ABSTRACT
Cardiovascular disease (CVD) exacts a disproportionate toll on rural African American communities in the
Southeast. Implementing and scaling a proven-effective, evidence-based program (EBP) is essential to
mitigate growing disparities in CVD risk among rural communities. We previously adapted PREMIER, an EBP,
into Heart Matters and conducted a randomized controlled feasibility trial at seven host sites in two rural
counties in eastern North Carolina (NC), largely populated with African Americans with high CVD burden. As
with PREMIER, systolic blood pressure and self-reported physical activity and dietary behaviors significantly
improved in the intervention arm compared to controls after 6 months. Heart Matters’ success, however, was
dampened by critical implementation barriers at the organizational level, including limited readiness, partial
collaboration between stakeholders, and low organizational efficacy to implement an EBP, which reduced
fidelity and penetration of Heart Matters. To address implementation barriers, our research team will
investigate the implementation and effectiveness of the Heart Matters EBP by scaling to five rural counties in
Eastern NC. Guided by the Consolidated Framework for Implementation Research, our overall objective is to
partner with organizations to scale and test Heart Matters implementation to other rural African American
communities, and support translation of evidence to practice in eastern NC. In year 1, we will collaborate with
our longstanding community-academic coalition to identify and recruit eligible organizations from our study
setting (Edgecombe, Franklin, Nash, Vance, and Warren Counties). We will engage organizations (n=60) in
formative research using concept mapping to identify and map contextual implementation factors affecting EBP
implementation in rural African American communities. We will use these findings to refine existing training
protocols and develop an organizational collaborative called “Collaborate and Leverage Evidence in an African
American Rural Network” or Co-LEARN. In year 2, we will identify Co-LEARN sites (n=18) and employ
participatory systems science methods to develop an implementation blueprint through: 1) shared learning
aimed at training and capacity building and 2) shared action planning aimed at continuous quality improvement
of implementation strategy at the site-level. The objective of Co-LEARN is to increase organizational
readiness, strengthen network collaborations, and enhance organizational efficacy to implement a CVD EBP.
In years 3-4, we will employ a hybrid type II implementation effectiveness design to conduct a cluster
randomized controlled trial (n=486). We will evaluate outcomes of implementation (e.g., acceptability, adoption,
penetration), CVD biomarkers (e.g., blood pressure, cholesterol, physical activity) and cost effectiveness of
Heart Matters. Our long-term goal is to increase acceptability, adoption, and penetration of CVD EBPs in rural
United States by building organizational readiness and capacities to implement sustainable and cost-effective
EBPs to mitigate CVD disparities.
