Discussion
In this population of Filipino Americans with hypertension, participants in both groups experienced improvements in SBP and DBP, although treatment participants were significantly more likely to experience SBP and DBP improvements after adjustments for other factors. Participants in the treatment group were more than twice as likely to report BP control at study follow-up, even after adjustment for other factors, demonstrating strong efficacy associated with the CHW intervention. The adjusted intervention effect was statistically significant for changes in controlled BP, SBP, and DBP. To our knowledge, this represents the first community-based research study utilizing a randomized controlled study design to improve BP control in the Filipino community. This strong design is a key strength of our study, as prior studies on CHW efficacy have suffered from lack of rigor. The intervention effect on BP control is similar to or higher than that of other CHW interventions conducted in African American and Hispanic communities, (Hill et al., 2003; Levine et al., 2003; Morisky et al., 2002) suggesting that the CHW model may be a particularly important community-clinical linkage model to improve BP control in the Filipino hypertensive population. Findings that individuals retained in the intervention were more likely to be uninsured, younger, and better educated suggests that CHW effectiveness in BP control may be particularly salient for low socio-economic status populations that are disconnected from the healthcare system, aligning with the randomized controlled trial design. Although the intervention effect on BP control and decreases in SBP and DBP were significant, control group participants also saw positive changes in BP outcomes. There was no difference in BP control outcomes or mean values of SBP and DBP between individuals in the control group who had contact with treatment group participants and those who did not.
