title: The Heart Healthy Lenoir project--an intervention to reduce disparities in hypertension control: study protocol.
abstract: BACKGROUND
  Racial disparities in blood pressure control are well established; however the impact of low health literacy (LHL) on blood pressure has garnered less attention. Office based interventions that are created with iterative patient, practice and community stakeholder input and are rolled out incrementally, may help address these disparities in hypertension control. This paper describes our study protocol.
  
  
  METHODS
  Using a community based participatory research (CBPR) approach, we designed and implemented a cohort study that includes both a practice level and patient level intervention to enhance the care and support of patients with hypertension in primary care practices in a rural region of eastern North Carolina. The study is divided into a formative phase and an ongoing 2.5 year implementation phase. Our main care enhancement activities include the integration of a community health coach, using home blood pressure monitoring in clinical decision making, standardizing care delivery processes, and working to improve medication adherence. Main outcomes include overall blood pressure change, the differential change in blood pressure by race (African American vs. White) and health literacy level (low vs. higher health literacy).
  
  
  CONCLUSIONS
  Using a community based participatory approach in primary care practice settings has helped to engage patients and practice staff and providers in the research effort and in making practice changes to support hypertension care. Practices have engaged at varying levels, but progress has been made in implementing and iteratively improving upon the interventions to date.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01425515.
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA. Jacqueline_halladay@med.unc.edu.
authors.forename: Jacquie R
authors.initials: JR
authors.lastname: Halladay
authors.forename: Katrina E
authors.initials: KE
authors.lastname: Donahue
authors.forename: Alan L
authors.initials: AL
authors.lastname: Hinderliter
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
authors.forename: Crystal W
authors.initials: CW
authors.lastname: Cene
authors.forename: Cassie L
authors.initials: CL
authors.lastname: Miller
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Garcia
authors.forename: Jim
authors.initials: J
authors.lastname: Tillman
authors.forename: Darren
authors.initials: D
authors.lastname: DeWalt
mesh_terms: D006801:Humans; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D055812:Community-Based Participatory Research; D037001:Directive Counseling; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006973:Hypertension / Q000628:therapy; D007407:Interviews as Topic; D055118:Medication Adherence; D009657:North Carolina / Q000453:epidemiology; D011320:Primary Health Care; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D064887:Observational Studies as Topic
chemical_list: D000959:Antihypertensive Agents