Scaling Telehealth Models to Improve Co-morbid Diabetes and Hypertension in Immigrant Populations

Project Summary/Abstract A cornerstone of Type 2 diabetes (DMII) care is the control of co-morbid cardiovascular disease (CVD) risk factors, including hypertension (HTN), to reduce morbidity and mortality. Yet only half of adults with diabetes achieve recommended blood pressure targets. These disparities are more pronounced in immigrant and minoritized groups that experience a disproportionate burden of CVD. South Asians (persons with ancestry from India, Bangladesh, Pakistan or other parts of the South Asian continent) represent one of the fastest -growing immigrant populations in the US and many of them experience high rates of poverty, limited English proficiency (LEP) and barriers to accessing healthcare that may contributeto their disproportionateburdenof DMII and HTN. Our work in NYC and Atlanta has demonstrated the efficacy and feasibility of linguistically and culturally tailored community health worker (CHW)-led telehealth programs to improve diabetes and co-morbid HTN management among South Asians with DMII. Our model offers opportunities to specifically inform diffusion of a telehealth intervention to the South Asian immigrant community, which has experienced growth in both large urban areas that may contain a wealth of culturally tailored resources, as well as in mid-sized/small cities and suburban areas where ethnic-specific resources may be sparse, creating the ideal context to evaluate the delivery of telehealth education centralized in urban hubs. The proposedproject will build on a well-established collaboration between researchers at the NYU School of Medicine, Emory School of Medicine, community-based primary care practices, and community partners across the northeastern and southeastern US to promote comorbid DMII and HTN management among South Asians. The overall goal of our type 1 hybrid trial is to test the effectiveness and implementation process of a culturally and contextually tailored telehealth -based CHW-led coaching intervention for HTN control among 450 South Asian patients with co-morbid DMII and HTN. The Specific Aims are to: 1. Using a randomized controlled trial design, test the effectiveness of a CHW-led telehealth intervention compared to usual care among individuals with DMII and uncontrolled HTN. The primary outcome is blood pressure control, defined as <130/80 mmHg. We hypothesize that 20% more patients in the intervention arm (relative to control) will achieve blood pressure control at 6 months. Secondary outcomes will include reduction in HbA1c and weight at 6 and 12 months, BP control at 12 months, enhanced use of community services, and increased self-efficacy; and 2. Using RE-AIM and CFIR frameworks, examine the reach, adoption, fidelity, and maintenance of the intervention within clinical and community settings, and delineate contextual factors influencing implementation outcomes. This study addresses the urgent need to test telehealth and CHW-led interventions to address CVD disparities in immigrant communities living outside of urban hubs. Our model offers a paradigm shift by addressing co-morbid HTN and DMII, and will foster dissemination of evidence-based interventions in settings that engage vulnerable populations with a high burden of chronic disease.