Project Summary/Abstract
Despite highly effective pharmacologic and non-pharmacologic interventions to lower blood pressure, elevated
blood pressure remains the leading global risk factor for early mortality. In Tanzanian communities, 28% of
adults aged 35 and above have hypertension, yet only 2% are aware of their diagnosis and less than 1% are
on anti-hypertensive treatment. Our long-term goal is to improve hypertension-related health outcomes in
Tanzanian communities. The overall objective of this proposal is to adapt our established model of promoting
community health interventions in partnership with highly respected religious leaders in order to bridge gaps in
rural communities’ awareness, prevention, and control of high blood pressure. Our central hypothesis is that
empowering religious leaders to engage their communities about high blood pressure will improve health
behavior and reduce the average blood pressure among adults both with and without hypertension in the
community. The rationale for our proposal is that even small reductions in community-wide blood pressure can
sharply decrease the risk of premature cardiovascular death in that community. To test this hypothesis, we will
pursue three specific aims: 1) Adapt and pilot-test our prior Religious Engagement in Health Intervention to
address blood pressure in religious contexts; 2) Determine the effectiveness of this intervention on reducing
mean community systolic blood pressure in a cluster randomized trial; and 3) Assess reach, effectiveness,
adoption, implementation, and maintenance of this intervention for 24 months. In the first aim, we will use data
from previously conducted interviews with religious leaders and community members to adapt, refine, and
pilot-test our Religious Engagement in Health Intervention to address the problem of high blood pressure using
the sequential ADAPT-ITT model. In the second aim, we will conduct a hybrid type I effectiveness-
implementation cluster randomized trial to test the hypothesis that the intervention communities will achieve at
least a 3 mmHg greater reduction in mean community systolic blood pressure than control communities. In the
third aim, we will use convergent mixed methods guided by the RE-AIM framework to measure reach to
religious leaders and community members, effect on community blood pressure and linkage to care, adoption
by religious leaders, fidelity to the planned intervention, and maintenance of the benefit at 24 months. We will
refine the intervention for dissemination and implementation in partnership with biomedical and religious
leaders. The proposed research is innovative because it uses a novel approach to impact community health, it
offers contextual flexibility to be adapted by religious leaders or other trusted community messengers for their
own contexts, and it may be a creative way to engage men. The proposed research is significant because a
community systolic blood pressure reduction of 3 mmHg is estimated to decrease premature cardiovascular
mortality by 13% in that community. If successful, this approach could prevent many thousands of deaths in
Tanzania and could be adapted for use in U.S. communities in which hypertension outcomes are poor.