{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:24:11Z","timestamp":1790814251376,"version":"4.1.0"},"reference-count":44,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U48\/DP0051017"],"award-info":[{"award-number":["U48\/DP0051017"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Health Promot"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the implementation and effectiveness of the Carolina Heart Alliance Networking for Greater Equity\u00a0(CHANGE) Program, an adapted evidence-based cardiovascular disease risk reduction intervention delivered by Community Health Workers (CHW) to rural adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Hybrid implementation-effectiveness study with a pre\u2013post design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>North Carolina Federally Qualified Health Center and local health department in a rural, medically underserved area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sample<\/jats:title>\n                    <jats:p>Participants (n = 255) included 87% Non-Hispanic Black with a mean age of 57\u00a0years; 84% had diagnosed hypertension, 55% had diabetes, and 65% had hypercholesterolemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>A CHW-delivered, low-intensity, 4-month behavioral lifestyle intervention promoting a southern-style Mediterranean dietary pattern and physical activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>We measured number and representativeness of participants reached and retained, intervention delivery fidelity, weight, blood pressure, and self-reported dietary and physical activity behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Analysis<\/jats:title>\n                    <jats:p>Pre\u2013post changes at 4\u00a0months were analyzed using paired t-tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Study participants completed 90% of planned intervention contacts; 87% were retained. Intervention delivery fidelity measures showed participants receiving a mean of 3.5 counseling visits, 2.7 booster calls, and on average completing 1.7 modules, setting 1.8 goals, and receiving 1.3 referrals per visit. There were significant mean reductions in systolic (\u22122.5\u00a0mmHg, P &lt; .05) and diastolic blood pressure (\u22122.1\u00a0mmHg, P &lt; .01); the proportion of participants with systolic blood pressure &lt;130 increased by 7 % points (P = .05), and diastolic pressure &lt;80 by 9 percentage points (P &lt; .01). Dietary behaviors improved significantly with average weekly servings of nuts increased by .5 serving (P &lt; .0001), and fruits and vegetables by .8 daily serving (P &lt; .0001). Physical activity also increased on average by 45\u00a0min.\/week (P &lt; .001). Weight did not change significantly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CHANGE program showed both implementation and program effectiveness and adds to the evidence supporting CHW-delivered lifestyle interventions to reduce CVD risk among rural, Non-Hispanic Black, and medically underserved populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08901171221078272","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T01:54:45Z","timestamp":1649987685000},"page":"948-958","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["A Hybrid Implementation-Effectiveness Study of a Community Health Worker-Delivered Intervention to Reduce Cardiovascular Disease Risk in a Rural, Underserved Non-Hispanic Black Population: The CHANGE Study"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3700-7578","authenticated-orcid":false,"given":"Carmen D.","family":"Samuel-Hodge","sequence":"first","affiliation":[{"name":"Gillings School of Global Public Health, Department of Nutrition, Center for Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"},{"name":"Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Ziya Gizlice","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-4572","authenticated-orcid":false,"given":"Sallie D.","family":"Allgood","sequence":"additional","affiliation":[{"name":"School of Nursing, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrina J.","family":"Bunton","sequence":"additional","affiliation":[{"name":"Cecil G Sheps Center for Health Services Research, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Erskine","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Leeman","sequence":"additional","affiliation":[{"name":"School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Cykert","sequence":"additional","affiliation":[{"name":"School of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,4,14]]},"reference":[{"key":"bibr1-08901171221078272","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0158"},{"key":"bibr2-08901171221078272","unstructured":"Centers for Disease Control and Prevention (CDC). 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