Report Sample on MANNA: Targeted Health Intervention for Hypertension

Introduction

This health intervention, titled MANNA, for hypertension, will focus on a select group of adults (age 18 and older) diagnosed with hypertension in Houston, Texas. The emphasis for this intervention will be upon African Americans located within the greater Houston (Harris County) area. According to recent data by the CDC, in 2017 in Harris County, TX, 30.8% of the population (age 18 and older) was diagnosed with hypertension (Centers for Disease Control and Prevention [CDC], 2020). African Americans make up 22% of the population in Houston. The approximate number of African Americans in the area in 2018 numbered 511,000 (usadata/io.com,n.d.). African Americans historically suffer health disparities that include access to preventative health, healthy food options and optimal healthcare services (Pullins et al., 2018, p.2538, paragraph 1.) Pullins and colleagues note that African Americans “experience disproportionately higher mortality rates from chronic diseases such as cardiovascular disease, stroke, diabetes and cancer as their life expectancy are four years less than White Americans” (2018, pg2534, paragraph 1).

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Intervention

The Manna project will institute a Healthy cooking class for adults (age 20 and older) with hypertension utilizing the Dietary Approaches to Stop Hypertension (DASH) dietary plan. Interactive teaching and demonstrations are reliable teaching methods. Jang and Beck (2018) cite research advocates for positive results that the design and delivery of communication messages should be tailored to populations socioeconomic status and health locus of control (HLC) for effective population health interventions. This intervention is culturally appropriate because food traditions among African Americans are an integral part of the culture, even to such a designated cuisine class known as “Soul Food”. With established dietary food history and inclusion in culture, a nutrition class to support healthy outcomes in hypertension is a potentially powerful mechanism in achieving better health outcomes for hypertension in this population.

Design

The intervention will encompass a nutritional cooking class offered once a week for three months along with self-monitoring of blood pressure for the duration of the project. Research participants will total in number from 10-12 individuals at a maximum considering occupancy regulations for the designated setting. The Centers for Disease Control and Prevention curriculum, “Developing Community Based Programs for People with Hypertension” will serve as the basis for the class structure (CD.gov, n.d.).

DASH Diet Rationale

Dietary modifications are proven to reduce blood pressure in hypertensive individuals, especially those on medications (Appel, 2017, page 198 para 5). The Dietary Approaches to Stop Hypertension is an evidence-based methodology to reduce blood pressure in hypertensive adults. Developed by the US Department of Health and Human Services in the early 1990s, the DASH diet has received scholarly accolades in the reduction of blood pressure through dietary changes (USDHHS, June 2020). The DASH diet is low in salt and rich legumes, whole grains, vegetables and fruits, low-fat dairy, and lean protein such as fish and other non-red meat sources of protein (USDHHS, JUNE 2020). It emphasizes the consumption of potassium-rich, fibre, magnesium and calcium-rich foods. Blood pressure reduction was shown in as little as two weeks in a randomized clinical study, according to Appel (2017, page 205, para 6). Even further positive outcomes were obtained in the clinical research by African Americans with more significant reductions in blood pressure against their white counterparts when eating a DASH diet (Appel, 2017, pg 206). The benefits mentioned above of the DASH diet in reducing hypertension validates this dietary plan as an effective means of helping African Americans with hypertension.

Class Structure

Classes will be held in a double-sided operating kitchen fully equipped with cooking items and five prep stations at Bibleway Fellowship Baptist Church. The kitchen is equipped to handle 14 people in the interior and at food preparation stations. The class will be 1 hour in length, comprised of a 15-minute interactive teaching lesson utilizing education material tailored to healthy food preparation and the DASH diet guidelines. The remainder of the class will be a hands-on cooking class by the participants. One of the objectives of the class is to prepare a healthy meal in less than an hour that will serve 1-4 family members. Participants will take home a DASH compliant, culturally sensitive prepared meal to their families each week.

Instructional culinary resources about the DASH diet will include the “Getting started with the DASH eating plan and the “The DASH eating plan as a part of a healthy lifestyle”. Both educational tools were developed by the National Heart, Lung and Blood Institute (n.d).

Blood Pressure Monitoring

An essential element of controlling hypertension involves frequent assessment of blood pressure. Blood pressure measurements will be taken at the start of the intervention by researchers. Participants will be taught how to monitor their blood pressure and record results on a standardized tool such as the Centers for Disease Control tool, “Self-measure blood pressure monitoring guide” for the duration of the intervention project. The participant will be instructed to measure their blood pressure at the same time daily and record immediately on the monitoring tool to help feasibility.

The US Department of Health and Human Services in partnership with local communities have created a program, “ 100 Congregations and Million Hearts” a subset of the “Community Partners and a Million Hearts” to combat cardiovascular disease in local communities. With an acute focus on reducing hypertensive rates across the country on a local level. This population health initiative from a federal level is realized within local communities to effect change. Creating partnerships within the community and collaborating with the organizational site is integral to the success of the partnership. According to Del Busto et al., forming partnerships with key stakeholders and establishing clear priorities by consensus is an essential step in community health projects (2019). Local ministry leaders, two grocery chains and one local gym within a 15-mile radius of the project site will be invited to a round table discussion by the research team. Bibleway Fellowship has already agreed to the following advertisement avenues, exposure to the “MANNA” project to be captured in the church twice a week during church service announcements. In addition, “MANNA” posters in the church facilities and internal media site will advertise project details. , Bibleway Fellowship Baptist Church will also disseminate flyers in their weekly food bank distribution for four weeks before the intervention start.

Disease-Specific Data

Hypertension or blood pressure measurements of 140/90 or higher are considered pathological. Normal blood pressure should be less than 120/80 mm Hg for an adult (Houstonstateofhealth.com (n.d.). Hypertension affects approximately 46% of the US population (Spikes et al., 2019).

African Americans (AA) makeup 13.4% (Census.gov) of the US population but carry 50% of the mortality burden for hypertension in comparison to Caucasians in the U.S (Musemwa&Gadegbeku, 2017). This significant health disparity for African Americans makes it a leading cardiovascular health concern.

It of note that women have the highest rate of burden at 46.3% as compared to AAA males at 45%. Both percentages exceed the rate of 32-33% range carried by their Caucasian counterparts (Spikes et al., 2019). Factors that account for the disease risk is multifactorial.Musemwa&Gadegbeku (2017) cite that hereditary influence, health beliefs, poor dietary intake, low physical activity, electrolyte sensitivity and high-stress socioeconomic environments are significant factors in hypertensive incidence in the Adult African American population. Complications resulting from hypertension as a chronic illness are worrisome in disease incidence as previously noted. These include heart disease, stroke, kidney disease, diabetes, decreased cognitive function, dementia (CDC.gov, n.d), their associated comorbidities and disease burden on population health.

Cultural Considerations

Traditionally, the influence of the black church in addressing the socio-cultural needs of the African American community is formidable. This influence extends to the healthcare services, education and promotion for its constituents (Pullins et al., 2018, 2539). Literature reviews on the subject of faith-based organizations and health promotions demonstrate a positive impact on preventative screening, health maintenance, health literacy and optimal health behaviours in the black community (Pullins et al., 2018, 2539).

As previously mentioned, numerous established studies correlate a positive relationship with religious participation and chronic health maintenance (Pullins et al., 2018, pg 2539). African Americans have the highest rate of attendance at houses of worship weekly far exceeding their other racial counterparts. The influence of the “Black Church” among its congregants is well established and continue to be a significant force in social, political, economic and health issues for African American communities (Pullins et al., 2018, pg 2539). The church serves as a voice of the African American community, and its members view the church as a protective mechanism in all realms of life. Therefore, utilizing a local faith-based organization to champion this initiative is culturally significant to achieve better outcomes for hypertensive health in this population.

In a study conducted by petty et al. 2016), cultural knowledge regarding the reason for hypertension and lifestyle changes to improvement was similar among participants. Researchers have posited that perceptions of HTN treatment adherence contribute to the poorer cardiovascular disease outcomes among AAs. According to Pettey et al. (2016 para 2 ). Many subjects knew that increased salt intake was detrimental to blood pressure. However, knowledge about how to mitigate salt intake was nominal at best. Participants cited many dietary home remedies passed down from elders in the family and religious affiliation as treatments for lowering blood pressure (Pettey et al., 2016 para 5). The latter giving even more credence to the power of religiosity in the African American community as a change agent for population health outcomes.

Conclusion

Understanding perceptions of how dietary changes to treat hypertension are foundational for creating optimal outcomes for population health in this community. Providing a culturally sensitive intervention such as a DASH nutritional class at a local faith-based organization has the potential to increase fitness for this at-risk population.