Church Wellness Coordinator–Led Intervention to Improve Hypertension Control in Communities

The prevalence of hypertension and related cardiovascular disease is higher in the residents of Louisiana, especially in Black populations, compared to the US general population. The overall objective of the proposed study is to test the effectiveness, implementation, and sustainability of a church wellness coordinator (CWC)–led multifaceted intervention, compared to enhanced usual care, for hypertension control in predominantly Black communities. A cluster randomized trial with an effectiveness-implementation hybrid design will be utilized to: 1. test the clinical effectiveness of the multifaceted implementation strategy on blood pressure (BP) control; 2. assess the implementation outcomes (acceptability, adoption, feasibility, fidelity, and cost-effectiveness) of the intervention; 3. study the sustainability of this multifaceted implementation strategy for clinical effectiveness and implementation outcomes in a post-intervention follow-up study; and 4. examine the communitywide impact of the intervention on mean BP and hypertension control. The Exploration, Preparation, Implementation, and Sustainment framework has been used to guide the development of the multifaceted implementation strategy. We have established a partnership with churches in predominantly Black neighborhoods and assessed the needs, barriers, and facilitators of hypertension control in community members, church leaders, CWCs, and healthcare providers. The intervention is developed using a community-based participatory research approach and is rooted in church-based wellness programs developed by and for church congregations. The evidence-based interventions include community-based BP screening, lifestyle modifications, and antihypertensive medication treatment. The CWCs are community health workers who will be trained on BP screening, hypertension care coordination, and health coaching. They will conduct community-based BP screening, coordinate care for patients with hypertension, assist patients with home BP monitoring, deliver discounted and free antihypertensive medications to patients, and conduct health coaching on lifestyle changes and medication adherence. Participation of faith-based organizations, Federally Qualified Health Centers and other primary care organizations, community pharmacies, and local health departments will strengthen this community intervention program. We will recruit 42 churches in predominantly Black communities in New Orleans and 28 eligible community members from each church. We will randomly assign 21 churches to the CWC-led multifaceted intervention and 21 to enhanced usual care. The multifaceted intervention program and enhanced usual care will last for 18 months. The primary clinical effectiveness outcome is the mean change of systolic BP from baseline to 18 months, and the primary implementation outcome is fidelity to the multifaceted intervention. The proposed cluster randomized trial has 90% statistical power to detect a group difference in mean systolic BP change of 5.8 mm Hg. This study will generate evidence on an effective, scalable, and sustainable strategy for hypertension control in communities.