Community health worker-led intervention helps South Asian Americans control BP
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In a cohort of South Asian Americans with uncontrolled BP, compared with the control group, those assigned to a community health worker-led intervention had greater odds of achieving BP control at 6 months, researchers reported.
“We had been working closely with South Asian community leaders for decades who noted high rates of CVD risk in the community, but lack of culturally tailored resources to address this burden,” Nadia Islam, PhD, associate professor in the department of population health and associate director at the Institute for Excellence in Health Equity at NYU Langone Health, told Healio. “Our early work had demonstrated the efficacy of community health worker (CHW)-led programs to improve health outcomes in diabetes. Nationally, the CDC had launched the Million Hearts campaign, which supported work with primary care practices to improve blood pressure control among patients by implementing team-based care models. Despite a large-scale campaign, many immigrant-serving practices were not fully engaged in the efforts. The IMPACT study represented our effort to integrate CHWs into South Asian-serving primary care practices to improve blood pressure control, in alignment with national efforts like Million Hearts.”
For the IMPACT trial, Islam and colleagues randomly assigned by clinic site 303 adults (mean age, 56.8 years; 54.1% women) of South Asian descent (Bangladesh, India, the Indo-Caribbean, Nepal, Pakistan or Sri Lanka) with uncontrolled BP (systolic BP 140 mm Hg, diastolic BP 90 mm Hg) from 14 PCPs in New York to a CHW-led intervention or the usual care.
Tailored intervention
The CHW-led intervention consisted of five monthly group health sessions promoting heart health and providing education on BP and CVD that were culturally and linguistically adapted to South Asian communities. The CHW followed up biweekly with each participant by phone or in-person to set goals and to discuss issues such as medication adherence, physical activity and nutrition. If necessary, referrals to programs on smoking cessation, exercise, mental health and other topics were made. The control group received the usual care and were able to participate in the intervention after the end of the study period.
The primary outcome was BP control, defined as systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg, at 6 months.
Improved odds of BP control
Islam and colleagues found that the primary outcome was achieved by 68.2% of participants in the intervention group and 41.6% of those in the control group (P < .001).
After adjustment for baseline systolic BP, sex, gender, PCP and days between BP measurements, the intervention group had more than threefold higher odds of having BP control compared with the control group (OR = 3.7; 95% CI, 2.1-6.5).
“We expected to see improvements in BP control, but were pleased to see the magnitude of results,” Islam told Healio. “Our positive results demonstrate that culturally tailored health education, integrated into primary care, improves health outcomes. The next steps are to create mechanisms to scale and sustain this model. We hope our results provide further evidence that CHW-based models are worth investing in to improve health equity.”
For more information:
Nadia Islam, PhD, can be reached at nadia.islam@nyulangone.org; Twitter: @nadiaislamnyc.
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