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Patil SJ, Bhayani V, Yoshida Y, Bushweller L, Udoh EO, Todorov I, Saper R, Stange KC, Bolen S. Lay advisor interventions for hypertension outcomes: A Systematic Review, Meta-analysis and a RE-AIM evaluation. Front Med (Lausanne) 2024; 11:1305190. [PMID: 38831986 PMCID: PMC11144929 DOI: 10.3389/fmed.2024.1305190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Lay advisor interventions improve hypertension outcomes; however, the added benefits and relevant factors for their widespread implementation into health systems are unknown. We performed a systematic review to: (1) summarize the benefits of adding lay advisors to interventions on hypertension outcomes, and (2) summarize factors associated with successful implementation in health systems using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Methods We systematically searched several databases, including Ovid MEDLINE, CINAHL, PsycINFO from January 1981 to May 2023. All study designs of interventions delivered solely by lay advisors for adults with hypertension were eligible. If both arms received the lay advisor intervention, the study arm with lower intensity was assigned as the low-intensity intervention. Results We included 41 articles, of which 22 were RCTs, from 7,267 screened citations. Studies predominantly included socially disadvantaged populations. Meta-analysis (9 RCTs; n = 4,220) of eligible lay advisor interventions reporting outcomes showed improved systolic blood pressure (BP) [-3.72 mm Hg (CI -6.1 to -1.3; I2 88%)], and diastolic BP [-1.7 mm Hg (CI -1 to -0.9; I2 7%)] compared to control group. Pooled effect from six RCTs (n = 3,277) comparing high-intensity with low-intensity lay advisor interventions showed improved systolic BP of -3.6 mm Hg (CI -6.7 to -0.5; I2 82.7%) and improved diastolic BP of -2.1 mm Hg (CI -3.7 to -0.4; I2 70.9%) with high-intensity interventions. No significant difference in pooled odds of hypertension control was noted between lay advisor intervention and control groups, or between high-intensity and low-intensity intervention groups. Most studies used multicomponent interventions with no stepped care elements or reporting of efficacious components. Indicators of external validity (adoption, implementation, maintenance) were infrequently reported. Discussion Lay advisor interventions improve hypertension outcomes, with high intensity interventions having a greater impact. Further studies need to identify successful intervention and implementation factors of multicomponent interventions for stepped upscaling within healthcare system settings as well as factors used to help sustain interventions.
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Affiliation(s)
- Sonal J. Patil
- Center for Health Equity, Engagement, Education, and Research (CHEEER), Department of Family Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
| | - Vishwa Bhayani
- Department of Public Health, University of Missouri, Columbia, MO, United States
| | - Yilin Yoshida
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Leila Bushweller
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Eno-Obong Udoh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Irina Todorov
- Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Robert Saper
- Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kurt C. Stange
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Shari Bolen
- Department of Medicine, Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
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Jing R, Eggleston K, Lai X, Fang H. Family physician services and blood pressure control in China: A population-based retrospective cohort study. J Health Serv Res Policy 2023:13558196221149929. [PMID: 36630298 DOI: 10.1177/13558196221149929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Given the importance of continuous family physician (FP) care in the management of hypertension, we explored the effects of such care among hypertensive patients in China, a country where such care is generally underutilized. We examined the longitudinal association between the use and continuity of FP services and health outcomes including blood pressure (BP) control rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP). METHODS We conducted a population-based cohort study using data from the retrospective regional electronic health record database in Xiamen City, China. The study considered 18,119 hypertensive patients aged over 18 years who had at least two visits to a health center in the preceding 12 months. The generalized estimating equation model was adopted to estimate the longitudinal association between FP service utilization and health outcomes. RESULTS Hypertensive patients treated by their own FPs had a higher BP control rate (OR = 1.14, 95% CI: 1.02-1.28) and lower DBP (-0.36 mmHg, 95% CI: -0.52 to -0.20) than those without a FP or those with a FP but treated by a general community physician (GCP). Compared with hypertensive patients treated exclusively by GCPs, patients treated continuously and exclusively by a FP were 45% more likely to have their BP under control (OR = 1.45, 95% CI: 1.32-1.60), and their SBP and DBP were lower by 0.6 mmHg (95% CI: -0.78 to -0.39) and 0.6 mmHg (95% CI: -0.79 to -0.47), respectively. CONCLUSIONS Hypertensive patients continuously treated by their own FPs performed better in terms of BP control rate, SBP and DBP values. In addition, the number and continuity of FP visits were associated with better BP control.
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Affiliation(s)
- Rize Jing
- School of Public Administration and Policy, 12471Renmin University of China, Beijing, China
| | - Karen Eggleston
- Shorenstein Asia Pacific Research Center, Freeman Spogli Institute for International Studies, 6429Stanford University, California, USA
| | - Xiaozhen Lai
- School of Public Health, 12465Peking University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, 12465Peking University, Beijing, China
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Mbuthia GW, Magutah K, Pellowski J. Approaches and outcomes of community health worker's interventions for hypertension management and control in low-income and middle-income countries: systematic review. BMJ Open 2022; 12:e053455. [PMID: 35365519 PMCID: PMC8977767 DOI: 10.1136/bmjopen-2021-053455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs). METHOD We performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables. RESULTS Of the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level. DISCUSSION AND CONCLUSION The current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Karani Magutah
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Jennifer Pellowski
- International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, USA
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Sujarwoto S, Maharani A. Participation in community-based health care interventions (CBHIs) and its association with hypertension awareness, control and treatment in Indonesia. PLoS One 2020; 15:e0244333. [PMID: 33370385 PMCID: PMC7769427 DOI: 10.1371/journal.pone.0244333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Little attention has been paid to whether CBHIs improve awareness, treatment and control of hypertension in the contexts of low- and middle- income countries (LMICs). This study therefore aims to examine participation in CBHIs for non-communicable diseases (NCDs) and its association with awareness, treatment, and control of hypertension among Indonesians. METHODS This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from 30,351 respondents aged 18 years and older. Participation in CBHIs was measured by respondents' participation in CBHIs for NCDs (Posbindu PTM and Posbindu Lansia) during the 12 months prior to the survey. Logistic regressions were used to identify the relationships between participation in CBHIs for NCDs and awareness, treatment, and control of blood pressure among respondents with hypertension. RESULTS The age-adjusted prevalence of hypertension was 31.2% and 29.2% in urban and rural areas, respectively. The overall age-adjusted prevalence was 30.2%. Approximately 41.8% of respondents with hypertension were aware of their condition, and only 6.6% of respondents were receiving treatment. Participation in CBHIs for NCDs was associated with 50% higher odds of being aware and 118% higher odds of receiving treatment among adults with hypertension. There was no significant association between participation in CBHIs for NCDs and controlled hypertension. CONCLUSION Our data emphasise the importance of CBHIs for NCDs to improve the awareness and treatment of hypertension in the Indonesian population.
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Affiliation(s)
- Sujarwoto Sujarwoto
- Portsmouth Brawijaya Center for Global Health, Population and Policy & Department of Public Administration, Universitas Brawijaya, Malang, Indonesia
| | - Asri Maharani
- Division of Nursing, Midwifery, & Social Work, University of Manchester, Manchester, United Kingdom
- Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
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Smith L, Atherly A, Campbell J, Flattery N, Coronel S, Krantz M. Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk. BMC Public Health 2019; 19:1234. [PMID: 31492118 PMCID: PMC6728976 DOI: 10.1186/s12889-019-7573-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) risk-reduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. This program has previously demonstrated success, but the cost-effectiveness is unknown. CHW-based interventions are potentially attractive complements to healthcare delivery because laypersons implement the intervention at a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources. METHODS CHWs performed screenings and provided ongoing participant support within predominantly rural communities. A point-of-service software tool was used to generate 10-year Framingham CVD risk scores and assist CHWs to make medical referrals and provide ongoing individualized support for lifestyle changes. A sample of program participants returned for reassessment of risk factors. We calculated quality-adjusted life years (QALYs) gained and program costs using a Markov model. Transition probabilities were calculated using Framingham risk equations or derived from the literature using the observed mean reduction in 10-year CVD risk score over of 37- months follow-up. Program cost-effectiveness was calculated for both at-risk (abnormal baseline CVD risk factors) and overall program populations. RESULTS The base-case scenario evaluating a 52-year-old male participant revealed an incremental cost savings of $3576 and a gain of 0.16 QALYs associated with the intervention. Cost savings were greater in at-risk populations. The economic dominance of the model was robust in multiple sensitivity analyses. CONCLUSIONS A community-based CVD intervention demonstrated to reduce CVD risk is cost-effective. This suggests that population-based public health programs may have the potential to complement primary care preventative services to improve health and reduce the burden of traditional medical care.
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Affiliation(s)
- Lauren Smith
- School of Public Health, University of Colorado, Aurora, USA
| | - Adam Atherly
- Center for Health Services Research, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Jon Campbell
- School of Pharmacy University of Colorado, Aurora, USA
| | | | | | - Mori Krantz
- Denver Health Medical Center Cardiology Division, Denver, USA.,School of Medicine, University of Colorado, Aurora, USA
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Shahim B, Hasselberg S, Boldt-Christmas O, Gyberg V, Mellbin L, Rydén L. Effectiveness of different outreach strategies to identify individuals at high risk of diabetes in a heterogeneous population: a study in the Swedish municipality of Södertälje. Eur J Prev Cardiol 2018; 25:1990-1999. [PMID: 30289273 DOI: 10.1177/2047487318805582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identifying type 2 diabetes mellitus (T2DM) is a prerequisite for the institution of preventive measures to reduce future micro and macrovascular complications. Approximately 50% of people with T2DM are undiagnosed, challenging the assumption that a traditional primary healthcare setting is the most efficient way to reach people at risk of T2DM. A setting of this kind may be even more suboptimal when it comes to reaching immigrants, who often appear to have inferior access to healthcare and/or are less likely to attend routine health checks at primary healthcare centres. OBJECTIVES The objective of this study was to identify the best strategy to reach individuals at high risk of T2DM and thereby cardiovascular disease in a heterogeneous population. METHODS All 18-65-year-old inhabitants in the Swedish municipality of Södertälje ( n∼51,000) without known T2DM and cardiovascular disease were encouraged to complete the Finnish Diabetes Risk Score (FINDRISC: score > 15 indicating a high and > 20 a very high risk of future T2DM and cardiovascular disease) through the following communication channels: primary care centres, workplaces, Syrian orthodox churches, pharmacies, crowded public places, mass media, social media and mail. Data collection lasted for six weeks. RESULTS The highest response rate was obtained through workplaces (27%) and the largest proportion of respondents at high/very high risk through the Syrian orthodox churches (18%). The proportion reached through primary care centres was 4%, of whom 5% were at elevated risk. The cost of identifying a person at elevated risk through the Syrian orthodox church was €104 compared with €8 through workplaces and €112 through primary care centres. CONCLUSIONS The choice of communication channels was important to reach high/very high-risk individuals for T2DM and for screening costs. In this immigrant-dense community, primary care centres were inferior to strategies using workplaces and churches in terms of both the proportion of identified at-risk individuals and costs.
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Affiliation(s)
- Bahira Shahim
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Sofia Hasselberg
- 2 McKinsey & Company, Stockholm, Sweden.,3 Getinge AB, Gothenburg, Sweden
| | | | - Viveca Gyberg
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden.,4 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Linda Mellbin
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Lars Rydén
- 1 Department of Medicine Solna, Karolinska Institutet, Sweden
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Ursua RA, Aguilar DE, Wyatt LC, Trinh-Shevrin C, Gamboa L, Valdellon P, Perrella EG, Dimaporo MZ, Nur PQ, Tandon SD, Islam NS. A community health worker intervention to improve blood pressure among Filipino Americans with hypertension: A randomized controlled trial. Prev Med Rep 2018; 11:42-48. [PMID: 29984137 PMCID: PMC6030569 DOI: 10.1016/j.pmedr.2018.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/20/2018] [Accepted: 05/05/2018] [Indexed: 11/28/2022] Open
Abstract
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 ≥ 140 mmHg and/or DBP ≥ 90 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.
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Affiliation(s)
| | - David E. Aguilar
- Community Collaborative Solutions, LLC, New Providence, NJ, United States
| | - Laura C. Wyatt
- New York University School of Medicine, Department of Population Health, New York, NY, United States
| | - Chau Trinh-Shevrin
- New York University School of Medicine, Department of Population Health, New York, NY, United States
| | | | | | | | | | | | - S. Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nadia S. Islam
- New York University School of Medicine, Department of Population Health, New York, NY, United States
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Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, Gitlin LN, Han HR. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. Am J Public Health 2016; 106:e3-e28. [PMID: 26890177 PMCID: PMC4785041 DOI: 10.2105/ajph.2015.302987] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. OBJECTIVES We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions. SEARCH METHODS We undertook 4 electronic database searches-PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane-and hand searched reference collections to identify randomized controlled trials published in English before August 2014. SELECTION We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. DATA COLLECTION AND ANALYSIS Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. MAIN RESULTS All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by CBHWs included health education (n = 48), counseling (n = 36), navigation assistance (n = 21), case management (n = 4), social services (n = 7), and social support (n = 18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n = 9) and supervision procedures (n = 24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n = 21) and cardiovascular risk reduction (n = 16). Eight articles documented cost analyses and found that integrating CBHWs into the health care delivery system was associated with cost-effective and sustainable care. CONCLUSIONS Interventions by CBHWs appear to be effective when compared with alternatives and also cost-effective for certain health conditions, particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote noncommunicable health outcomes among vulnerable populations.
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Affiliation(s)
- Kyounghae Kim
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Janet S Choi
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Eunsuk Choi
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Carrie L Nieman
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Jin Hui Joo
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Frank R Lin
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Laura N Gitlin
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Hae-Ra Han
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
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Woods SS, Costanzo CL. Community Lay Worker Guided Home-Based Monitoring Program for Hypertension Control. J Dr Nurs Pract 2016; 9:249-256. [PMID: 32750995 DOI: 10.1891/2380-9418.9.2.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: The purpose of this study was to determine the incidence of hypertension (HTN), compare clinic versus home visit blood pressure (BP) control, and examine the feasibility of home BP monitoring in a vulnerable adult population. Significance: HTN control continues to be an unmet health maintenance challenge across America. This project used a community lay worker (CLW) to guide individuals in a home BP monitoring program for HTN control. Results: Individuals who were educated in monitoring BP at home significantly reduced their systolic BP. Participants validated that this method was effective in meeting their needs for BP control.
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Mobula LM, Okoye MT, Boulware LE, Carson KA, Marsteller JA, Cooper LA. Cultural competence and perceptions of community health workers' effectiveness for reducing health care disparities. J Prim Care Community Health 2014; 6:10-5. [PMID: 24986493 DOI: 10.1177/2150131914540917] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals' perceptions of their effectiveness may impede integration of CHWs into health care delivery systems. Whether health professionals' attitudes and skills, such as those related to cultural competence, influence perceptions of CHWs, is unknown. METHODS A questionnaire was administered to providers and clinical staff from 6 primary care practices in Maryland from April to December 2011. We quantified the associations of self-reported cultural competence and preparedness with attitudes toward the effectiveness of CHWs using logistic regression adjusting for respondent age, race, gender, provider/staff status, and years at the practice. RESULTS We contacted 200 providers and staff, and 119 (60%) participated. Those reporting more cultural motivation had higher odds of perceiving CHWs as helpful for reducing health care disparities (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 3.48-28.80). Those reporting more frequent culturally competent behaviors also had higher odds of believing CHWs would help reduce health disparities (OR = 3.58, 95% CI = 1.61-7.92). Attitudes toward power and assimilation were not associated with perceptions of CHWs. Cultural preparedness was associated with perceived utility of CHWs in reducing health care disparities (OR = 2.33, 95% CI = 1.21-4.51). CONCLUSIONS Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities. Cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities.
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Affiliation(s)
- Linda M Mobula
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mekam T Okoye
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kathryn A Carson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A Cooper
- Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wenze SJ, Armey MF, Miller IW. Feasibility and Acceptability of a Mobile Intervention to Improve Treatment Adherence in Bipolar Disorder: A Pilot Study. Behav Modif 2014; 38:497-515. [PMID: 24402464 DOI: 10.1177/0145445513518421] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We evaluated the feasibility and acceptability of a 2-week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to deliver treatment as clients engage in their typical daily routines, in their usual settings. Overall, participants (N = 14) stated that EMI sessions were helpful, user-friendly, and engaging, and reported satisfaction with the timing and burden of sessions, as well as the method of delivery. All participants completed the study, and all PDAs were returned undamaged. On average, participants completed 92% of EMI sessions. Although this study was not designed to assess efficacy, depression scores decreased significantly over the study period and data suggest relatively high rates of treatment adherence; missed medication was reported 3% of the time and three participants reported missing a total of six mental health appointments. Negative feedback largely involved technical and logistical issues, many of which are easily addressable. These preliminary findings add to the growing body of literature indicating that mobile-technology-assisted interventions are feasible to implement and acceptable to patients with serious mental illnesses.
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Affiliation(s)
- Susan J Wenze
- Brown University, Providence, RI, USA Butler Hospital, Providence, RI, USA
| | - Michael F Armey
- Brown University, Providence, RI, USA Butler Hospital, Providence, RI, USA
| | - Ivan W Miller
- Brown University, Providence, RI, USA Butler Hospital, Providence, RI, USA
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Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35:399-421. [PMID: 24387091 DOI: 10.1146/annurev-publhealth-032013-182354] [Citation(s) in RCA: 488] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.
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Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki-Leewing A, Grubisic M. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:863-871. [PMID: 23947982 DOI: 10.1016/j.jval.2013.03.1631] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/09/2013] [Accepted: 03/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To systematically review the evidence on the impact of interventions to improve medication adherence in adults prescribed antihypertensive medications. METHODS An electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive medication adherence among patients (≥18 years) with essential hypertension. Studies must have measured adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data. RESULTS Ninety-seven articles were identified for inclusion; 35 (35 of 97, 36.1%) examined interventions to directly improve medication adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in medication adherence. DISCUSSION/CONCLUSIONS Interventions aimed at improving patients' knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research.
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Affiliation(s)
- Femida H Gwadry-Sridhar
- Faculty of Science, Department of Computer Science, The University of Western Ontario, London, Ontario, Canada.
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Krantz MJ, Coronel SM, Whitley EM, Dale R, Yost J, Estacio RO. Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings. Am J Public Health 2012; 103:e19-27. [PMID: 23153152 DOI: 10.2105/ajph.2012.301068] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We evaluated whether a program to prevent coronary heart disease (CHD) with community health workers (CHWs) would improve CHD risk in public health and health care settings. METHODS The CHWs provided point-of-service screening, education, and care coordination to residents in 34 primarily rural Colorado counties. The CHWs utilized motivational interviewing and navigated those at risk for CHD into medical care and lifestyle resources. A software application generated a real-time 10-year Framingham Risk Score (FRS) and guideline-based health recommendations while supporting longitudinal caseload tracking. We used multiple linear regression analysis to determine factors associated with changes in FRS. RESULTS From 2010 to 2011, among 4743 participants at risk for CHD, 53.5% received medical or lifestyle referrals and 698 were retested 3 or more months after screening. We observed statistically significant improvements in diet, weight, blood pressure, lipids, and FRS with the greatest effects among those with uncontrolled risk factors. Successful phone interaction by the CHW led to lower FRS at retests (P = .04). CONCLUSIONS A CHW-based program within public health and health care settings improved CHD risk. Further exploration of factors related to improved outcomes is needed.
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Affiliation(s)
- Mori J Krantz
- Community Health Department, The Colorado Prevention Center, Aurora, CO, USA.
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Parada H, Horton LA, Cherrington A, Ibarra L, Ayala GX. Correlates of medication nonadherence among Latinos with type 2 diabetes. DIABETES EDUCATOR 2012; 38:552-61. [PMID: 22546741 DOI: 10.1177/0145721712445215] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to assess factors related to diabetes medication nonadherence in a sample of predominantly Spanish-speaking Mexican-origin adults residing along the US-Mexico border. METHODS As part of a randomized controlled trial, 302 patients randomly sampled from a clinic roster completed a baseline interview. Medication nonadherence was assessed with the Morisky Medication Adherence Scale. Consistent with the framework proposed by Venturini et al, four factors were examined: patient-related attributes, drug regimen characteristics and complexity, health status, and patient-provider interaction characteristics. RESULTS Sixty percent of the patients were classified as nonadherent. Men, those who engaged in diabetes control behaviors less frequently, and individuals with depression were more likely to be classified as nonadherent. Among those who were Spanish-dominant, education and self-rated health also were significantly and negatively related to medication adherence; patients with a high school education or greater and those who more positively rated their health were more likely to be classified as nonadherent compared to those with less than a high school education and those who rated their health as poor. CONCLUSIONS Results reflect potentially higher medication nonadherence rates for Latinos with type 2 diabetes living in rural communities along the US-Mexico border. Additionally, this study supports the need to address strategies to support medication adherence, including addressing depression, for diabetes control. Strategies to promote adherence among Latino men are sorely needed, as are strategies to address forgetfulness and carelessness regarding diabetes medicine taking.
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Affiliation(s)
- Humberto Parada
- The Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego State University, San Diego (Mr Parada, Ms Horton, and Dr Ayala)
| | - Lucy A Horton
- The Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego State University, San Diego (Mr Parada, Ms Horton, and Dr Ayala)
| | | | | | - Guadalupe X Ayala
- The Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego State University, San Diego (Mr Parada, Ms Horton, and Dr Ayala)
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Henderson S, Kendall E, See L. The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:225-249. [PMID: 21208326 DOI: 10.1111/j.1365-2524.2010.00972.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Culturally and linguistically diverse (CALD) communities in Australia experience both significant health disparities and a lack of access to services. Consequently, there have been calls for culturally appropriate services for people with chronic disease in CALD populations. This paper presents a systematic review of the literature on the effectiveness of culturally appropriate interventions to manage or prevent chronic disease in CALD communities. Evidence was sought from randomized controlled trials and controlled studies that examined strategies for promoting cultural competence in health service delivery to CALD communities. The outcomes examined included changes in consumer health behaviours, utilisation/satisfaction with the service, and the cultural competence of health-care providers. Of the 202 studies that were identified only 24 met the inclusion criteria. The five categories of intervention that were identified included: (1) the use of community-based bi-lingual health workers; (2) providing cultural competency training for health workers; (3) using interpreter service for CALD people; (4) using multimedia and culturally sensitive videos to promote health for CALD people and (5) establishing community point-of-care services for CALD people with chronic disease. The review supported the use of trained bi-lingual health workers, who are culturally competent, as a major consideration in the development of an appropriate health service model for CALD communities.
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Affiliation(s)
- Saras Henderson
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.
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Whitley EM, Main DS, McGloin J, Hanratty R. Reaching individuals at risk for cardiovascular disease through community outreach in Colorado. Prev Med 2011; 52:84-6. [PMID: 21040742 DOI: 10.1016/j.ypmed.2010.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 09/30/2010] [Accepted: 10/24/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this program was to (1) increase awareness of individual cardiovascular disease (CVD) risk in underserved communities, (2) educate participants about lifestyle modifications to reduce CVD risk, and (3) link individuals at moderate to high risk with healthcare. Community health workers (CHWs) delivered the program in 14 urban, rural and frontier Colorado communities. METHOD We analyzed data from CVD screenings of 17,995 individuals throughout Colorado between 2006 and 2009 in order to understand the reach and impact of the program on reaching target populations, identifying at-risk individuals and improving awareness of CVD risk. RESULTS In 3 years, 15 CHWs screened 17,995 clients for CVD risk, of which, almost 60% were racial and ethnic minorities and 42% were uninsured. Twenty-nine percent of participants had medium or high Framingham Risk Scores. Over three-quarters were overweight or obese, over one-fifth had mildly to severely high blood pressure, and 42% had borderline high or high cholesterol. Significantly, 82% had no knowledge of their CVD risk prior to screening. CONCLUSION This program is a replicable model for reaching minority and medically underserved populations who are at risk for CVD in urban, rural and frontier communities.
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Abstract
Stroke is the third common cause of death in the UK. It is also a leading cause of disability. The recent National Stroke Strategy (Department of Health, 2007) has provided major impetus behind changes in the ways in which stroke is prevented and treated (National Audit Office, 2010). Stroke awareness sits as a significant part of the Strategy, but there are some concerns that the Government's centrepiece campaign to increase public knowledge is not reaching some of the most vulnerable sections of our population, people from black and minority ethnic communities, despite clear evidence of increased risk among some ethnic communities. This paper describes some of the literature, mainly from the United States, which can help nurses working in community settings consider strategies for raising awareness about both stroke knowledge and risk. The paper points to three important themes: initial and prolonged engagement with local communities; self-management and cultural sensitivity.
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Abstract
OBJECTIVES We conducted a systematic review on outcomes and costs of community health worker (CHW) interventions. CHWs are increasingly expected to improve health outcomes cost-effectively for the underserved. RESEARCH DESIGN We searched Medline, Cochrane Collaboration resources, and the Cumulative Index to Nursing and Allied Health Literature for studies conducted in the United States and published in English from 1980 through November 2008. We dually reviewed abstracts, full-text articles, data abstractions, quality ratings, and strength of evidence grades and resolved disagreements by consensus. RESULTS We included 53 studies on outcomes of CHW interventions and 6 on cost or cost-effectiveness. For outcomes, limited evidence (5 studies) suggests that CHW interventions can improve participant knowledge compared with alternative approaches or no intervention. We found mixed evidence for participant behavior change (22 studies) and health outcomes (27 studies). Some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes compared with various alternatives, but other studies suggested that CHW interventions provide no statistically different benefits than alternatives. We found low or moderate strength of evidence suggesting that CHWs can increase appropriate health care utilization for some interventions (30 studies). Six studies with economic information yielded insufficient data to evaluate the cost-effectiveness of CHW interventions relative to other interventions. CONCLUSIONS CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.
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Manias E, Williams A. Medication adherence in people of culturally and linguistically diverse backgrounds: a meta-analysis. Ann Pharmacother 2010; 44:964-82. [PMID: 20442356 DOI: 10.1345/aph.1m572] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Medication adherence is of particular importance for people of culturally and linguistically diverse (CALD) backgrounds due to language difficulties, lack of social and organizational supports, lack of access to healthcare resources, and disengagement with the health-care system. OBJECTIVE To evaluate the impact of interventions to improve medication adherence in people of CALD backgrounds through a systematic review and meta-analysis. METHODS A search was performed using the following databases: Cochrane Database of Systematic Reviews, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Journals@Ovid, PsychInfo, PubMed, Science Direct, Scopus, and Web of Science. Databases were searched from January 1978 to October 2009. RESULTS Forty-six articles reviewed were assessed as being relevant, which included 36 randomized controlled trials, 2 observational cohort studies, and 8 quasi-experimental studies. The most common method for assessing medication adherence was self-reporting measures, such as the Morisky Scale and its modifications. Few studies used combinations of adherence measures, and adherence involving a medication event monitoring system (MEMS) was used in only 6 studies. Individuals of CALD backgrounds were recruited with people of non-CALD backgrounds and subsequent analyses tended to be undertaken of the whole sample. Twenty studies showed statistically significant improvements in medication adherence, 15 of which were randomized controlled trials. Six of the successful interventions involved delivery by a bilingual person or the use of translated materials and 4 involved the use of a conceptual model. Meta-analyses demonstrated modest improvements in medication adherence. CONCLUSIONS Relatively little high-quality work has been conducted on adherence-enhancing interventions for people of CALD backgrounds. Greater attention needs to be given to examining the needs of specific CALD population groups. Future researchers should consider rigorously testing interventions that take into account the enormous diversity and differences that exist within any particular CALD group.
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Affiliation(s)
- Elizabeth Manias
- Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
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Einhorn PT. National heart, lung, and blood institute-initiated program "interventions to improve hypertension control rates in African Americans": background and implementation. Circ Cardiovasc Qual Outcomes 2010; 2:236-40. [PMID: 20031843 DOI: 10.1161/circoutcomes.109.850008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Paula T Einhorn
- Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
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Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev 2010:CD005182. [PMID: 20238338 DOI: 10.1002/14651858.cd005182.pub4] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals - a condition labelled as "uncontrolled" hypertension. The optimal way to organize and deliver care to hypertensive patients has not been clearly identified. OBJECTIVES To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. To evaluate the effectiveness of reminders on improving the follow-up of patients with hypertension. SEARCH STRATEGY All-language search of all articles (any year) in the Cochrane Controlled Trials Register (CCTR) and Medline; and Embase from January 1980. SELECTION CRITERIA Randomized controlled trials (RCTs) of patients with hypertension that evaluated the following interventions: (1) self-monitoring (2) educational interventions directed to the patient (3) educational interventions directed to the health professional (4) health professional (nurse or pharmacist) led care (5) organisational interventions that aimed to improve the delivery of care (6) appointment reminder systemsOutcomes assessed were: (1) mean systolic and diastolic blood pressure (2) control of blood pressure (3) proportion of patients followed up at clinic DATA COLLECTION AND ANALYSIS Two authors extracted data independently and in duplicate and assessed each study according to the criteria outlined by the Cochrane Handbook. MAIN RESULTS 72 RCTs met our inclusion criteria. The methodological quality of included studies varied. An organized system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce systolic blood pressure (weighted mean difference (WMD) -8.0 mmHg, 95% CI: -8.8 to -7.2 mmHg) and diastolic blood pressure (WMD -4.3 mmHg, 95% CI: -4.7 to -3.9 mmHg) for three strata of entry blood pressure, and all-cause mortality at five years follow-up (6.4% versus 7.8%, difference 1.4%) in a single large RCT- the Hypertension Detection and Follow-Up study. Other interventions had variable effects. Self-monitoring was associated with moderate net reduction in systolic blood pressure (WMD -2.5 mmHg, 95% CI: -3.7 to -1.3 mmHg) and diastolic blood pressure (WMD -1.8 mmHg, 95% CI: -2.4 to -1.2 mmHg). RCTs of educational interventions directed at patients or health professionals were heterogeneous but appeared unlikely to be associated with large net reductions in blood pressure by themselves. Nurse or pharmacist led care may be a promising way forward, with the majority of RCTs being associated with improved blood pressure control and mean SBP and DBP but these interventions require further evaluation. Appointment reminder systems also require further evaluation due to heterogeneity and small trial numbers, but the majority of trials increased the proportion of individuals who attended for follow-up (odds ratio 0.41, 95% CI 0.32 to 0.51) and in two small trials also led to improved blood pressure control, odds ratio favouring intervention 0.54 (95% CI 0.41 to 0.73). AUTHORS' CONCLUSIONS Family practices and community-based clinics need to have an organized system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. Self-monitoring and appointment reminders may be useful adjuncts to the above strategies to improve blood pressure control but require further evaluation.
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Affiliation(s)
- Liam G Glynn
- Department of General Practice, National University of Ireland, No 1, Distillery Road,, Galway, Ireland
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Yu AP, Yu YF, Nichol MB, Gwadry-Sridhar F. Delay in filling the initial prescription for a statin: a potential early indicator of medication nonpersistence. Clin Ther 2008; 30:761-74; discussion 716. [PMID: 18498924 DOI: 10.1016/j.clinthera.2008.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identification of early predictors of medication nonpersistence may allow timely adherence-promoting interventions and potentially reduce the risk of negative health outcomes. OBJECTIVE This study was conducted to determine whether delay in filling an initial statin prescription predicts subsequent nonpersistence with medication. METHODS This observational study of a cohort of adult patients (>18 years) who newly initiated statin therapy between December 1997 and June 2000 employed data from the administrative claims database of a large US managed care organization. Patients initiating statin therapy had to have at least 18 months of continuous eligibility and no statin use in the 6-month period before the index prescription. A new measure, dispensation delay, was measured as the gap between the most recent physician or hospital visit and the fill date of the index prescription. Five categories of dispensation delay were created--no delay, 1 to 7 days, 8 to 30 days, 31 to 183 days, and >183 days. Nonpersistence was defined as a gap of >or=30 days in the statin prescription supply during the follow-up period. Cox proportional hazards regression was used to model the risk of the initial dispensation delay on the time to discontinuation, controlling for such variables as demographic characteristics, comorbidities, physician specialty, and previous health care utilization. RESULTS The final sample included 19,038 patients. Among all variables studied, the dispensation-delay variables were the most significant predictors of non-persistence, with a longer delay predicting a higher risk of early discontinuation. Patients with delays in filling the initial prescription of >30 days but <183 days were 30% more likely to discontinue therapy than those without delays (hazard ratio=1.30; 95% CI=1.20-1.40). CONCLUSIONS The delay in filling the first statin prescription significantly predicted future non-persistence. Use of this measure may allow early identification of patients at high risk for early discontinuation.
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Affiliation(s)
- Andrew Peng Yu
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, California, USA.
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Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008; 10:348-54. [PMID: 18453793 PMCID: PMC2562622 DOI: 10.1111/j.1751-7176.2008.07572.x] [Citation(s) in RCA: 1955] [Impact Index Per Article: 122.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 12/05/2007] [Accepted: 01/08/2008] [Indexed: 02/06/2023]
Abstract
This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
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Affiliation(s)
- Donald E Morisky
- Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA.
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Connell P, Wolfe C, McKevitt C. Preventing stroke: a narrative review of community interventions for improving hypertension control in black adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:165-187. [PMID: 18290982 DOI: 10.1111/j.1365-2524.2007.00737.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Incidence rates for stroke and hypertension are higher in black ethnic groups of African descent in the USA and UK than in white groups, suggesting a need for targeted intervention. We conduct a narrative review of published research evidence on community interventions to manage hypertension among black ethnic groups, and explore the concept of cultural sensitivity in these interventions. Data sources comprised computer-aided searches of published studies over the years 1981 to March 2006, on community strategies for improving hypertension control targeting black groups, and further references from these articles. Twenty-seven relevant studies were identified. Health education was associated with improvements in knowledge about hypertension, while education combined with individualised support for patients to self-manage hypertension, including goal setting and monitoring to enhance patient self-management of hypertension, and family support in managing hypertension were associated with reductions in blood pressure levels and improvements in blood pressure control. Collaboration with black communities, using local or minority ethnic staff, conducting preliminary research with target groups to investigate perceptions and canvass ideas for the intervention design were common methods assumed to achieve cultural sensitivity. Studies, however, provided insufficient robust evidence of the effectiveness of these strategies in terms of quantifiable outcomes, although this criterion is contested, with social justice arguments being offered instead. Implicit assumptions about homogeneity and shared interests within the 'community', and representation of 'community' views have implications for the effectiveness of interventions. These findings highlight areas for the future development of interventions to reduce hypertension rates in black groups, and factors that need to be robustly investigated and explicitly addressed in intervention design.
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Affiliation(s)
- Patricia Connell
- Division of Health and Social Care Research, King's College London, London, UK.
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Brownstein JN, Chowdhury FM, Norris SL, Horsley T, Jack L, Zhang X, Satterfield D. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med 2007; 32:435-47. [PMID: 17478270 DOI: 10.1016/j.amepre.2007.01.011] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 11/22/2006] [Accepted: 01/10/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND The contributions of community health workers (CHWs) in the delivery of culturally relevant programs for hypertension control have been studied since the 1970s. This systematic review examines the effectiveness of CHWs in supporting the care of people with hypertension. METHODS Computerized searches were conducted of multiple bibliographic electronic databases from their inception until May 2006. No restrictions were applied for language or study design, and studies were restricted to those that reported at least one outcome among participants. RESULTS Fourteen studies were identified, including eight randomized controlled trials (RCTs). Many of the studies focused on poor, urban African Americans. Significant improvements in controlling blood pressure were reported in seven of the eight RCTs. Several studies reported significant improvements in participants' self-management behaviors, including appointment keeping and adherence to antihypertensive medications. Four studies reported positive changes in healthcare utilization and in systems outcomes. Two of the RCTs showed significant improvements in other patient outcomes, such as changes in heart mass and risk of CVD. CONCLUSIONS Community health workers may have an important impact on the self-management of hypertension. Programs involving CHWs as multidisciplinary team members hold promise, particularly for diverse racial/ethnic populations that are under-served.
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Affiliation(s)
- J Nell Brownstein
- Division for the Prevention of Heart Disease and Stroke, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
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Kuhajda MC, Cornell CE, Brownstein JN, Littleton MA, Stalker VG, Bittner VA, Lewis CE, Raczynski JM. Training community health workers to reduce health disparities in Alabama's Black Belt: the Pine Apple Heart Disease and Stroke Project. FAMILY & COMMUNITY HEALTH 2006; 29:89-102. [PMID: 16552287 DOI: 10.1097/00003727-200604000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
African American women have significantly higher mortality rates from heart disease and stroke than White women despite advances in treatment and the management of risk factors. Community health workers (CHWs) serve important roles in culturally relevant programs to prevent disease and promote health. This article describes the Pine Apple Heart and Stroke Project's activities to (1) revise the Women's Wellness Sourcebook Module III: Heart and Stroke to be consistent with national guidelines on heart disease and stroke and to meet the needs of African American women living in rural southern communities; (2) train CHWs using the revised curriculum; and (3) evaluate the training program. Revisions of the curriculum were based on recommendations by an expert advisory panel, the staff of a rural health clinic, and feedback from CHWs during training. Questionnaires after training revealed positive changes in CHWs' knowledge, attitudes, self-efficacy, and self-reported risk reduction behaviors related to heart disease, stroke, cancer, and patient-provider communication. This study provides a CHW training curriculum that may be useful to others in establishing heart disease and stroke programs in rural underserved communities.
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Affiliation(s)
- Melissa C Kuhajda
- Department of Community and Rural Medicine, University of Alabama School of Medicine, Tuscaloosa Campus, AL 35487, USA.
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Brownstein JN, Bone LR, Dennison CR, Hill MN, Kim MT, Levine DM. Community health workers as interventionists in the prevention and control of heart disease and stroke. Am J Prev Med 2005; 29:128-33. [PMID: 16389138 DOI: 10.1016/j.amepre.2005.07.024] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 06/21/2005] [Accepted: 07/13/2005] [Indexed: 11/21/2022]
Abstract
A considerable body of research indicates that community health workers (CHWs) are effective in improving chronic disease care and health outcomes. Much of the focus of cardiovascular research involving CHWs has been on hypertension because of its high prevalence and because it is a major risk factor for cardiovascular, cerebrovascular, and renal diseases. Adding CHWs to the patient-provider team has a beneficial effect on the quality of care for populations most in need. CHWs have contributed to significant improvements in community members' access to and continuity of care and adherence to treatment for the control of hypertension. CHWs assume multiple roles, including patient and community education, patient counseling, monitoring patient health status, linking people with health and human services, and enhancing provider patient communication and adherence to care. Current recommendations for CHWs to be interventionists on healthcare teams and in community-based research increase opportunities for CHWs to play an important role in eliminating disparities in heart disease and stroke. Adequate translation of research into clinical practice remains a major challenge, however. Addressing this issue, which has national implications, will require sustainable funding; appropriate reimbursement; enhanced efforts to incorporate CHWs into healthcare teams; better utilization of their skills; improved CHW supervision, training, and career development; policy changes; and ongoing evaluation, including a reporting of costs.
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Affiliation(s)
- J Nell Brownstein
- Cardiovascular Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia 30341-3717, USA.
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