Abstract
Introduction
Hypertension remains a leading cause of cardiovascular disease and disproportionately affects Black adults in the United States. In Portsmouth, Virginia, the rates of hypertension and associated morbidity exceed the state average, underscoring the need for equity-focused, community-based interventions. This study evaluates the implementation, reach, early outcomes, and equity impact of the Healthy Portsmouth Million Hearts Initiative.
Methods
We conducted a mixed-methods quality improvement and implementation evaluation using blood pressure (BP) screening data and resident and stakeholder questionnaires collected through Research Electronic Data Capture (REDCap). The analytical sample included 125 Portsmouth residents who completed the resident questionnaire. Quantitative analyses included descriptive statistics and exploratory geographic analyses by ZIP code. Qualitative responses were analyzed using thematic analysis. The study was guided by Ecosocial Theory and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
Results
The program reached a high-risk population, with 81.6% identifying as Black and 89.6% classified as having elevated, stage 1, or stage 2 hypertension. Of the participants who completed the resident questionnaire, 79.2% reported improved understanding of BP, 67.2% reported motivation to engage with a healthcare provider, and 51.2% reported that screening supported their ability to manage BP. Self-reported behavioral changes included increased confidence in managing BP (85.6%) and healthier eating behaviors (80.0%). Post-screening follow-up data showed that 29.1% of those with valid contact information completed follow-up engagement. Geographic analysis identified significant variation in structural barriers across ZIP codes. Participants in ZIP code 23704 were more likely to face at least one structural barrier and transportation issues compared with participants from other ZIP codes. Qualitative findings identified persistent structural barriers, including food access, transportation, and financial constraints, as well as implementation challenges in staffing capacity, resource availability, and partner organizations.
Conclusion
Community-based BP screening programs can effectively improve awareness, knowledge, and self-reported behavior among high-risk groups. However, maintaining long-term engagement after screening is shaped by structural and place-based barriers. Improving coordinated post-screening engagement strategies, expanding access to community resources, and using ZIP code-level barrier data to guide resource alignment may improve the initiative’s equity impact and help reduce hypertension-related disparities in Portsmouth and similar communities.