Research Project: Scaling Community-Clinical Linkage Models to Address Diabetes and Hypertension Disparities in the Southeastern U.S.

New York University School Of Medicine, New York NY

Investigators

Linked publications, trials & patents

Abstract

Project Summary/Abstract Hypertension (HTN) is an extremely common comorbid condition in Type II diabetes (diabetes), and uncontrolled HTN among individuals with diabetes significantly increases the risk of stroke. South Asian Americans have higher diabetes and HTN prevalence compared with non-Hispanic whites and other racial/ethnic minority groups. However, there are few culturally and linguistically adapted interventions for diabetes and HTN management for the South Asian population, many of whom experience high rates of limited English proficiency (LEP) and social disadvantage. Our previous work has demonstrated the acceptability and efficacy of a CHW-led diabetes management intervention in community settings to improve health behaviors, self-efficacy, and social support in South Asians, improvements in reduction of Hemoglobin A1c (HbA1c) and physician-led diabetes management indicators, and HTN control among individual with co-morbid hypertension and diabetes. We have further demonstrated improvements in HTN control through culturally tailored CHW interventions implemented in community and clinical settings. Scaling such programs, however, remains a challenge without appropriate attention to factors that impact replication across diverse geographic contexts and settings, adaptation of programs to the diversity across South Asian communities, and consideration of adoption and sustainability for community-clinical linkage models. The NYU Center for the Study of Asian American Health (CSAAH) is poised to build on its established scientific track on cardiovascular disease and diabetes, wide network of partners, and transdisciplinary expertise in community-engaged, intervention, and implementation science research to replicate and scale our previously tested, efficacious, and culturally tailored CHW interventions to address co-morbid HTN and diabetes management. We will build on our strong platform of national community partners and establish a formal partnership with Emory University School of Medicine to maximize our impact and reach across Southeastern US geographic regions with growing concentrations of South Asian populations. The overall goal of the supplemental award is to provide technical assistance, training and dissemination centered on cultural adaptation, implementation, and evaluation of evidence-based CHW-led HTN and diabetes management relevant to South Asian communities in the Southeastern US. The Specific Aims are to: 1) Provide research training, technical assistance, and capacity- building to community and clinical sites in Georgia for implementation of culturally tailored, evidenced-based CHW programs to improve HTN and diabetes management for South Asians living in the Southeastern US; 2) Utilizing a multi-theoretical framework, test the effectiveness of a CHW-led intervention compared to usual care among individuals with diabetes and uncontrolled HTN; and 3) Guided by RE-AIM and CFIR frameworks, delineate factors influencing appropriateness, fidelity, adoption, and maintenance of the intervention within clinical and community settings to optimize intervention replication and reduce chronic disease disparities.