A Hybrid Implementation-Effectiveness Study of a Community Health Worker-Delivered Intervention to Reduce Cardiovascular Disease Risk in a Rural, Underserved Non-Hispanic Black Population: The CHANGE Study Public Deposited

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  • Samuel-Hodge, Carmen D.
    • ORCID: https://orcid.org/0000-0002-3700-7578
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
    • Other Affiliation: Center for Promotion and Disease Prevention, University of North Carolina at Chapel Hill
  • Gizlice, Ziya
    • Affiliation: UNC Center for Health Promotion and Disease Prevention
  • Allgood, Sallie D.
  • Bunton, Audrina J.
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Erskine, Amber
    • Affiliation: UNC Center for Health Promotion and Disease Prevention
  • Leeman, Jennifer
    • Affiliation: School of Nursing
  • Cykert, Samuel
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Purpose To evaluate the implementation and effectiveness of the Carolina Heart Alliance Networking for Greater Equity (CHANGE) Program, an adapted evidence-based cardiovascular disease risk reduction intervention delivered by Community Health Workers (CHW) to rural adults. Design Hybrid implementation-effectiveness study with a pre–post design. Setting North Carolina Federally Qualified Health Center and local health department in a rural, medically underserved area. Sample Participants (n = 255) included 87% Non-Hispanic Black with a mean age of 57 years; 84% had diagnosed hypertension, 55% had diabetes, and 65% had hypercholesterolemia. Intervention A CHW-delivered, low-intensity, 4-month behavioral lifestyle intervention promoting a southern-style Mediterranean dietary pattern and physical activity. Measures We measured number and representativeness of participants reached and retained, intervention delivery fidelity, weight, blood pressure, and self-reported dietary and physical activity behaviors. Analysis Pre–post changes at 4 months were analyzed using paired t-tests. Results Study participants completed 90% of planned intervention contacts; 87% were retained. Intervention delivery fidelity measures showed participants receiving a mean of 3.5 counseling visits, 2.7 booster calls, and on average completing 1.7 modules, setting 1.8 goals, and receiving 1.3 referrals per visit. There were significant mean reductions in systolic (−2.5 mmHg, P < .05) and diastolic blood pressure (−2.1 mmHg, P < .01); the proportion of participants with systolic blood pressure <130 increased by 7 % points (P = .05), and diastolic pressure <80 by 9 percentage points (P < .01). Dietary behaviors improved significantly with average weekly servings of nuts increased by .5 serving (P < .0001), and fruits and vegetables by .8 daily serving (P < .0001). Physical activity also increased on average by 45 min./week (P < .001). Weight did not change significantly. Conclusions The CHANGE program showed both implementation and program effectiveness and adds to the evidence supporting CHW-delivered lifestyle interventions to reduce CVD risk among rural, Non-Hispanic Black, and medically underserved populations.
Date of publication
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  • Article
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  • In Copyright
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  • SAGE Publications
  • Attribution 4.0 International
Journal title
  • American Journal of Health Promotion
Journal volume
  • 36
Journal issue
  • 6
Page start
  • 948
Page end
  • 958
  • Centers for Disease Control and Prevention
  • 0890-1171
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  • SAGE Publications

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