How Does the Organization of Community-Based Networks Foster Screening, Prevention and Management of Blood Pressure?


Principal investigators:

Dolovich, Lisa and McDonough, Beatrice (McMaster University)


Agarwal, Gina (McMaster University); Chambers, Larry (Elisabeth Bruyère Research Institute); Liddy, Clare (Elisabeth Bruyère Research Institute).
High blood pressure (BP) is one of the most ready preventable causes of cardiovascular disease (CVD) and stroke. Successful stroke prevention activities will not only increase control of high BP but also other major chronic diseases with shared risk factors, such as diabetes, coronary artery disease and dementia. Once diagnosed, management of hypertension requires ongoing monitoring and activities. Community-level interventions to improve cardiovascular health have shown positive results. 
In order to make improvements in CVD within the community population, entire communities need to be engaged in achieving program goals. Population-wide behavioural strategies are shown to complement clinical strategies to reduce the burden of disease. Community resources such as volunteers, community health nurses and local organizations are locally available but largely underutilized to support health promotion and primary prevention (HPPP) in Canada. Community empowerment can lead to improvement in health outcomes of community residents.
Since 2000, the Cardiovascular Health Awareness Program (CHAP) Working Group has developed and refined CHAP, a community-led program that unites primary care, pharmacy practice, community resources and senior volunteers in stroke/CVD prevention to high risk populations. In 2006, as part of a randomized trial in medium-sized communities across Ontario, 20 communities delivered CHAP to 15,889 participants in the intervention arm. These communities are the focus of the proposed study.
Our project seeks to add to this body of evidence through application of the Butterfoss and Kegler (2002) Community Coalition Action Theory (CCAT), to CHAP communities. In the CCAT model, coalitions progress through stages from formation to maintenance to institutionalization in an iterative feedback loop. This study will explore factors related to collaborative partnerships and networks including the networks that have developed within communities that support the maximum uptake of best practices in HPPP within the scope of the CHAP. By implementing interventions at multiple levels (both individual and community), coalitions are able to create change in communities that can reduce risk factors and increase preventive factors. 
The primary research question proposed is: how are the three stages of coalition development (formative, maintenance, and institutionalization) associated with changes over time in individual health, population health and system-level outcomes within CHAP communities? 
A modified time series analysis over three years incorporating agency and participant surveys will be collected from ten CHAP communities. The study integrates many sources of data already being collected within CHAP with new data that will improve understanding of community development over time. Data collected yearly (or more frequently) from eight data collection tools, administrative data as well as an environmental scan will capture the relationships between the independent variables of coalition stages and environmental context and the dependent variables of individual patient outcomes of changes in blood pressure, actions taken as a result of CHAP, and community population data on morbidity and mortality data (from hospitalization administration data for acute myocardial infarction, unstable angina, coronary artery bypass graft and stroke and mortality) as well as community change/system outcomes to identify the presence of at least 1 community-wide policy, ongoing program, or practice to improve cardiovascular health.
Because the community context is so variable reflecting the social and economic climate, 3 years are required to adequately reflect any changes over time that could impact the coalition effectiveness. The information gleaned will be important for funders such as the Local Health Integration Networks, will provide support for public health engagement into knowledge translation and dissemination and will provide a template for further community participatory research approaches to chronic disease management and prevention.