دانلود رایگان مقاله انگلیسی مداخله یک CHW برای بهبود فشارخون در میان آمریکایی های با فشار خون بالا - الزویر 2018

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.

 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.