Support Community Health Workers Research Articles

Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed-Methods Study.

Adults with serious mental illness have high rates of tobacco use disorder and underuse pharmacotherapy for tobacco cessation. In a previous randomized controlled trial, participants receiving community health worker (CHW) support and education for their primary care providers (PCPs) had higher tobacco abstinence rates at 2 years, partly because of increased initiation of tobacco-cessation pharmacotherapy. The authors aimed to determine the association between CHW-participant engagement and tobacco abstinence outcomes. The authors conducted a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of the number and duration of CHW visits, number of smoking-cessation group sessions attended, and number of CHW-attended PCP visits on initiation of tobacco-cessation pharmacotherapy and tobacco abstinence were modeled via logistic regression. Interviews with 12 CHWs, 17 patient participants, and 17 PCPs were analyzed thematically. Year 2 tobacco abstinence was significantly associated with CHW visit number (OR=1.85, 95% CI=1.29-2.66), visit duration (OR=1.51, 95% CI=1.00-2.28), and number of group sessions attended (OR=1.85, 95% CI=1.33-2.58); effects on pharmacotherapy initiation were similar. One to three CHW visits per month across 2 years were optimal for achieving abstinence. Interviews identified CHW-patient engagement facilitators (i.e., trust, goal accountability, skills reinforcement, assistance in overcoming barriers to treatment access, and adherence). Training and supervision facilitated CHW effectiveness; barriers included PCPs' and care teams' limited understanding of the CHW role. Greater CHW-participant engagement, within feasible dose ranges, was associated with tobacco abstinence among adults with serious mental illness. Implementation of CHW interventions may benefit from further CHW training and integration within clinical teams.

Eliminating Health Care Access and Quality Inequities in Sickle Cell Disease: Policy Lessons from the End Sepsis Initiative

Abstract: Sickle cell disease is a prime example of the devastating impact of healthcare inequities. The End Sepsis Initiative developed after a tragic death due to sepsis, provides a powerful model for the sickle cell community. This model recognizes the importance of evidence-based protocols and policy recommendations/mandates to drive transformative systems change. We propose that the sickle cell community mirror this approach. We propose that hospital systems, healthcare organizations, and insurers implement evidence-based protocols, including personalized pain plans, stigma reduction through staff training, vaccinations, preventative screening, disease-modifying therapies, pediatric to adult transition, and connecting unaffiliated SCD patients to a medical home. We recommend state-level interventions, such as using SCD navigator in electronic health records for quality reporting, supporting community health workers' use, and ensuring rural hospitals have access to SCD specialists.

Malaria Transmission at The Zimbabwe-Mozambique Border: An Observational Study of Parasitemia by Travel History and Household Location.

Cross-border human population movement contributes to malaria transmission in border regions, impeding national elimination. However, its impact in low-to-moderate transmission settings is not well characterized. This community-based study in Mutasa District, Zimbabwe, estimated the association of parasite prevalence with self-reported overnight travel to Mozambique and household distance to the border from 2012-2020. A fully adjusted Poisson regression model with robust variance estimation was fit using active surveillance data. The population attributable fraction of parasite prevalence from overnight travel was also estimated. The relative risk of testing positive for malaria by rapid diagnostic test declined 14% (prevalence ratio [PR] = 0.86, 95% CI = 0.81-0.92) per kilometer from the border up to 12 km away. Travel to Mozambique was associated with a 157% increased risk (PR = 2.57, 95% CI = 1.38-4.78), although only 5.8% of cases were attributable to overnight travel (95% CI = -1.1% to 12.7%), reflecting infrequent overnight trips (1.3% of visits). This study suggests that transmission in eastern Zimbabwe is driven by increasingly conducive social or environmental conditions approaching the border and low levels of importation from overnight travel. Although day trips to Mozambique during peak biting hours were not assessed, the contribution of such trips to ongoing transmission may be significant. Future malaria control efforts should prioritize high coverage of existing interventions and continued support for community health workers and health facilities at the border, which provide free case management.

Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation.

Enabling community health workers (CHWs) to treat acute malnutrition improves treatment access and coverage. However, data on the cost and cost-effectiveness of this approach is limited. We aimed to cost the treatment at scale and determine the cost-effectiveness of different levels of supervision and technical support. This economic evaluation was part of a prospective nonrandomized community intervention study in 3 districts in Mali examining the impact of different levels of CHW and health center supervision and support on treatment outcomes for children with severe acute malnutrition. Treatment admission and outcome data were extracted from the records of 120 participating health centers and 169 CHW sites. Cost data were collected from accountancy records and through key informant interviews. Results were presented as cost per child treated and cured. Modeled scenario sensitivity analyses were conducted to determine how cost-efficiency and cost-effectiveness estimates change in an equal scale scenario and/or if the supervision had been done by government staff. In the observed scenario, with an unequal number of children, the average cost per child treated was US$203.40 in Bafoulabé where a basic level of supervision and support was provided, US$279.90 in Kayes with a medium level of supervision, and US$253.9 in Kita with the highest level of supervision. Costs per child cured were US$303.90 in Bafoulabé, US$324.90 in Kayes, and US$311.80 in Kita, with overlapping uncertainty ranges. Additional supervision has the potential to be a cost-effective strategy if supervision costs are reduced without compromising the quality of supervision. Further research should aim to better adapt the supervision model and associated tools to the context and investigate where efficiencies can be made in its delivery.

Delivering HIV and TB services amidst the COVID-19 pandemic in Indonesia: a qualitative study of challenges and mitigation strategies

Background Indonesia has the second-highest burden of tuberculosis (TB) globally and is experiencing one of the fastest-growing HIV epidemics worldwide. The COVID-19 pandemic disrupted access to essential health services, including those for TB and HIV, due to health system overload, social distancing measures, and negative economic repercussions on the health sector and the population. An in-depth understanding of these challenges and the health system responses to mitigate the negative impact of the pandemic on TB and HIV services is crucial to building health system resilience and preparing for future emergencies. Methods This qualitative study, conducted in two cities in Indonesia, explored the impact of the COVID-19 pandemic on TB and HIV services including mitigation strategies to sustain the provision of testing and treatment in the midst of the pandemic. Between February and June 2022, semi-structured interviews were conducted with 16 healthcare workers and 16 clients at nine health centers (puskesmas), three hospitals, and one Community Center for Lung Health in Bandung and Yogyakarta. Themes were identified from transcripts using open and selective coding and then refined. Results Extraordinary measures were implemented in health facilities to sustain TB and HIV service delivery, and prevent the spread of COVID-19, including testing of clients for COVID-19 before receiving medical care, physical distancing when visiting healthcare facilities, revised schedules for medicine dispensing, involvement of community health workers and peers in community outreach activities such as the home delivery of medicines, and the use of telemedicine. Challenges encountered during the implementation of these strategies included medicine stock-outs, health worker overload, lack of sufficient client-provider interaction and technical difficulties when implementing telemedicine, and the risk or fear of exposure to COVID-19 among the community health workers and peers. Conclusions Significant efforts were made to mitigate disruptions to TB and HIV services during the COVID-19 pandemic. However, some challenges were encountered. Key policy recommendations to strengthen pandemic preparedness include investing in local manufacturing and robust drug supply networks to prevent medicine shortages, and supporting community health workers to alleviate workload issues, reduce the risk of disease exposure, and explore the potential for a financial incentive system. Equally vital is the need to invest in staff training and education, as well as implementing user-friendly telemedicine technologies.

Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH).

Lebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours. A mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components. Data revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities. MUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.

Prevalence of non-communicable chronic diseases in rural India amongst peri- and post-menopausal women: Can artificial intelligence help in early identification?

AimsTo identify peri- and post-menopausal women at risk of non-communicable diseases in rural India and to assess their prevalence amongst these groups via the use of artificial intelligence. Settings and designAn observational study conducted by the Indian Menopause Society in collaboration with the Government of Maharashtra. The study included rural women residents of three villages in the Latur district of Maharashtra, India. Materials and methodsAccredited social health activist workers identified 400 peri- and post-menopausal women aged 45–60 years. Specific symptoms able to predict the presence of a non-communicable disease were identified through the use of artificial intelligence. Statistical analysis usedDescriptive statistics and predictive network charts analysis. ResultsThe mean age of 316 women included in the analysis was 50.4 years and the majority of them were illiterate (68 %). The prevalence of dyslipidaemia, osteopenia, diabetes mellitus, obesity and hypertension were 58 %, 50 %, 25 %, 25 %, and 20 % respectively. None of their symptoms or laboratory reports could be significantly correlated directly with any of these non-communicable diseases. Hence, we used a cluster of symptoms to suggest the presence of hypertension, diabetes mellitus, osteoporosis and hypothyroidism via predictive network analysis charts. ConclusionsScreening of at-risk women can be done using an artificial intelligence-based screening tool for early diagnosis, timely referral and treatment of non-communicable diseases with the support of community health workers.

Implementation Barriers and Recommendations for a Multisite Community Health Worker Intervention in Palliative Care for African American Oncology Patients: A Qualitative Study.

Background: Palliative care remains underutilized by African American patients with advanced cancer. Community health workers (CHWs) may help improve palliative care outcomes among this patient population. Objectives: To explore barriers to success of a proposed CHW intervention and synthesize design and implementation recommendations to both optimize our intervention and inform others working to alleviate palliative care disparities. Design: Semi-structured qualitative interviews. Setting/Subjects: Key informants were health care professionals across clinical, leadership, and community health fields. Participants were recruited through purposive sampling from Baltimore, Maryland; Birmingham, Alabama; and Salisbury, Maryland. Measurements: Interviewers used an interview guide grounded in established implementation science models. Data were analyzed through a combined abductive/deductive approach by independent coders. A framework methodology was used to facilitate thematic analysis. Results: In total, 25 professionals completed an interview. Key informants discussed multiple barriers, including at the patient level (lack of knowledge), clinician and facility level (decreased workflow efficiency), and health system level (limited funding). Recommendations related to the intervention's design included high quality preintervention CHW training and full integration of CHWs into the care team to "bridge" divides between outpatient, inpatient, and at-home settings. Intervention delivery recommendations included clearly defining care team roles and balancing flexibility and standardization in CHW support approaches. These recommendations were then used to adapt the planned intervention and its implementation process. Conclusions: Clinicians, cancer center leaders, and CHWs identified multilevel potential barriers to the intervention's success but also described recommendations that may mitigate these barriers. Key informant input represents an important step prior to initiating CHW-based interventions.

Use of Community Health Workers Among U.S. Male Latino Population: A Scoping Review.

Community Health Workers (CHWs) are an effective strategy to address the health needs of specified communities. The purpose of this scoping review was to explore the use of CHWs to address the health needs of the Latino male population. This project used specific search terms to identify relevant articles from PubMed, PsycINFO, and Google Scholar. Eligible articles included studies, conducted in the U.S. and in English from 2010 to 2022, that assessed the use of CHWs among a predominantly male (≥ 50%) Latino population. Twenty articles consisting of 13 interventions were identified for review and were further categorized into male-only participant samples (n = 10) and mixed-gender but predominantly-male participant samples (n = 10) for synthesis. Male-only participant samples focused on occupational health and participant's social support and networks. Predominantly-male, mixed-gender participant sample interventions were disease-centered and emphasized the longitudinal support of CHWs as well as social networks. Of the 13 interventions reviewed, almost all (n = 10) utilized existing social networks for engagement and nearly half (n = 6) employed community-based participatory research (CBPR) principles. Findings suggest that recruiting CHWs from within existing social networks and using CBPR are important factors for successful health promotion among male Latinos.

"Nos apoyamos mutuamente": Strategies to supporting community health workers addressing the emergency and chronic needs of Latinx families.

Community health workers (CHWs) have established pathways to implementing effective, sustainable, and cost-effective health programs among underserved populations. Despite the significant role of CHWs, there is limited literature describing the needs of CHWs, specifically in times of health emergencies and crises. Thus, we explored the challenges and sources of support among CHWs providing services to Latinx families. Participants were recruited from a Latinx community-based organization in metro Atlanta, working to strengthen family relationships using evidence-based programming. Fifteen semistructured interviews were conducted among CHWs. Interviews were conducted primarily in Spanish, recorded, transcribed, and translated into English for analysis. Following a thematic analysis, data were double-coded, and codes were described and compared for themes. Participants identified as Latinx (n = 15), were between the ages of 29 and 69 years, and had worked as CHWs between 1 month to 4 years. Two themes and seven subthemes were identified in the data. Theme 1 highlighted barriers and strategies employed by CHWs to address clients' preexisting and emerging needs, and Theme 2 focused on responding to client needs during the COVID-19 pandemic, which introduced new challenges and barriers that provoked adaptive organizational strategies to promote worker resilience. Addressing the needs of vulnerable communities in times of crisis to improve the working conditions for CHWs will require a multifaceted approach that prioritizes the removal of structural barriers. Barriers can be mitigated by prioritizing cultural assets, adopting flexible and equitable work policies, and enacting policies at the federal level that promote health justice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities.

Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. Overall, 63% of participants (n=268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.

Tailoring HIV Care for Black Populations: A Pilot Feasibility Prospective Cohort Study.

Research has shown that integrating community health workers (CHWs) into the formal health care system can improve outcomes for people living with HIV, yet there is limited literature exploring this framework among marginalized minority populations. Herein, we discuss the feasibility of a clinic-embedded CHW strategy to improve antiretroviral therapy adherence among Black people living with HIV in Miami-Dade County, Florida, a designated priority region for the US Department of Health and Human Services' Ending the HIV Epidemic Initiative. From December 2022 to September 2023, three CHWs were trained and integrated into the hospital workflow to provide support as members of the clinical team. Ten Black adults with an HIV viral load over 200 copies/mL were enrolled to received 3 months of CHW support focused on navigating the health system and addressing poor social determinants of health. Intervention feasibility was based on 4 criteria: recruitment rate, demographic composition, study fidelity, and qualitative feedback on CHW perceptions. Participants were recruited at a rate of 5.7 participants per month, with the sample evenly distributed between men and women. Retention was moderately strong, with 7 (70%) of the 10 participants attending more than 75% of CHW sessions. Qualitative feedback reflected CHW perceptions on clinical interactions and intervention length. Outcomes indicate that a clinic-integrated CHW approach is a feasible and acceptable methodology to address adverse social determinants and improve HIV treatment adherence. By offering targeted social and clinical support, CHWs may be a promising solution to achieve sustained viral suppression and care engagement for Black people living with HIV.

Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT) efficacy trial: Community health worker support may increase hydroxyurea adherence of youth with sickle cell disease.

Despite disease-modifying effects of hydroxyurea on sickle cell disease (SCD), poor adherence among affected youth commonly impedes treatment impact. Following our prior feasibility trial, the "Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT)" multi-site randomized controlled efficacy trial aimed to increase hydroxyurea adherence for youth with SCD ages 10-18years. Impaired adherence was identified primarily through flagging hydroxyurea-induced fetal hemoglobin (HbF) levels compared to prior highest treatment-related HbF. Eligible youth were enrolled as dyads with their primary caregivers for the 1-year trial. This novel semi-structured supportive, multidimensional dyad intervention led by community health workers (CHW), was augmented by daily tailored text message reminders, compared to standard care during a 6-month intervention phase, followed by a 6-month sustainability phase. Primary outcomes from the intervention phase were improved Month 6 HbF levels compared to enrollment and proportion of days covered (PDC) for hydroxyurea versus pre-trial year. The secondary outcome was sustainability of changes up to Month 12. The 2020-2021 peak coronavirus disease 2019 (COVID-19) pandemic disrupted enrollment and clinic-based procedures; CHW in-person visits shifted to virtual scheduled interactions. We enrolled 50 dyads, missing target enrollment. Compared to enrollment levels, both HbF level and PDC significantly - but not sustainably - improved within the intervention group (p=.03 and .01, respectively)with parallel increased mean corpuscular volume (MCV) (p=.05), but not within controls. No significant between-group differences were found at Months 6 or 12. These findings suggest that our community-based, multimodal support for youth-caregiver dyads had temporarily improved hydroxyurea usage. Durability of impact should be tested in a trial with longer duration of CHW-led and mobile health support.

Using CFIR framework for understanding barriers and facilitators to implementation of community tuberculosis program in Burkina Faso.

In 2020, there were nearly 9.9 million new Tuberculosis cases and 1.3 million deaths, with about 95% occurring in developing nations. Burkina Faso implemented a community Tuberculosis program, involving Civil Society Organizations, to increase screening and improve treatment outcomes. Therefore, this study aims to identify the factors influencing the implementation of community interventions involving these organizations in the fight against TB in Burkina Faso. This qualitative study conducted semi-structured key informant interviews with a purposive sample of health providers from the ministry of health and community health workers. We used framework (the consolidated framework for implementation research was used method to identify barriers and facilitators to implementation of community tuberculosis program in Burkina Faso. A total of 23 interviews were conducted. The results of this research shed light on several key factors that either contributed to or hindered the program's success. Among the facilitating factors, we identified close collaboration between national and international stakeholders, as well as remarkable program flexibility to adapt to local conditions. Furthermore, continuous training and support for community health workers proved crucial for the program's implementation. However, significant challenges were also unveiled. These challenges encompassed insufficient financial resources, difficulties related to the recruitment and management of civil society associations, and issues regarding program ownership at the peripheral level. Additionally, irregular payments to community health workers had a detrimental impact on their motivation and commitment. Our study conducted a comprehensive examination of the obstacles and facilitators encountered in the implementation of a community-based tuberculosis control program in Burkina Faso. The results of this research shed light on several key factors that either contributed to or hindered the success implementation of program. Measures should be taken to mobilize national resources, strengthen the capacities of associations, and promote local ownership of the program. Special attention should also be given to improving financial management and resolving issues related to the recruitment and compensation of community health workers. For such community-based tuberculosis programs to succeed in Burkina Faso and in similar context it is essential to address these obstacles and facilitators.

Cadre Knowledge And Self-Efficacy Following Care For Child Development Post Intervention: A Four-Year Prospective Follow-Up Study

Background: Stunting is a significant malnutrition problem in Indonesia, and community health cadres play a vital role in addressing it through programs like Care for Child Development (CCD) training. This study aimed to delineate the knowledge and self-efficacy of cadres who participated in CCD training in Yogyakarta in 2018, comparing their status in 2022. Methods: In October 2022, a quantitative cross-sectional approach was utilized to examine the knowledge and self-efficacy of 56 cadres who had undergone CCD training in 2018, organized by the same authors and documented in a prior publication, with participants selected through total sampling. Three instruments were utilized, including a participant demographic survey, the CKCDI, and the GSES. The paired t-test was employed to analyzed the data. Results: The study's results reveal a significant difference (p=0.002) in the mean knowledge scores of cadres following their participation in the Care For Child Development (CCD) training program in 2018 and four years later. The mean score was 13.39 in 2018, decreased to 11.9 in 2022. Likewise, the self-efficacy component among cadres exhibited a reduction, with mean scores of 30.93 in 2018 and 29.4 in 2022. However, it is important to note that there is no statistically significant difference in self-efficacy (p=0.106). The decline in average knowledge scores over the four-year period may be attributed to potential knowledge decay. Conclusion: This study underscores the significance of sustained training and support for community health workers, emphasizing the need for flexible approaches to maintain their knowledge and self-efficacy over time.

CO-DESIGNING A STAGE 1B FEASIBILITY STUDY OF INPATIENT PALLIATIVE COMMUNITY HEALTH WORKER SUPPORT

Abstract Persons living with dementia (PLWD) are 2-3 times more likely than their non-dementia peers to be hospitalized annually and experience burdensome care transitions and treatments at the late stage of dementia. Minoritized PLWDs are significantly more likely to be hospitalized and experience frequent transitions between care settings, and also less likely to access palliative care. There is a pressing need to develop better models of care transition support for PLWDs and their family caregivers. Proactive palliative care can reduce unnecessary hospitalization and improve outcomes for PLWDs and family caregivers. Community health workers (CHW) can effectively bridge cultural gaps between vulnerable patients/families and formal care systems, and provide care navigation and coaching support. We are currently conducting a single-site randomized controlled pilot trial study to co-design with key stakeholders (Stage 1a), implement and assess (Stage 1b) the acceptability and feasibility of a palliative CHW support for hospitalized PLWDs and caregivers. To date, we have conducted a needs assessment with 34 PLWD/caregiver dyads, key informant interviews with 4 palliative care providers and 2 CHW and social care experts, and multiple stakeholder meetings with hospital frontline providers and CHW groups to develop intervention components and research implementation plans that address language and cultural barriers and healthcare provider and system level barriers experienced by PLWD and caregivers from minoritized and financially vulnerable backgrounds. In this presentation, we will describe stakeholder engagement and co-design process outcomes and preliminary findings on intervention fidelity, participant recruitment and retention, and PLWD/caregiver outcomes.

THE NIH STAGE MODEL AND STUDY EXAMPLES OF EARLY STAGES IN DEMENTIA CARE INTERVENTION DEVELOPMENT RESEARCH

Abstract The NIH’s Stage Model provides a common language to facilitate discussion of intervention development research. According to NIH Stage Model (2022), “an examination of the mechanisms of behavior change or the principles underlying an intervention is encouraged by the NIH Stage Model in every Stage of behavioral intervention development.” The five papers in this symposium focus on early-stage intervention development by refinement, adaptation and pilot testing (Stage 1) related to dementia and palliative care (PC) clinical trials. The first paper is a cluster trial of a PC education program for nurses (N=23) in 10 assisted living communities that tested the mechanism of staff self-efficacy in increases in advance care planning discussions with family members of residents living with dementia. The second paper is a clinical trial that tested the feasibility of Companion Robots in live-alone Korean-American older adults (N=30) to determine which features help improve health behaviors (e.g. medication adherence, daily exercises). The third paper is a single-site clinical trial pilot study developed with stakeholders which tested the feasibility of a palliative care community health worker support program for hospitalized minoritized persons living with dementia and their caregivers. The fourth paper adapts an evidence-based e-PainSupport intervention for use with dementia caregivers to report patient pain and administration of analgesics. The fifth paper is a protocol to test the feasibility and acceptability of a culturally sensitive caregiver peer support program (Pair2Care) in current (n=15) and trained former (n=15) African-American dementia caregivers. The discussant will highlight ways to improve clinical trial mechanisms.

Habit Efficacy Trial: A Multi-Site Randomized Controlled Trial of Community Health Worker Support to Increase Hydroxyurea Adherence of Youth with Sickle Cell Disease

Introduction: Despite disease-modifying effects of hydroxyurea (HU) on sickle cell disease (SCD), poor adherence among affected youth commonly impedes treatment impact. The HABIT multi-site randomized controlled efficacy trial aimed to increase HU adherence. Methods: Youth with SCD ages 10-18 years with impaired adherence were identified through laboratory evidence, primarily flagging levels of treatment-induced fetal hemoglobin (HbF). Eligible youth were enrolled as dyads with their primary caregivers for one year. We tested a 6-month phase of semi-structured supportive, multi-dimensional dyad intervention led by community health workers (CHW) with 4-5 visits addressing information, social issues/referrals, barriers, habit formation using goal-setting and cues, augmented by daily tailored automated text message reminders, compared to standard care. This phase was followed by a 6-month sustainability phase (months 7-12) of observation and, for the intervention group, 1 CHW booster visit. Primary intervention outcomes were 1) HbF levels compared to enrollment; and 2) proportion of days covered (PDC) for HU versus the pre-trial year. The secondary outcome was sustainability of these changes up to month 12. Results: Starting in 2020, the COVID-19 pandemic disrupted enrollment and clinic-based procedures. The trial enrolled 50 dyads, missing target enrollment. Compared to enrollment levels, both HbF level and PDC significantly improved within the intervention group at month 6 (p=. 03 and . 01, respectfully), with parallel increased MCV (p=.05). Increased HbF did not reach signifance compared to controls (p=.07). No significant within- or between-group differences were found at month 12. Conclusions: Within-group results suggest that our CHW-based dyad intervention with text message reminders improved HU adherence at 6 months but there were no between-group differences. Effects did not endure through the subsequent 6-month sustainability phase. These findings suggest that improved HU adherence for youth with SCD though our community-based, multi-modal support for youth-caregiver dyads temporarily improved usage. Durability of impact on adherence may require integrating CHW-led support and text reminders into clinical care.

Abstract 15921: Reaching Patients With Hypertension: A Model of Remote Blood Pressure Monitoring Plus Team-Based Care

Background: Social determinants of health (SDoH) significantly impact hypertension (HTN) control, yet are not addressed as part of the medical model. We used a team-based approach, integrating remote blood pressure monitoring (RBPM), pharmacists, and community health workers (CHWs) to address HTN among patients with persistently uncontrolled HTN referred from cardiology fellows clinics. This study assesses the impact of this model in achieving BP control. Methods: Pharmacists screened patients for SDoH using a tool adapted from the Accountable Health Communities initiative and managed BP during biweekly virtual visits. Patients with SDoH were referred to Project Access-New Haven for CHW support. We describe clinical characteristics, SDoH, program metrics, and BP changes among the first 100 patients. We also assessed predictors of BP control (< 130/80 mmHg) using multivariable logistic regression. Results: Among referred patients, multiple SDoH were identified; 18% of whom accepted support by a CHW (Table). BP decreased from a mean of 154/86 mmHg to 135/78 mmHg (mean reduction 20/8 mmHg). BP control was associated with greater medication adherence, having diabetes and competing health priorities. There was no association between SDoH and BP control. Conclusions: A team-based care model with pharmacists and CHWs was effective in reducing BP among low income patients with multiple SDoH and persistently uncontrolled HTN. SDoH was not associated with achieving BP control, suggesting that this model may overcome or attenuate SDoH impacting BP control. Still, half of patients did not achieve BP control, highlighting the need for continual partnership and program improvement.