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.

Journal Article (Journal Article)


To evaluate the implementation and effectiveness of the Carolina Heart Alliance Networking for Greater Equity (CHANGE) Program, an adapted evidence-based cardiovascular disease risk reduction intervention delivered by Community Health Workers (CHW) to rural adults.


Hybrid implementation-effectiveness study with a pre-post design.


North Carolina Federally Qualified Health Center and local health department in a rural, medically underserved area.


Participants (n = 255) included 87% Non-Hispanic Black with a mean age of 57 years; 84% had diagnosed hypertension, 55% had diabetes, and 65% had hypercholesterolemia.


A CHW-delivered, low-intensity, 4-month behavioral lifestyle intervention promoting a southern-style Mediterranean dietary pattern and physical activity.


We measured number and representativeness of participants reached and retained, intervention delivery fidelity, weight, blood pressure, and self-reported dietary and physical activity behaviors.


Pre-post changes at 4 months were analyzed using paired t-tests.


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 (-2.5 mmHg, P < .05) and diastolic blood pressure (-2.1 mmHg, P < .01); the proportion of participants with systolic blood pressure <130 increased by 7 % points (P = .05), and diastolic pressure <80 by 9 percentage points (P < .01). Dietary behaviors improved significantly with average weekly servings of nuts increased by .5 serving (P < .0001), and fruits and vegetables by .8 daily serving (P < .0001). Physical activity also increased on average by 45 min./week (P < .001). Weight did not change significantly.


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.

Full Text

Duke Authors

Cited Authors

  • Samuel-Hodge, CD; Ziya Gizlice, ; Allgood, SD; Bunton, AJ; Erskine, A; Leeman, J; Cykert, S

Published Date

  • July 2022

Published In

Volume / Issue

  • 36 / 6

Start / End Page

  • 948 - 958

PubMed ID

  • 35422132

Pubmed Central ID

  • PMC9198395

Electronic International Standard Serial Number (EISSN)

  • 2168-6602

International Standard Serial Number (ISSN)

  • 0890-1171

Digital Object Identifier (DOI)

  • 10.1177/08901171221078272


  • eng