A randomized controlled trial of community health workers using patient stories to support hypertension management: Study protocol
Department of Family and Community Health; Department of Quantitative Health Sciences
Cardiovascular Diseases | Clinical Epidemiology | Community Health and Preventive Medicine | Epidemiology | Health Services Administration | Health Services Research | Medical Education | Public Health Education and Promotion
BACKGROUND: Uncontrolled hypertension is a significant public health problem in the U.S. with about one half of people able to keep blood pressure (BP) under control. Uncontrolled hypertension leads to increased risk of stroke, heart attack, and death. Furthermore, the social and economic costs of poor hypertension control are staggering. People living with hypertension can benefit from additional educational outreach and support.
METHODS: This randomized trial conducted at two Community Health Centers (CHCs) in Massachusetts assessed the effect of community health workers (CHWs) assisting patients with hypertension. In addition to the support provided by CHWs, the study uses video narratives from patients who have worked to control their BP through diet, exercise, and better medication adherence. Participants enrolled in the study were randomly assigned to immediate intervention (I) by CHWs or a delayed intervention (DI) (4 to 6months later). Each participant was asked to meet with the CHW 5 times (twice in person and three times telephonically). Study outcomes include systolic and diastolic BP, diet, exercise, and body mass index.
CONCLUSION: CHWs working directly with patients, using multiple approaches to support patient self-management, can be effective agents to support change in chronic illness management. Moreover, having culturally appropriate tools, such as narratives available through videos, can be an important, cost effective aid to CHWs. Recruitment and intervention delivery within a busy CHC environment required adaptation of the study design and protocols for staff supervision, data collection and intervention delivery and lessons learned are presented.
RETROSPECTIVE TRIAL REGISTRATION: Clinical Trials.gov registration submitted 8/17/16: Protocol ID# 5P60MD006912-02 and Clinical trials.gov ID# NCT02874547 Community Health Workers Using Patient Stories to Support Hypertension Management.
Blood pressure control, Community health centers, Community health workers, Delayed randomization, Health disparities, Hypertension, Methodology, Narrative communication
DOI of Published Version
Contemp Clin Trials. 2018 Jun;69:76-82. doi: 10.1016/j.cct.2018.04.004. Epub 2018 Apr 12. Link to article on publisher's site
Contemporary clinical trials
Hargraves JL, Bonollo D, Person SD, Ferguson WJ. (2018). A randomized controlled trial of community health workers using patient stories to support hypertension management: Study protocol. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.cct.2018.04.004. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1191