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 and CVD mortality is increasing in reproductive-age women. Rural, farmworker women have high CVD risks and CVD morbidity and mortality during reproductive years and later in life. Non-biological drivers of health (NBDOH), including access to healthcare and supportive services, nutrition, housing stability, transportation, chronic stress, and social support, are major contributors to health risks, health-related behaviors, and health outcomes across the lifespan. Farmworker women have multiple adverse NBDOH and unmet social needs, compounding their CVD risk and negatively affecting their cardiovascular health (CVH). The long-term goal of this project is to mitigate adverse NBDOH of rural, 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 combined with interventions to reduce unmet social needs and mitigate adverse NBDOH in this high-risk population. The scientific premise of this proposal is that addressing NBDOH-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-led peer support and community resource navigation intervention , build CHW capacity, and strengthen partnerships among community stakeholders. The specific aims of this hybrid type-I effectiveness-implementation trial are:1) assess the effectiveness of this CHW-led intervention in: a) decreasing stress, social isolation, and psychological distress and increasing perceived social support and access to community-based resources and b.) decreasing cardiometabolic risk factors in this population determined by the American Heart Association Life’s Essential 8; 2) examine potential mediation effects among these variables: and,3) evaluate implementation outcomes of the intervention and barriers and facilitators to implementation. This innovative study includes a NBDOH assessment of social needs (e.g., housing, food, utility, transportation, interpersonal safety, literacy), social support, social isolation, and access to healthcare and supportive services; and intervention in a CVD prevention intervention, recognizes the high occupational stress exposure in this population and incorporates patient-centered 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 that has significant health problems and adverse NBDOH. The expected outcome is an understanding of the potential mediating effect of addressing unmet social needs and adverse NBDOH 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, farmworker population.
