Project Summary Midlife Black women (ages 45-64) have a 69% greater risk of suffering a cardiovascular disease (CVD) related mortality compared to White women. Among midlife Black women who suffer a myocardial infarction, 10% will die within one year compared to only 5% of White women. Tailored interventions are recommended to address the stark disparities experienced by midlife Black women. Chronic stress, in particular daily life stress, contributes to the development of CVD and can impede adoption of healthy lifestyle behaviors associated with optimal cardiovascular health. Midlife Black women experience multiple competing stressors and have been identified as an at-risk group for chronic disease and poor health outcomes. The Midlife Black Women’s Stress and Wellness intervention (B-SWELL) is a culturally tailored, community-based intervention designed to lower stress and increase CVD risk awareness and the adoption of healthy lifestyle behaviors. The B-SWELL was deemed feasible in a virtual trial with low attrition and high satisfaction. Outcome trends for B-SWELL participants were positive but regressed 4 weeks post intervention, suggesting a need for modification. The purpose of this study is to modify the B-SWELL and increase individualization prior to conducting a randomized control pilot trial (RCT). Modifications will include 1) the addition of 1:1 coaching during the 8-week intervention and coaching booster sessions at 10- and 14-weeks post intervention for B-SWELL participants, 2) offering choice in the mode of delivery (virtual or in person) and receipt (paper binder, tablet, or USB), 3) use of community facilitators, and 4) development of a training plan for community facilitators. The literature suggests that individualization is key to reach at-risk populations, such as midlife Black women, and impact the existing health disparities. Individualization requires insight and knowledge of the needs, beliefs, and experiences of the targeted population. Community participatory methods were used at each stage of the B-SWELL development, giving voice to midlife Black women. The proposed RCT will randomize 64 midlife Black women to either the B-SWELL (n=32) or an attention control (n=32) group. We hypothesize that the modified B- SWELL participants will have greater self-efficacy, lower perceived stress, higher scores for cardiovascular health (as measured by the American Heart Association’s Life’s Essential 8 metrics), and sustained outcome trends compared to control. We expect the modifications will increase sustainability of the B-SWELL by strengthening ties with the community and minimizing the impact of social determinants of health through choice, allowing participants to select the mode of delivery and receipt that best fits their needs. Our immediate goal is to optimize delivery of the B-SWELL and assess the preferences of midlife Black women, thus increasing our knowledge about tailoring and targeting future interventions or aw...