Insights for Community Health

Poor blood pressure (BP) control is a major contributor to the racial disparity in hypertension (HTN) among African American and black individuals. Improving BP control leads to significant cardiovascular risk reduction; however, evidence-based interventions targeting self-management behaviors are not widely disseminated to community-based settings. The challenge for local health departments is to redesign these evidence-based approaches to function sustainably at the level of resources and skills available in typical community-based organizations.

This study assessed the feasibility of implementing a personal health record (PHR) at three predominately black churches in New York City. The PHR was customized to enable lay health workers (LHWs) to track individual and aggregate changes in BP and health behaviors using a Congregational Dashboard among black congregants with HTN. The impact of the PHR system was then evaluated from baseline to 9 months.

The specific aims of this project were as follows:

• Assess the feasibility of implementing a customized PHR system to support a church-based BP monitoring program in two predominately black churches in New York City. 
• Evaluate the effect of implementing the PHR system on changes in systolic and diastolic BP from baseline to 9 months. 
• Evaluate the effect of implementing the PHR system on changes in daily servings of fruits and vegetables, level of physical activity, within-participant weight loss, and number of visits to a primary care physician from baseline to 9 months. 

LHWs were trained to facilitate recruitment, retention, and adoption of the PHR. A pre-post study design was used to track and compare individual and aggregate changes in BP and health behaviors before and after PHR implementation. Analysis of utilization data showed that participants had an average of 11 BP readings in the PHR over the 9-month study. Overall, there was a significant increase in fruit and vegetable intake, as well as in the mean number of physician visits. While change in BP was not significant for the total study sample, participants aged 65 years and older with greater than 10 BP readings exhibited a significant reduction in BP. Qualitative interviews showed that the dashboard was regarded as a valuable resource to the church and offered many advantages over the traditional paper-based record system.