The Health for Hearts United Collaborative

Program Director/Principal Investigator (Last, First, Middle): Ralston, Penny A.

The Health for Hearts United Collaborative Project Summary Cardiovascular disease (CVD) is the leading cause of death in the United States, and disproportionately affects African Americans (AAs) who have the highest rates for CVD-related morbidity and mortality in comparison to other ethnic/racial groups.

Risk factors for these high CVD rates are related to a variety of factors, including lifestyle. Church-based interventions have been shown to be effective in improving physical health outcomes of AAs.

However, a critical barrier to advancing the science of church-based health is understanding the most effective strategies and the extent to which evidence-based health programs can be implemented and maintained by churches themselves The Health for Hearts United Collaborative (HHUC), a community- academic partnership comprised of 45 churches in collaboration with a broader multi-county health coalition, was established after two successful intervention studies to reduce CVD risk in AAs in a two-county area of North Florida, using community-based participatory research approaches.

We now seek to use this collaborative environment to investigate implementation of this intervention by the churches themselves as we expand the HHUC.

Thus, the proposed project will determine the effectiveness of HHUC implementation strategies in relation to process outcomes and reducing CVD risk in AAs, guided by ecological theory, the Consolidated Framework for Implementation Research (CFIR), and the RE-AIM framework, and using a two- phase approach.

The HHUC model currently includes three components: governance structure, annual events, and basic support.

Based on observed successes in selected HHUC churches, we propose adding a fourth component that includes one of two possible implementation strategies: 1) an internal champions (IC)-driven strategy that includes two features (leadership development, culturally-tailored planning approaches) or 2) an external change agent (external professionals [EP])-driven strategy without these features.

In Phase 1, we will pilot and refine the IC and EP-driven implementation strategies using health leaders from four churches in the two-county area by determining feasibility and acceptability.

In Phase 2, we will use an effectiveness- implementation hybrid Type 3 design to evaluate the IC and EP implementation strategies in relation to process outcomes (reach, adoption, implementation and maintenance); and individual health behaviors (food choice, dietary quality, physical activity) and clinical outcomes (BMIs, girth circumferences, systolic and diastolic blood pressure), using congregants ((>18, n=225) in nine churches in the two-county area: three IC treatment, three EP treatment, and three comparison with delayed comparable activities.

The findings from this study will inform the expansion of the HHUC and the reduction of CVD risk in AAs, with implications for other communities and regions in the U.S. OMB No. 0925-0001/0002 (Rev. 03/2020 Approved Through 02/28/2023) Page Continuation Format Page