Hypertension affects 1 in every 3 adults in the US and contributes to 410,000 deaths
annually. Hypertension and its associated complications disproportionately affect
minority populations living in urban areas. In Chicago, health status indicators show
worsening disparities between black and white residents, with the highest rates of
hypertension, heart disease, and stroke clustering in the predominantly black South and
West Sides. Kaiser Permanente demonstrated that a bundle of evidence-based interventions
implemented within a large, integrated health system in Northern California significantly
increased blood pressure control rates. However, it is unclear whether a health system
centered intervention can be adapted to other settings, particularly under-resourced
urban communities. Therefore, the overall goal is to support a community-centered design
and adaptation of the Kaiser bundle. The investigative team will adapt the delivery model
of the Kaiser bundle to be centered within churches within the South Side of Chicago, one
of the most medically underserved communities in the United States. The proposed
interventions are the same as in the Kaiser bundle (e.g., registry/audit and feedback,
simplified treatment regimens, accurate Blood Pressure measurement) but implementation of
the components of the bundle will be adapted for delivery in the community. The
intervention will be carried out by local community health workers and ministry
facilitators, with health clinics and hospitals in the community as support, all
connected through a common data platform.
Thus, the proposed project will identify the best strategies to support adoption,
implementation with fidelity, and sustainability of the Kaiser bundle in the community
setting. The proposed study will follow the Exploration, Preparation, Implementation and
Sustainment (EPIS) process model and implementation is rigorously evaluated using a
multimethod approach to the Reach, Effectiveness, Adoption, Implementation, and
Maintenance (REAIM) evaluation framework. The specific aims are: Aim 1: Convene community
stakeholders in order to adapt implementation strategies using the Dynamic Adaptation
Process model. Aim 2: Design, implement, and evaluate pilot projects in order to optimize
implementation strategies within the target community. Aim 3: Implement, test and
evaluate an adapted implementation strategy to control hypertension through faith-based
organizations in the South Side of Chicago. The study uses a hybrid Type 2
effectiveness-implementation design based within one primary community area (South Side
Chicago) and in two settings (church and clinic). The overall study outcome is the Public
Health Impact metric (reach * effect size of the intervention). Aim 4: Disseminate
findings internally to community stakeholders and externally through creation of
community implementation toolkits.