Abstract
BackgroundCommunity Health Workers (CHW) are recommended for delivery of interventions to prevent cardiovascular disease, but there is insufficient evidence to guide implementation of CHW interventions in rural, medically underserved areas.MethodsUsing a hybrid implementation-effectiveness design, we evaluated the implementation and effectiveness of an adapted, evidence-based cardiovascular disease risk reduction intervention among rural high-risk adults. CHWs at a community health center and local health department recruited, enrolled and counseled participants during 4 monthly home visits and 3 brief phone contacts. Participant data collection included pre- and post-intervention measurements of blood pressure, weight, and dietary and physical activity behaviors. We evaluated implementation with measures of intervention reach and delivery fidelity. Statistical analyses included descriptive statistics and paired t-tests.ResultsStudy participants (n = 105) had a mean age of 62 years and included 88% Non-Hispanic Blacks and 82% females. Recruitment strategies resulted in the enrollment of 38% of interested and eligible participants who received 80% of the planned intervention visits and phone contacts. Mean differences in pre−/post-intervention measures showed significant mean reductions in blood pressure (− 5.4 mmHg systolic, p = .006; − 2.3 mmHg diastolic, p = .04) and body weight (− 3.8 lb., p = .02). Self-reported dietary and physical activity behaviors also improved significantly.ConclusionThis feasibility study demonstrated preliminary implementation and program effectiveness of a CHW-delivered intervention to reduce cardiovascular disease risk factors. Additionally, it identified areas for future refinements to strategies that strengthen community-clinical linkages with an integrated role of CHWs in rural health care delivery. If results from this feasibility study can be enhanced in a larger sample, there would be significant potential to positively impact the excess burden of chronic diseases that adversely impact rural, low-income, and medically underserved populations.Trial registrationClinicalTrials.gov: NCT03582696.
Highlights
Community Health Workers (CHW) are recommended for delivery of interventions to prevent cardiovascular disease, but there is insufficient evidence to guide implementation of CHW interventions in rural, medically underserved areas
cardiovascular disease (CVD) rates are highest among African Americans, [4] Native Americans, those with lower socioeconomic status, [5] and those living in rural communities [6]
While there is some CVD risk reduction intervention research in rural settings, [17,18,19] evidence gaps remain for studies with CHWs among rural African Americans
Summary
Community Health Workers (CHW) are recommended for delivery of interventions to prevent cardiovascular disease, but there is insufficient evidence to guide implementation of CHW interventions in rural, medically underserved areas. The leading cause of death in the US is cardiovascular disease (CVD), with the greatest CVD burden concentrated in the southeastern states [1,2,3] Within this geographic region, CVD rates are highest among African Americans, [4] Native Americans, those with lower socioeconomic status, [5] and those living in rural communities [6]. In clinical-community linkages research with CHWs, [20] more evidence is needed on the effectiveness of CHWs working “interchangeably in both community and healthcare settings” to determine whether they can build and enhance these linkages [15] This feasibility study aims to address these evidence gaps with preliminary data
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