مقاله انگلیسی رایگان در مورد مداخله یک CHW برای بهبود فشارخون – الزویر ۲۰۱۸

Behavioral interventions utilizing community health workers (CHWs) have demonstrated effectiveness in improving hypertension disparities in ethnic minority populations in the United States, but few have focused on Asian Americans. We assessed the efficacy of a CHW intervention to improve hypertension management among Filipino Americans with uncontrolled blood pressure (BP) in New York City (NYC) from 2011 to 2013. A total of 240 Filipino American individuals (112 in the treatment group and 128 in the control group) with uncontrolled hypertension (SBP ≥ ۱۴۰ mmHg and/or DBP ≥ ۹۰ mmHg) were recruited from community-based settings in NYC. Using a community-based participatory research approach, treatment participants received 4 educational workshops and 4 one-on-one visits with CHWs over a 4-month period, while control group participants received 1 educational workshop. Main outcome measures included BP control, changes in SBP and DBP, and changes in appointment keeping at 8-months. At 8-months, BP was controlled among a significantly greater percentage of treatment group participants (83.3%) compared to the control group (42.7%). The adjusted odds of controlled BP for the treatment group was 3.2 times the odds of the control group (P < 0.001). Both groups showed decreases in SBP and DBP, with greater decreases among treatment participants. Significant between-group differences were also demonstrated in adjusted analyses (P < 0.001). Individuals in the treatment group showed significant changes in appointment keeping. In conclusion, a community-based intervention delivered by CHWs can help improve BP and related factors among Filipino Americans with hypertension in NYC.

Introduction

Million Hearts© aims to prevent heart disease and stroke in the United States (US) by mobilizing public and private sectors around a core set of objectives, with particular attention on blood pressure (BP) control in minority populations (Department of Health and Human Services, n.d.). Disparities in hypertension among non-Hispanic blacks has been well-documented (Mensah et al., 2005; Ong et al., 2007; Centers for Disease Control and Prevention, 2005; Barnes et al., 2008). Research within Asian American communities is limited, yet a growing body of evidence indicates that compared to non-Hispanic whites, Filipino Americans experience a higher burden of hypertension (23.9–۶۷%) (Barnes et al., 2008; Jose et al., 2013; Zhao et al., 2015; Bayog and Waters, 2017; Ma et al., 2017; Ye et al., 2009; Ursua et al., 2013; Ursua et al., 2014a) and lower rates of control (Zhao et al., 2015; Ursua et al., 2014a; Ea et al., 2018). Given the rapid population expansion of Filipino Americans in the US (38.9% increase between 2000 and 2010) (U.S. Census Bureau, 2012) as well as in regions such as New York City, (Federation AA, 2009) strategies to mitigate the burden of hypertension among Filipinos are warranted (Ursua et al., 2014b). A cornerstone of Million Hearts© has been the dissemination of evidence-based, community-clinical linkage strategies, including the use of community health workers (CHWs). CHWs are frontline public health professionals with a close understanding of the communities they serve through shared racial/ethnic background, culture, language, socioeconomic status, and life experiences (American Public Health Association, 2014; Islam et al., 2015). They link community members to healthcare resources, provide culturally appropriate health coaching, and organize communities to improve physical and social well-being (USAID From the American People, n.d.). CHWs involved in chronic disease management provide social support and education on disease management (Adair et al., 2013; Katigbak et al., 2015; Lopez et al., 2017; Islam et al., 2018).