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American Heart Association

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Final ID: HUP9

Framing a Complex Multilevel Blood Pressure Intervention after Stroke or Myocardial Infarction

Abstract Body: Background:
Blood pressure (BP) management is crucial for secondary prevention of stroke and myocardial infarction (MI); however, optimal BP control remains a challenge, particularly among historically disenfranchised populations. Effective interventions must address both medical and social determinants of health. BP-REACH (Blood Pressure disparities Reduction, Equity, and Access among safety net patients with Cardiovascular Health risk) is an RCT of a complex, individualized, multilevel team-based intervention to improve BP control after stroke or MI in a safety net public healthcare system. Pharmacists prescribe and titrate medications while community health worker (CHW) health coaches use motivational interviewing to collaboratively discern and address barriers with participants. Since the intervention is complex and individualized, it is crucial to frame it in a way that fidelity and tailoring can be assessed.

Methods:
We used a form and function method which has been used to frame other complex multilevel interventions. We identified key domains (overall goals of intervention), motivating needs (importance of targeting each domain), functions (methods for addressing motivating needs), and forms (tools, resources, methods for accomplishing each function).

Results:
Core functions included patient education and health literacy; ensuring evidence-based prescribing and titration of medications; exploring and addressing barriers to medication adherence and lifestyle change; enhancing digital health literacy; improving care coordination, and optimizing self-management skills. Forms included pharmacist management of BP medications; CHW health coaching calls; motivational interviewing; resource navigation; culturally tailored educational handouts and videos; self-management tools and coaching; and patient narrative videos. Figures 1-3 depict examples of domains, motivating needs, core functions, and their menus of forms.


Conclusion:
A form and function model is a useful tool to describe, analyze, and interpret complex interventions. Once the study is complete, the coaches and participants will be surveyed to determine the fidelity to functions and the adaptations and tailoring of forms in order to determine which were the most useful. This will be helpful for dissemination.
  • Scott, Lisa  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Mittman, Brian  ( Kaiser Permanente Southern Californ , Pasadena , California , United States )
  • Towfighi, Amytis  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Akhavan, Setareh  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Ayala-rivera, Monica  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Casillas, Alejandra  ( UCLA , Los Angeles , California , United States )
  • Morales, Maria G  ( UCLA , Los Angeles , California , United States )
  • Ruiz, Dania  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Ow, Garrett  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Chen, Steven  ( USC SCHOOL OF PHARMACY , Los Angeles , California , United States )
  • Lian, Kendra  ( Los Angeles General Hospital , Los Angeles , California , United States )
  • Author Disclosures:
    Lisa Scott: DO NOT have relevant financial relationships | Brian Mittman: No Answer | Amytis Towfighi: DO NOT have relevant financial relationships | Setareh Akhavan: DO NOT have relevant financial relationships | Monica Ayala-Rivera: No Answer | Alejandra Casillas: No Answer | Maria G Morales: DO NOT have relevant financial relationships | Dania Ruiz: No Answer | GARRETT Ow: DO NOT have relevant financial relationships | Steven Chen: DO have relevant financial relationships ; Speaker:Otsuka Pharmaceuticals:Active (exists now) | Kendra Lian: No Answer
Meeting Info:
Session Info:

HEADS-UP: Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving

Tuesday, 02/04/2025 , 08:30AM - 05:45PM

Pre-Con Symposium – HEADS-UP

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