Gillings School of Global Public Health, Department of Nutrition, Center for Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Room 216, CB #7426, Chapel Hill, NC, 27599-7426, USA.
Center for Health Promotion & Disease Prevention, 1700 Martin Luther King Jr. Blvd. CB# 7426, Chapel Hill, NC, 27599-7426, USA.
BMC Public Health. 2020 Feb 21;20(1):264. doi: 10.1186/s12889-020-8223-x.
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.
Using 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.
Study 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.
This 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.
ClinicalTrials.gov: NCT03582696.
社区卫生工作者（CHW）被推荐用于实施预防心血管疾病的干预措施，但在农村医疗资源不足的地区，缺乏指导 CHW 干预措施实施的充分证据。
采用混合实施-有效性设计，我们评估了适应性、基于证据的心血管疾病风险降低干预措施在农村高危成年人中的实施和效果。社区卫生中心和当地卫生部门的 CHW 通过 4 次每月家访和 3 次简短电话联系来招募、登记和辅导参与者。参与者数据收集包括干预前和干预后的血压、体重以及饮食和身体活动行为测量。我们使用干预措施的覆盖面和交付一致性的措施来评估实施情况。统计分析包括描述性统计和配对 t 检验。
研究参与者（n=105）的平均年龄为 62 岁，包括 88%的非西班牙裔黑人，82%的女性。招募策略导致有兴趣和符合条件的参与者中，有 38%被招募并接受了计划中 80%的干预访问和电话联系。干预前后测量的平均值差异表明，血压有显著的平均降低（收缩压-5.4mmHg，p=0.006；舒张压-2.3mmHg，p=0.04）和体重减轻（-3.8 磅，p=0.02）。自我报告的饮食和身体活动行为也显著改善。
这项可行性研究表明，社区卫生工作者提供的降低心血管疾病风险因素的干预措施在实施和项目效果方面具有初步可行性。此外，它确定了未来加强社区与临床联系的策略需要进一步改进的领域，同时还需要社区卫生工作者在农村医疗保健中发挥综合作用。如果这项可行性研究的结果在更大的样本中得到增强，那么对于积极影响农村、低收入和医疗资源不足人群中慢性疾病的过度负担，将具有重大潜力。
ClinicalTrials.gov：NCT03582696。
