Browsing by Author "Richardson, Caroline R"
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- ItemImproving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial.(0000-00-00) Buis, Lorraine R; Dawood, Katee; Kadri, Reema; Dawood, Rachelle; Richardson, Caroline R; Djuric, Zora; Sen, Ananda; Plegue, Melissa; Hutton, David; Brody, Aaron; McNaughton, Candace D; Brook, Robert D; Levy, PhillipBACKGROUND African Americans shoulder significant disparities related to hypertension HTN which is a serious public health problem in the city of Detroit Michigan where more than 80 of the population is African American Connectivity through smartphones use of home blood pressure BP monitoring and newly developed mobile health mHealth interventions can facilitate behavioral changes and may improve long term self care for chronic conditions but implementation of a combined approach utilizing these methods has not been tested among African American patients with uncontrolled HTN Since African Americans are more likely than other racial or ethnic subgroups to utilize the emergency department ED for ambulatory care this presents an opportunity to intervene on a population that is otherwise difficult to reach OBJECTIVE The MI BP app aims to reduce health disparities related to HTN in the community by employing a user centered intervention focused on self BP monitoring physical activity reduced sodium intake and medication adherence We seek to test the efficacy of MI BP an mHealth app for HTN self management on BP control primary aim physical activity sodium intake and medication adherence secondary aim in African Americans with HTN This study also seeks to evaluate the cost effectiveness of MI BP when compared with usual care methods METHODS This is a 1 year randomized controlled trial that will recruit individuals who have uncontrolled HTN from 2 EDs in the city of Detroit with a planned sample size of 396 randomized participants To be eligible for inclusion potential participants must be African American 25 to 70 years old previously diagnosed with HTN have a smartphone compatible with MI BP and have uncontrolled BP at triage and on repeat measurement at least 1 hour post triage vitals Once a participant is deemed eligible all study procedures and subsequent follow up visits 8 in total are conducted at the Wayne State University Clinical Research Service Center We seek to determine the effect of MI BP on BP for 1 year using BP control and mean systolic BP as coprimary outcomes and physical activity sodium intake and medication adherence as secondary outcomes compared with usual care controls RESULTS Recruitment for this study began in January 2018 The study will continue through 2021 CONCLUSIONS As the first of its kind conducted in an ED setting MI BP was designed to document the efficacy and acceptability of a multicomponent mHealth approach to help African Americans with uncontrolled BP modify their lifestyle to better manage their HTN We expect to lay the foundation to sustainably reduce HTN related health disparities through better integration of multiple behavior self monitoring and improve outcomes for those who traditionally rely on the ED for chronic disease care TRIAL REGISTRATION ClinicalTrials gov NCT02360293 http clinicaltrials gov ct2 show NCT02360293 INTERNATIONAL REGISTERED REPORT IDENTIFIER IRRID RR1 10 2196 12601
- ItemThe Phased Implementation of a National Telehealth Weight Management Program for Veterans: Mixed-Methods Program Evaluation.(0000-00-00) Goodrich, David E; Lowery, Julie C; Burns, Jennifer A; Richardson, Caroline RBACKGROUND The burden of obesity is high among US veterans yet many face barriers to engaging in in person facility based treatment programs To improve access to weight management services the Veterans Health Administration VHA developed TeleMOVE a home based 82 day curriculum that utilizes in home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility based services OBJECTIVE The primary aim was to establish preliminary evidence for the program by comparing outcomes for TeleMOVE with standard facility based MOVE weight management services group individual modalities over the evaluation period based on the number of patients enrolled per site and the program s clinical effectiveness as demonstrated by average weight lost per patient The secondary aim was to understand factors influencing TeleMOVE implementation variability across demonstration sites to develop recommendations to improve national program dissemination METHODS We employed a formative mixed methods design to evaluate the phased implementation of TeleMOVE at 9 demonstration sites and compare patient and site level measures of program uptake Data were collected between October 1 2009 and September 30 2011 Patient level program outcomes were extracted from VHA patient care databases to evaluate program enrollment rates and clinical outcomes To assess preliminary clinical effectiveness weight loss outcomes for veterans who enrolled in TeleMOVE were compared with outcomes for veterans enrolled in standard MOVE at each demonstration site as well as with national averages during the first 2 years of program implementation For the secondary aim we invited program stakeholders to participate in 2 rounds of semistructured interviews about aspects of TeleMOVE implementation processes site level contextual factors and program delivery Twenty eight stakeholders participated in audio recorded interviews RESULTS Although stakeholders at 3 sites declined to be interviewed objective program uptake was high at 2 sites delayed high at 2 sites and low at 5 sites At 6 months post enrollment the mean weight loss was comparable for TeleMOVE n 417 and MOVE n 1543 participants at 5 2 lb SD 14 4 and 5 1 lb SD 12 2 respectively P 91 All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE due to logistical and technical assistance issues related to the devices High uptake sites overcame implementation challenges by leveraging communication networks with stakeholders adapting the program to patient needs whenever possible setting programmatic goals and monitoring feedback of results and taking time to reflect and evaluate on delivery to foster incremental delivery improvements whereas low uptake sites reported less leadership support and effective communication among stakeholders CONCLUSIONS This implementation evaluation of a clinical telehealth program demonstrated the value of partnership based research in which researchers not only provided operational leaders with feedback regarding the effectiveness of a new program but also relevant feedback into contextual factors related to program implementation to enable adaptations for national deployment efforts