Blood Pressure Monitoring, Self, Health Promotion, Quality of Life
Conditions
Brief summary
The investigators propose to implement and evaluate the effectiveness of the peer-led CARE Intervention designed to mitigate health differences among rural and low-income communities in Texas. This intervention leverages the expertise of Community Health Workers (CHWs) to empower rural and low-income communities, improving health outcomes through outreach, education, counseling, and social support.
Detailed description
The investigators will employ a randomized controlled trial through which individual participants will be randomized to either the intervention or control group. Randomization will be achieved by employing a computer program containing a random number generator (e.g., R). Given the study will be conducted at two sites (Rio Grande Valley and Harris County), randomization and subsequent clinical trials will be conducted independently at each site for feasibility and practicability. Participants in the control group will receive no intervention, but will be invited to receive health education sessions after the follow-up period has ended at 6-months post intervention. Trained interventionists (e.g., CHWs) will deliver the intervention across four in-person visits and provide verbal reinforcement using implementation scripts, evidence-based skills (e.g., motivational interviewing, protocol-based counseling, health education) to leverage opportunities during conversations with participants to address flawed information and provide accurate information about quality of life-wellness-mental health (Session #1), blood pressure (Session #2), nutrition (Session #3), and physical activity (Session #4). Interventionists will utilize their CARE facilitators guide with embedded scripts to address inaccurate information on quality of life-wellness-mental health, blood pressure, nutrition, and physical activity and gently challenge/provide accurate information and sources. Throughout the study period, the participants will complete the CARE + CS4 survey online via a Qualtrics or REDcap link for both study arms at 4 (four) timepoints: baseline, post-intervention, 3 months after intervention, and 6 months after intervention. The CARE + CS4 survey is a153 item questionnaire that will evaluate Health-related Quality of Life; Flawed information, Health Knowledge, Attitudes, and Beliefs; Health Behavior (Measuring and monitoring blood pressure), physical activity, nutrition, sleep); Physical and Mental Wellbeing; Social Needs, and Healthcare Utilization among participants.
Interventions
BEHAVIORALConversations Advancing Resilience and Empowerment (CARE)
Health promotion intervention to address chronic disease risk
Sponsors
University of Texas Rio Grande Valley
National Heart, Lung, and Blood Institute (NHLBI)
CAN DO Houston
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 49 Years
Healthy volunteers
Yes
Inclusion criteria
* Females between the ages of 18-49 * Self-report at least one risk factor cardiovascular disease (e.g. high blood pressure, high cholesterol, diabetes, overweight, and family history of heart disease). * Reside in one of the priority communities will be eligible to participate in the study. * Meet minimum digital literacy criteria, defined as having a working and readily accessible email address and using a smart device daily for texting, calling, and checking email. Priority communities for the South Texas site include Harris, Hidalgo, Cameron, Willacy, Starr, and Nueces counties plus surrounding coastal communities served by South Coastal AHEC.
Exclusion criteria
* Those not meeting the inclusion criteria will not be eligible to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Health-related Quality of Life | From Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention. | The health-related quality of life (HRQOL) is measured by a decrease in the number of total unhealthy days compared to the control group at baseline, end of intervention at 4-weeks, and the 3- and 6-month follow-ups. The assessment used to measure this outcome is the World Health Organization Quality-of-Life-Scale Brief version (WHOQOL-BREF). The items from this assessment are scored using a likert scale of 1-5, 1 being the worst and 5 being the best. The raw score is calculated for each facet and each domain. Both facets and domains are scored through a simple summation of each item in that scale. Each question contributes equally to the facet score and each facet contributes equally to the domain score. Since each facet has four items with response values of 1 through 5, the raw score for any facet must have a minimum value of 4 and a maximum value of 20. Community narratives can be powerful tools that increase health narratives and promote behavior change. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Flawed information on nutrition, physical activity, blood pressure, and mental health | From Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention. | Flawed information measures the increase in self-efficacy in evaluating health information (flawed information) and to prevent and/or manage chronic conditions, health promotion knowledge, intention to change behavior. Trust in health information sources is measured using 11 investigator-developed items assessing trust in healthcare providers, media, government agencies, community health workers, and community organizations. Responses are rated from 1 (Not at all) to 4 (A great deal), with a Does Not Apply option treated as missing. Item scores are averaged across rated items; higher scores indicate greater trust. Flawed nutrition, physical activity, blood pressure, and mental health information are measured using two likert-scale items rated from 1 (Strongly agree) to 5 (Strongly disagree). Items are reverse coded as needed so higher scores indicate lower endorsement of nutrition flawed information. |
| Health knowledge on nutrition, physical activity, blood pressure, and mental health | From Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention | Nutrition knowledge is measured using investigator-developed multiple-choice items based on the USDA Dietary Guidelines for Americans. Correct responses receive one point; incorrect and "Don't know" responses receive zero points. Scores are summed, with higher scores indicating greater nutrition knowledge. Physical activity knowledge is measured using investigator-developed true/false and multiple-choice items informed by the Physical Activity Guidelines for Americans. Blood pressure knowledge is assessed using investigator-developed true/false and multiple-choice items based on American Heart Association recommendations. Correct responses receive one point; higher summed scores indicate greater knowledge. Knowledge of the relationship between sleep and mental health is measured using five investigator-developed true/false items informed by the CDC and Journal of Clinical Sleep Medicine. Higher summed scores indicate greater sleep-related knowledge. |
| Attitudes and beliefs on nutrition, physical activity, blood pressure, and sleep | From Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention. | Nutrition, physical activity, blood pressure, and sleep attitudes and beliefs are measured using six different Theory of Planned Behavior-based (TPB) items rated 1-5 for each measure. Composite scale scores are created after reverse-coding any negatively worded items. Higher scores indicate more favorable attitudes and beliefs for each measure. |
| Health Behavior | Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention | This survey variable is an adoption of preventative health behaviors. Smoking behavior is measured by current smoking status and average cigarettes smoked per day. Lower smoking frequency indicates healthier behavior. Nutrition behavior is measured by self-reported frequency of fruit, vegetable, sugar-sweetened beverage intake and stage of change. Higher healthy food intake and advanced stage indicate healthier behavior. Physical activity behavior is measured by activity frequency, minutes/week and stage of change. Higher activity and maintenance stage indicate healthier behavior. Blood pressure behavior is measured by stage of change and confidence checking blood pressure at home. Higher scores indicate greater engagement. Sleep behavior is measured by using a stage-of-change item for obtaining 7-9 hours of sleep. Higher stage indicates healthier sleep behavior. |
| Physical and Mental Wellbeing | Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention | The outcome will be measured by a decrease in the number of total unhealthy days compared to the control group at baseline, end of intervention at 4-weeks, and the 3- and 6-month follow-ups. |
| Social Needs | Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention | Social needs are measured by the number of essential social needs for food insecurity, increase in social support, increase in awareness of resources; using the USDA 2-item Food Insecurity Screener. Responses range from 'Often true' to 'Never true'. Higher affirmative responses indicate greater food insecurity. |
| Health Status (Blood pressure) | Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention | Blood pressure outcomes are assessed by changes in systolic and diastolic blood pressure, based on the average of two measurements obtained from the left arm using an electronic blood pressure monitor, with readings collected at least 60 seconds apart. Blood pressure is measured four times per week by the Community Health Worker (CHW) during the intervention period and is self-reported monthly for six months following the intervention. |
| Healthcare Utilization | Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention | Measured by our health assessment (CARE + CS4) using investigator-developed items assessing healthcare access, insurance, transportation, neighborhood environment, housing, employment and related factors. Variables are analyzed individually or grouped by domain as appropriate. All assessments are completed at baseline, end of intervention at 4-weeks, and the 3- and 6-month follow-up. |
| Community Health Workers (CHW) Knowledge, Self-Efficacy, Skill Development, Beliefs | Baseline, end of intervention (following completion of Health Education Session #4; the intervention was designed to last 4 weeks but may be extended due to scheduling considerations), 3 months post-intervention, 6 months post-intervention. | Measures changes in Community Health Worker (CHW) knowledge, self-efficacy, skills, and beliefs related to implementation and delivery of the CARE intervention. |
Countries
United States
Contacts
CONTACTCandace A Dr. Robledo, PhD, MPH
CONTACTMoises Cisneros, BS, Exercise Science
PRINCIPAL_INVESTIGATORCandace A Robledo, PhD, MPH
The University of Texas at Rio Grande Valley
PRINCIPAL_INVESTIGATORJasmine J Opusunju, DrPH, MSEd
CAN DO Houston
Outcome results
None listed