Hypertension
Conditions
Keywords
Barbershop-based facilitation, Blood pressure
Brief summary
The CLIP program will train Community Health Workers (CHWs) to screen and identify Black men with elevated blood pressure (BP) or stage 1 hypertension (HTN), initiate lifestyle counseling; and link them to primary care and social services.
Detailed description
The study will consist of: 1. An implementation phase that will use a cluster randomized cluster trial of 20 barbershops among Black men with elevated BP or Stage 1 HTN, to compare the effect of the Barbershop-based Facilitation (BF) strategy (n=10 barbershops; n=210 participants) vs. self-directed control (i.e. receipt of information for implementation of CLIP without the BF strategy; n=10 barbershops; n=210 participants), on BP reduction, HTN prevention, linkage to care, and adoption of CLIP at 12 months 2. A post-implementation phase that will use Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) to evaluate the effect of the BF strategy versus self-directed control on sustainability of CLIP 6 months after completion of the trial; and cost-effectiveness over a 10-year time horizon.
Interventions
BEHAVIORALCommunity-to-Clinic Linkage Implementation Program in Barbershops (CLIP)
Multilevel intervention designed to mitigate adverse social determinants of health (SDoH) via linkage to care, health system navigation, and referral to social services.
BEHAVIORALBarbershop-Based Facilitation (BF)
Trained and qualified facilitators assist community health workers (CHWs) to: 1) increase their confidence in delivering CLIP; 2) understand participants' concerns and beliefs about hypertension (HTN); and 3) develop skills in lifestyle counseling to help the men initiate lifestyle modification.
Sponsors
NYU Langone Health
American Heart Association
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. 18 years of age as of date of data extraction 2. Repeat customer within the last 3 months 3. Self-identify as Black 4. Self-identify as male 5. Have elevated blood pressure (PB) (120-129/\<80 millimeters of mercury (mm Hg)) or untreated stage 1 hypertension (HTN) (130-139/80-89 mm Hg) (defined by American Heart Association's 2017 HTN clinical guidelines)
Exclusion criteria
1. Age \<18 years 2. Prescribed antihypertensive medication 3. Diagnosis of end-stage renal disease (ESRD) 4. Condition which interferes with outcome measurement (e.g., dialysis) 5. Serious medical condition which either limits life expectancy or requires active management (e.g., cancer) 6. Cognitive impairment or other condition preventing participation in the intervention 7. Upper arm circumference \>50 cm (maximum limit of the extra-large BP cuff) 8. Active alcohol or substance use disorder (i.e., not sober/abstinent for ≥ 30 days) 9. Pregnant or planning pregnancy in the next 24 months 10. Currently nursing a child 11. Current participation in another research study focused on reducing BP 12. Unwillingness to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Systolic Blood Pressure (SBP) Levels | Baseline, Month 12 | All participants will have office blood pressure (BP) measured on their non-dominant arm with an Omron HEM-907XL BP device. 3 BP readings separated by one minute will be obtained at each visit. The 3 BP readings will be averaged to obtain mean BP. SBP Levels are classified as follows: * Normal: Below 120 millimeters of mercury (mm Hg) * Elevated: 120-129 mm Hg * Stage 1 hypertension: 130-139 mm Hg * Stage 2 hypertension: 140 mm Hg or more * Hypertensive crisis: 180 mm Hg or more |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Diastolic Blood Pressure (DBP) Levels | Baseline, Month 12 | All participants will have office blood pressure (BP) measured on their non-dominant arm with an Omron HEM-907XL BP device. At each visit, 3 BP readings separated by one minute will be obtained. The 3 BP readings will be averaged to obtain study BP. DBP Levels are classified as follows: * Normal: Lower than 80 millimeters of mercury (mm Hg) * Stage 1 hypertension: 80-89 mm Hg * Stage 2 hypertension: 90 mm Hg or more * Hypertensive crisis: 120 mm Hg or more. |
| Number of Participants Presenting to Referral Clinics within 3 Months of Community Health Worker (CHW) Referral | Baseline | Measurement of linkage to care. Data will be gathered via telephone interview or during barbershop visit. |
| Number of Barbershops Completing all Components of CLIP | Month 12 | Measurement of the rate of adoption of Community-to-Clinic Linkage Implementation Program in Barbershops (CLIP). |
| Number of Barbershops Continuing to Use CLIP at 6 Months Post-Completion of Intervention | Month 18 | Measurement of the sustainability of Community-to-Clinic Linkage Implementation Program in Barbershops (CLIP). |
| Number of Participants Presenting with Incident Stage 2 HTN | Baseline | Incident Stage 2 hypertension (HTN) is defined as: * Systolic Blood Pressure (SBP) of at least 140 millimeters of mercury (mm Hg)/Diastolic Blood Pressure (DBP) of at least 90 mm Hg; or * Antihypertensive medication initiation. |
| 12-Item Short Form Survey (SF-12) Questionnaire Score | Baseline | The SF-12 is a self-reported outcome measure assessing the impact of health on an individual's everyday life. It is often used as a quality-of-life measure. SF-12 consists of 12 questions that are scored in various ways. The total score range is 12-48; the higher the score, the better the physical and mental health functioning. |
| Cost per Millimeters of Mercury (mm Hg) Reduction in Blood Pressure (BP) | Up to Month 18 | Dollar amount associated with a 1-mm Hg reduction in BP. Lower costs are considered more desirable outcomes. |
| Cost per Incident Stage 2 Hypertension (HTN) Case Prevented | Up to Month 18 | Dollar amount associated with the prevention of an Incident Stage 2 HTN case. Lower costs are considered more desirable outcomes. Incident Stage 2 HTN is defined as: * Systolic Blood Pressure (SBP) of at least 140 millimeters of mercury (mm Hg)/Diastolic Blood Pressure (DBP) of at least 90 mm Hg; or * Antihypertensive medication initiation. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJoseph Ravenell, MD
NYU Langone Medical Center
Outcome results
None listed