Lifestyle intervention delivered in churches by community-based health workers led to a significant reduction in blood pressure among African Americans compared to health education alone, according to a study led by researchers at NYU School of Medicine publishing online October 9 in the journal Circulation: Cardiovascular Quality and Outcomes.
Churches are an influential institution for health promotion in black communities. While some faith-based interventions have successfully increased cancer screening, lowered weight, and promoted better nutrition, the research team says that this study--commonly referred to as FAITH--is the first and largest community-based study that evaluates the effect of comprehensive lifestyle intervention on reducing blood pressure among African Americans in black churches.
"African Americans have a significantly greater burden of hypertension and heart disease, and our findings prove that people with uncontrolled hypertension can, indeed, better manage their blood pressure through programs administered in places of worship." said Gbenga Ogedegbe, MD, MPH, professor of Population Health and Medicine at NYU School of Medicine and the study's lead author. "Vulnerable populations often have lower access to primary care. We need to reduce racial disparities in hypertension-related outcomes between blacks and whites. Additionally, we hope clergy and church leaders will take note of our findings and replicate these interventions in their churches."
How the Study Was Constructed and Reviewed
Researchers collected data from 2010 to 2014 from 373 participants from 32 New York City churches who identified as black and had a self-reported diagnosis of hypertension and uncontrolled blood pressure. The research team then compared the effectiveness of a therapeutic lifestyle intervention plus motivational interviewing versus health education alone on blood pressure reduction among the participants. Results were analyzed after both six and nine months.
Participants in the intervention group received eleven 90-minute weekly group sessions that focused on healthy lifestyle behaviors, plus three motivational interviewing sessions delivered monthly by community health workers. The curriculum was uniquely tailored to church members by including prayer, scripture, and faith-based discussion related to health. Participants in the control group received one lifestyle session on hypertension management plus 10 informational sessions on health education topics that were led weekly by health experts.
Motivational interviewing -- the second aspect of the intervention -- enhanced an individual's desire and confidence to engage in a given behavior, which in this case was the adoption of healthy lifestyle behaviors. According to Ogedegbe, there is strong evidence that motivational interviewing is effective for African Americans -- and it was used to help the study participants sustain the behavior changes that they engaged in during their 12-week group sessions. During the individual counseling sessions, participants were able to continue to work through the barriers to change and develop personalized goals.
After six months, researchers saw a net reduction of 5.8 mm Hg in systolic blood pressure in the intervention group compared to the control group. However, although the intervention group had greater blood pressure control than the control group at nine months, the difference was not statistically significant.
Because the intervention was delivered by lay health advisors, it could not be determined whether issues of medication adherence were addressed during patient encounters in clinic. "Our results may have been even more effective if intervention had included community-clinic partnerships to provide more comprehensive, structured health management," says Ogedegbe. "We plan to address this in new research that introduces community health workers into a team-based model of care for African Americans with poorly controlled high blood pressure."
In addition to Dr. Ogedegbe, study co-authors include Dr. Antoinette Schoenthaler, Dr. Mark Butler, and Dr. Jessica Forsyth at the Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine; Dr. Kristie Lancaster, New York University; Dr. William Chaplin, St. John's University, Queens, New York.
The research was supported by the National Heart, Lung, and Blood Institute.