Partners for Native Health, Washington State University, Spokane, WA
Centers for American Indian and Alaska native Health, University of Colorado, Anschutz Medical Campus, Aurora, CO
American Indians and Alaska Natives (AI/ANs) and Native Hawaiians and Pacific Islanders (NHPIs) are the smallest and second-smallest US racial groups, with populations of 1.2 and 5.2 million, respectively. These groups experience harsh disparities in health and mortality compared to US Whites. Concerning are their population prevalence of hypertension, cardiovascular disease (CVD), and stroke, which are as high as, and usually higher than, US Whites. Despite these serious public health inequities, both groups have been largely neglected by health research. A literature search for interventions targeting blood pressure (BP) control as a contributor to CVD and stroke in AIs, ANs, and NHPIs returned no results. No interventions−and thus no multilevel intervention studies−have ever focused on BP control in these populations.
With funding through the National Institutes of Health (U54), the Native-Controlling Hypertension And Risks through Technology (NCHART) is a nationwide network of 7 satellite centers whose overarching objective is to improve control of blood pressure and associated cardiovascular disease and stroke risk factors among American Indians (AIs), Alaska Natives (ANs), and Native Hawaiians and Pacific Islanders (NHPIs). NCHART’s goal is to move research on BP control and CVD and stroke risk factors in these communities beyond its current, largely descriptive state, and translate that knowledge into meaningful action.
NCHART has three specific aims:
- Expand and establish new collaborations with research partners across private, tribal, and public constituencies that address BP control within a multilevel intervention framework
- Develop a multilevel, multisector infrastructure that ensures inclusion of local, regional, and national views on research priorities and approaches to controlling blood pressure
- Promote a scientifically rigorous, culturally informed program of inquiry that acquires new knowledge to implement innovative approaches to increase hypertension knowledge and awareness, activate patients, increase medication adherence, and improve BP control among AIs, ANs, and NHPIs
NCHART includes three research projects, which feature interventions at the individual, family, community, and policy levels.
- Chickasaw Healthy Eating Environments in Retail Stores (CHEERS) study. This multilevel intervention spans 24 months in partnership with the first full-service, Chickasaw-owned supermarket and will collect data on the availability, price, and shelf space devoted to healthy and less healthy options in existing local retail outlets at baseline (before the intervention) and again at 12 and 24 months. It measures change in blood pressure and secondary outcomes among hypertensive community members at baseline and again at 12 and 24 months. Finally, the study will create a documentary on the implications of the study for the local community and will evaluate the documentary’s effect on tribal leaders’ readiness to implement CHEERS across the Chickasaw Nation and other tribal communities.
- Blood Pressure: Improving Control among Alaska Native People (BP-ICAN). This multilevel prevention trial targets BP control among ANs diagnosed with hypertension. In partnership with Southcentral Foundation, participants with a systolic BP ≥ 140 mmHg at 2 or more visits in the prior 18 months will be randomly chosen for the intervention and will receive equipment and training for home BP measurements (HBPM) to self-manage hypertension. This study examines BP-ICAN’s impact on within-person change in systolic BP and secondary outcomes from baseline to 12 months. It will quantify impact on prescribing behaviors in response to participant-initiated reports or system-triggered alerts of uncontrolled BP and will evaluate overall impact on BP control among all hypertensive patients regardless of enrollment into the individual-level intervention.
- Engaging NHPIs and Activating Communities to Take Steps (ENACTS). This multilevel 6-month intervention uses peer-facilitated, self-care BP education delivered weekly for 8 weeks that emphasizes, healthy diet, traditional NHPI foods, adherence to medication, and encouragement to increase physical activity and stop smoking, using text messaging to boost adherence. The study randomizes NHPI adults with hypertension and elevated BP to either ENACTS or usual care. Both groups will receive general health education brochures and a $30 weekly credit for grocery shopping. It compares within-person change in BP and secondary outcomes between the intervention and control groups. The study evaluates ENACTS’ effects on BP and secondary outcomes as within-person change in family members. It also evaluates the intervention’s ability to influence grocery store policy on clearly identifying foods that are low in sodium or high in potassium.