# Collaboration to Improve Blood Pressure in the US Black Belt- Addressing the Triple Threat

> **NIH NIH UH3** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2020 · $116,001

## Abstract

The central objective of this proposal is to rigorously compare two strategies designed to improve blood
pressure (BP) control in primary care practices serving rural Southeastern African Americans with low
socioeconomic status living in the “Black Belt”. The Black Belt is in the heart of the Stroke Belt, a geographic
area long recognized to have the highest cardiovascular disease mortality in the US. We draw on the growing
evidence that practice facilitation (PF), a highly customized, staged approach to helping practices to
implement process and structural changes, can enhance the quality of care and improve patient and staff
satisfaction, but there is less evidence on its ability to improve outcomes such as BP control. An alternate
approach to improving CVD risk factors that is more relationship-focused and with growing evidence of
effectiveness involves the use of peer coaches. We and others have shown that peer coaches are effective in
Black Belt communities, where mistrust of the healthcare system is common. Using well-established
community-based partnerships and the RE-AIM implementation framework, our UH2 Specific Aims are: 1.
Engage rural primary care practices, hypertension (HTN) patients, peer coaches, and Community Advisory
Boards in AL and NC to collaboratively finalize a PF intervention and a peer coaching intervention, both
designed to improve BP in African Americans. 2. Create the data systems for the trial. Our UH3 Specific Aims
are: 3. Enroll 80 practices and 25 African American patients with uncontrolled HTN at each practice (total
n=2000) in a cluster-randomized, controlled pragmatic implementation trial to compare the two multi-
component, multi-level interventions finalized in the UH2 phase with enhanced usual care using a 2 x 2
factorial design. We hypothesize that both interventions will improve BP more than enhanced usual care, and
that both interventions delivered together will result in greater improvements in BP than either intervention
alone. While we aim to control BP in 75% of participating intervention patients overall, the trial is designed to
detect >15% difference in BP control (primary outcome) between the combined intervention and the enhanced
usual care arms. Secondary outcomes will include group mean BP differences between baseline and follow-
up; quality of life; patient satisfaction; healthcare utilization; and provider and staff satisfaction. The study is
designed to examine differences by sex, age, depression, and health literacy/numeracy. Aim 4. Establish
scalability of the intervention throughout the entire Black Belt region using extensive process data intended to
facilitate future implementation, including practice characteristics, patient characteristics, intervention
implementation variables and fidelity measures, as well as focus groups and interviews with patients, peer
coaches, facilitators, practice staff, and clinicians. We have extensive experience with community-based peer
coaching interventi...

## Key facts

- **NIH application ID:** 10191671
- **Project number:** 3UH3HL130691-05S1
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Andrea L Cherrington
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $116,001
- **Award type:** 3
- **Project period:** 2020-08-31 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10191671

## Citation

> US National Institutes of Health, RePORTER application 10191671, Collaboration to Improve Blood Pressure in the US Black Belt- Addressing the Triple Threat (3UH3HL130691-05S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10191671. Licensed CC0.

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