Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada

Gina Agarwal, Magali Girard, Ricardo Angeles, Melissa Pirrie, Marie-Thérèse Lussier, Francine Marzanek, Lisa Dolovich, J Michael Paterson, Lehana Thabane, Janusz Kaczorowski, Gina Agarwal, Magali Girard, Ricardo Angeles, Melissa Pirrie, Marie-Thérèse Lussier, Francine Marzanek, Lisa Dolovich, J Michael Paterson, Lehana Thabane, Janusz Kaczorowski

Abstract

Background: The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors' housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program.

Methods/design: This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50-200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience.

Discussion: It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing.

Trial registration: ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.

Keywords: Cardiometabolic risk factors; Diabetes; Hypertension; Older adults; Poverty; Social housing; Volunteer.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design flowchart
Fig. 2
Fig. 2
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) figure showing schedule of interventions and assessments. CHAP Cardiovascular Health Awareness Program, ED Emergency Department, CVD cardiovascular disease

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