis 14:E90
Sehgal, N K R; Sullivan, C; Figueroa, M et al. (2017) A Standardized Donor Designation Ratio to Assess the Performance of Driver's License Agencies. Transplant Proc 49:1211-1214