Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Erica Spatz

Second Advisor

Archana Shrestha

Abstract

Hypertension, or high blood pressure, is a common condition characterized by elevated blood pressure. It is a major risk factor for global cardiovascular disease-related illness and death [1]. Uncontrolled hypertension raises the risk of heart attack, heart failure, kidney disease, stroke, and cognitive decline [2-4]. Although routine blood pressure screening, patient education, and early linkage to care are proven strategies for detecting and managing hypertension, awareness, treatment, and control rates remain suboptimal in the United States and worldwide [5,6]. Community-based hypertension programs involving trained non-clinical personnel have shown effectiveness in increasing screening participation and improving blood pressure control, especially among underserved groups [7,8]. However, significant gaps remain in understanding how best to implement, sustain, and scale volunteer-driven screening efforts, as well as how volunteer skills and adherence to protocols affect program outcomes. Frameworks like the Consolidated Framework for Implementation Research (CFIR) provide a systematic way to identify multilevel barriers and enablers to implementation, including intervention features, organizational context, implementation procedures, and characteristics of the individuals involved [9]. Using the CFIR as a guide, this study will explore factors influencing the adoption, implementation, and long-term success of a community-based, volunteer-led hypertension screening and education program, focusing on aspects that promote consistent, high-quality service delivery across different community sites. Aim 1: Identify determinants of adoption, implementation, and sustainability of a community-based, volunteer-led hypertension screening program using the CFIR framework. Determinants will be assessed through site characterization and readiness evaluation at Boston, Massachusetts; Houston, Texas; New Haven, Connecticut; and Norfolk, Virginia. Following the identification of barriers, thematic analysis will be conducted to map findings onto the CFIR model. Assessing existing community resources at the four sites will inform the design of strategies to support hypertension management. Aim 2: Evaluate the effectiveness of trained community volunteers in conducting accurate blood pressure screenings and delivering education to improve hypertension awareness, treatment, and control. Blood pressure measurements will be compared with those obtained by a trained supervisor subsample, and volunteer skill competency will be assessed using a standardized competency form. Aim 3: Assess volunteer competency, protocol fidelity, and participant satisfaction. Periodic direct observations of volunteer-led screenings will be conducted, accompanied by assessments of volunteer competency and experience. Participant satisfaction and acceptability will also be evaluated. Finally, a cross-site synthesis and sustainability assessment will be performed.

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