Data Analysis Strategies for a Nurse Led Hypertension Initiative

DNP PROJECT : DATA COLLECTION AND ANALYSIS

Implementation Plan/Procedures

Phase 1: Program Development (Months 1-3)

· Conduct comprehensive literature review on evidence-based practices for culturally tailored hypertension self-management

· Collaborate with community stakeholders and minority health organizations to understand sociocultural determinants and barriers

· Design culturally relevant, linguistically appropriate education curriculum with interactive multimedia resources

· Recruit and train a diverse team of bilingual, culturally competent nurses and community health workers

Phase 2: Participant Recruitment (Month 4)

· Establish partnerships with community organizations, faith-based institutions, and healthcare providers serving minorities

· Conduct informational sessions to raise awareness about the program

· Screen and enroll 300-400 minority adults with hypertension residing in Tulsa

· Obtain informed consent and administer baseline assessments (blood pressure, SF-36 survey)

Phase 3: Program Implementation (Months 5-7)

· Week 1: Introduction to hypertension and importance of self-management

· Weeks 2-3: Skills training (BP monitoring, medication adherence, dietary education, cooking demos)

· Week 4: Physical activity promotion and goal-setting

· Week 5: Mid-program BP reassessment and progress evaluation

· Week 6: Motivational interviewing and behavior change techniques

· Week 7: Stress management and emotional well-being

· Weeks 8-9: Connecting with community resources, peer support groups

· Week 10: Post-intervention assessments, program evaluation

Phase 4: Data Analysis and Dissemination (Months 8-12)

· Analyze quantitative data (e.g., blood pressure, SF-36 scores)

· Conduct qualitative analysis of program feedback

· Prepare results for publication and conference presentations

· Develop plan for program refinement and broader dissemination

Project Management

· Biweekly team meetings to coordinate activities

· Ensure adherence to protocols and regulatory compliance

· Ongoing input from community advisory board

· Leverage nursing leadership and community health workers

Taken together, the above-described implementation plan will deliver a culturally tailored, multi-component intervention with a focus on skills building, behavior change, and community engagement that will help improve hypertension control and quality of life for minority populations in Tulsa.

Data Collection Procedures

This project will collect both quantitative and qualitative data to evaluate the effectiveness of the culturally tailored hypertension self-management education program for minority populations in Tulsa, Oklahoma.

Quantitative Data

The primary quantitative data collected will include blood pressure measurements (continuous data) and resting blood pressure readings which will be obtained at three time points: baseline, mid-point (6 weeks), and post-intervention (12 weeks). Measurements will be taken by trained research staff using validated automatic blood pressure monitors and standardized protocols. Three readings will be obtained at each session, with the average used for analysis.

36-Item Short Form Health Survey (SF-36) (Ordinal/Interval Data)

· The SF-36 is a widely used instrument to measure health-related quality of life across 8 domains

· Participants will complete the paper survey at baseline and post-intervention

· Responses are scored on a standardized scale from 0-100 for each domain

Demographic Data (Nominal/Ordinal Data)

Age, gender, race/ethnicity, education level, income, employment (collected at baseline); to control for potential confounding variables:

· Eligibility criteria will exclude those with severe comorbidities that could impact blood pressure

· Participants will be instructed not to start any new medications/treatments during the study

· Demographic factors like age and gender will be included as covariates in statistical analyses

Qualitative Data

· Brief semi-structured interviews/focus groups will be conducted with a subset of participants after program completion to obtain feedback on experiences, challenges, satisfaction, and recommendations for improvement.

· All interviews/focus groups will be audio-recorded and transcribed verbatim.

Planned Data Analysis

Quantitative:

· Descriptive statistics will be calculated for demographic and baseline clinical characteristics

· Change in blood pressure from baseline to post-intervention will be assessed using paired t-tests or non-parametric equivalents

· SF-36 scores will be analyzed using repeated measures ANOVA or non-parametric methods

· Multivariate regression models will evaluate the effect of the intervention on outcomes while controlling for demographic/clinical covariates

· Effect sizes will be calculated to determine the magnitude of impact

· An intention-to-treat analysis will be performed to account for participant attrition

Qualitative:

· Transcripts will undergo thematic analysis using established qualitative methods (e.g. coding, identifying themes)

· Findings will supplement quantitative results to provide deeper insights into participants\\\\\\\' experiences

The quantitative analyses will determine if statistically and clinically significant improvements in blood pressure control and health-related quality of life were achieved through the education program. The qualitative data will shed light on potential sociocultural factors, facilitators, and barriers influencing the program\\\\\\\'s impact.

Implementation Plan

Pre-Intervention (Months 1-4)

· Conduct literature review and gather community input to inform curriculum

· Design culturally-tailored educational materials and multimedia resources

· Recruit and train facilitators (nurses, community health workers)

· Establish community partnerships for recruitment

· Obtain IRB approval

Intervention (Months 5-7)

· Week 1: Participant recruitment, screening, enrollment, baseline data collection

· Weeks 2-10: Implement 10-week group education program

· Blood pressure reassessments (weeks 6, 12)

· Administer SF-36 survey (weeks 1, 12)

· Conduct post-intervention qualitative interviews/focus groups

Post-Intervention (Months 8-12)

· Data entry, coding, and analysis (quantitative/qualitative)

· Interpret findings, write reports/manuscripts

· Disseminate results through publications/presentations

· Develop plan for potential program scale-up and future research

In sum, rigorously collecting and analyzing quantitative clinical outcome data along with qualitative participant feedback can generate comprehensive evidence on the real-world effectiveness of a culturally-tailored self-management strategy to address hypertension disparities in minority communities.

Recruitment and Selection

Participants will be recruited from community organizations, faith-based institutions, and healthcare facilities serving minority populations in Tulsa through informational sessions and screening for eligibility (adults aged ?18 years, self-reported hypertension diagnosis, English/Spanish speaking, without severe cognitive impairment or end-stage disease). This quasi-experimental pretest-posttest design is appropriate to evaluate the effectiveness of the 10-week culturally-tailored hypertension self-management group education program delivered by nurses/community health workers. Formative evaluation will occur at the 6-week midpoint by reassessing blood pressure to allow for program adjustments. Summative evaluation will assess changes in blood pressure (e.g., primary outcome) and health-related quality of life using the SF-36 survey (e.g., secondary outcome) from baseline to post-intervention at 12 weeks. Qualitative interviews/focus groups will also be conducted after program completion to obtain feedback to inform future refinements and dissemination efforts.

Data Analysis Plan

This project intends to evaluate the effectiveness of the 10-week nurse-led group education intervention in improving blood pressure control and health-related quality of life among minority adults with hypertension, as specified in the PICOT question. Both quantitative and qualitative data will be analyzed as follows.

Quantitative Analysis

The two primary quantitative outcomes are:

1. Blood Pressure Control

· Blood pressure readings will be obtained at baseline, 6-week midpoint, and 12-week post-intervention

· Change in systolic and diastolic blood pressure from baseline to 12 weeks will be analyzed using paired t-tests or Wilcoxon signed-rank tests depending on normality of data

· Mixed regression models will evaluate the impact of the intervention on longitudinal BP trajectories while controlling for potential confounders (age, gender, baseline BP, etc.)

2. Health-Related Quality of Life

· Quality of life will be measured using the SF-36 survey at baseline and 12 weeks post-intervention

· Change scores will be calculated for each of the 8 SF-36 domains

· Repeated measures ANOVA or nonparametric methods will assess within-subject changes pre-to-post

· ANCOVA models will compare changes in domain scores between intervention and control groups, adjusting for covariates (Neuman, 2018).

Secondary analyses will explore differential effects by participant characteristics (e.g. race/ethnicity, age, gender) through subgroup analyses and interaction terms in regression models. In addition, all statistical analyses will use an intent-to-treat approach to account for participant attrition/missing data. Effect sizes will be calculated to determine the magnitude of impact. A p-value

Qualitative Analysis

A subset of participants will be interviewed individually or in focus groups after completing the program. These qualitative data will provide insights into participants\\\\\\\' experiences, challenges faced, satisfaction with the program, and recommendations for improvement. All interviews will be audio-recorded, transcribed verbatim, and analyzed using a step-wise thematic analysis:

· Data immersion by reading full transcripts

· Generating initial codes to capture key concepts

· Categorizing codes into overarching themes

· Reviewing and refining themes

· Defining and naming final themes

This qualitative analytical approach will identify common facilitators, barriers, and sociocultural factors influencing success of the program and the findings will be integrated with quantitative results.

Evaluation of Outcomes

The quantitative results will determine if the expected clinical (e.g., improved BP control) and patient-reported (e.g., enhanced quality of life) outcomes were achieved through this culturally-tailored intervention.

Criteria for determining the degree to which outcomes were met:

· Met: Statistically significant improvements in both BP and multiple SF-36 domains

· Partially Met: Significant improvement in BP or quality of life, but not both

· Not Met: No significant changes in either BP or quality of life measures

The qualitative data will provide deeper context around why outcomes were met, partially met, or not met, allowing for refinement of the program before broader dissemination. In sum, this comprehensive quantitative and qualitative analysis plan will provide a robust evaluation of the clinical effectiveness and participant experiences of this innovative self-management strategy for reducing hypertension disparities in minority communities.

Instrumentation

The 36-Item Short Form Health Survey (SF-36) will be utilized to assess participants\\\\\\\' health-related quality of life as a key outcome measure. The SF-36 is a widely-used, validated instrument consisting of 36 items that evaluate 8 domains: physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health perception. Respondents rate items on Likert scales and yes/no responses, with final scores ranging from 0-100 for each domain, where higher scores indicate better quality of life (Peek et al., 2014).