Heart Matters: Collaborate and Leverage Evidence in an African American Rural Network to Implement Risk Reduction Strategies for CVD (Heart Matters: Co-Learn to Reduce CVD)

ABSTRACT Cardiovascular disease (CVD) exacts a disproportionate toll on rural African American communities in the Southeast. Implementing and scaling a proven-effective, evidence-based program (EBP) is essential to mitigate growing disparities in CVD risk among rural communities. We previously adapted PREMIER, an EBP, into Heart Matters and conducted a randomized controlled feasibility trial at seven host sites in two rural counties in eastern North Carolina (NC), largely populated with African Americans with high CVD burden. As with PREMIER, systolic blood pressure and self-reported physical activity and dietary behaviors significantly improved in the intervention arm compared to controls after 6 months. Heart Matters’ success, however, was dampened by critical implementation barriers at the organizational level, including limited readiness, partial collaboration between stakeholders, and low organizational efficacy to implement an EBP, which reduced fidelity and penetration of Heart Matters. To address implementation barriers, our research team will investigate the implementation and effectiveness of the Heart Matters EBP by scaling to five rural counties in Eastern NC. Guided by the Consolidated Framework for Implementation Research, our overall objective is to partner with organizations to scale and test Heart Matters implementation to other rural African American communities, and support translation of evidence to practice in eastern NC. In year 1, we will collaborate with our longstanding community-academic coalition to identify and recruit eligible organizations from our study setting (Edgecombe, Franklin, Nash, Vance, and Warren Counties). We will engage organizations (n=60) in formative research using concept mapping to identify and map contextual implementation factors affecting EBP implementation in rural African American communities. We will use these findings to refine existing training protocols and develop an organizational collaborative called “Collaborate and Leverage Evidence in an African American Rural Network” or Co-LEARN. In year 2, we will identify Co-LEARN sites (n=18) and employ participatory systems science methods to develop an implementation blueprint through: 1) shared learning aimed at training and capacity building and 2) shared action planning aimed at continuous quality improvement of implementation strategy at the site-level. The objective of Co-LEARN is to increase organizational readiness, strengthen network collaborations, and enhance organizational efficacy to implement a CVD EBP. In years 3-4, we will employ a hybrid type II implementation effectiveness design to conduct a cluster randomized controlled trial (n=486). We will evaluate outcomes of implementation (e.g., acceptability, adoption, penetration), CVD biomarkers (e.g., blood pressure, cholesterol, physical activity) and cost effectiveness of Heart Matters. Our long-term goal is to increase acceptability, adoption, and penetration of CVD EBPs in rural United States by building organizational readiness and capacities to implement sustainable and cost-effective EBPs to mitigate CVD disparities.