Hermanas de Corazón: A Community Health Worker Initiative for improving Heart Health in Migrant Farmworker Women? - Cardiovascular disease (CVD) is the leading cause of death of U.S. women with CVD mortality is increasing in reproductive-age women. Rural, migrant farmworker women have high CVD risks and CVD morbidity and mortality during reproductive years and later in life. Social determinants of health (SDOH) are major drivers of health risks, health-related behaviors, and health outcomes across the lifespan. Migrant farmworker women have multiple adverse SDOH and unmet social needs, compounding their CVD risk and negatively affecting cardiovascular health (CVH). The long-term goal of this project is to mitigate adverse SDOH of rural, migrant farmworkers and to improve their CVH, thus decreasing their CVD morbidity and mortality. The objective of this proposal is to bring an evidence-based approach to promoting cardiometabolic health, i.e., peer support, combined with interventions to reduce unmet social needs and mitigate adverse SDOH in this high-risk population. The scientific premise of this proposal is that addressing SDOH-related needs is an essential component of a CVD reduction intervention to improve CVH outcomes in rural populations. The proposed work will leverage a 31-year-long community partnership, the Farm Worker Family Health Program in southwest Georgia, to evaluate effectiveness and implementation of a community health worker/promotora (CHW/P)-led peer support and community resource navigation intervention (Hermanas de Corazón), build CHW capacity, and strengthen partnerships among community stakeholders. The specific aims of this hybrid type-I effectiveness-implementation trial are to: 1) assess the effectiveness of the Hermanas de Corazón intervention in: a) decreasing stress, social isolation, and psychological distress and increasing perceived social support and access to SDOH-related resources, b) decreasing cardiometabolic risk factors in this population, quantified by the American Heart Association Life’s Essential 8; 2) examine potential mediation effects among these variables: and,3) evaluate barriers and facilitators to implementation and implementation outcomes. This innovative study includes SDOH assessment and intervention in a CVD prevention intervention, recognizes the high trauma exposure in this population, and incorporates trauma-informed care in the intervention. The proposed work is significant because it targets a population of women about which biomedical research has yielded little information and has significant health problems and adverse SDOH. The expected outcome is an understanding of the potential mediating effect of addressing unmet social needs and adverse SDOH to improve health. This work will have positive impact in that it will advance the science of effective interventions and test implementation approaches to address health risks in this rural, migrant farmworker population. Modified
