Intervention Enhancement Phase (Months 1-4)

Conceptually, we divided the CHW intervention into the following 2 phases: the enhancement phase, which consists of individualized health education, and the maintenance phase. The enhancement phase occurs during the first 4 months and includes home visits and phone calls. Although the number of home visits and phone calls is based on individualized decisions, as a rough, estimate we plan 5 home visits in this 4-month period and 2-3 phone calls per month. Although the length of calls is determined by CHW, it is expected that most calls would average under 15 minutes. In this phase, CHW helps the participant identify the issues that may affect his or her overall health and well-being. These can include direct influences, such as comorbid health conditions and behavioral risk factors, or more indirect influences, such as socioeconomic status and social context, poor health literacy, barriers in communication, and limited experience navigating the health care system. Once these barriers are identified, participants can then develop structured goals and methods for overcoming these obstacles in a manner that aligns with their needs and preferences.

CHW guides participants through this process by developing individualized health and well-being plans. This includes orienting participants on the principles of self-management and engaging them in a problem solving process that sets priorities for immediate problem resolution. To ensure that participants achieve their personal health goals regarding stroke risk and related risk factors, each CHW is tasked with a number of roles including, but not limited to, health and behavior counseling and coaching, medical service navigation (eg, scheduling appointments, sending reminders, providing guidance through the health system bureaucracy, etc), and social support (eg, identifying local social resources programs such as immigration services, tenant advocacy, and domestic violence programs). A major component of health education consists of blood pressure home self-monitoring. For participants who do not have a home blood pressure meter, CHWs help by providing one at no cost to them. However, data from these monitors will not be used for the outcome analyses. Those will be based on the blood pressure readings obtained during a structured assessment at 12 months, as described below.