Activate Tennessee: A CHW-Supported Program for Patient Activation

NCT07279415 | Not Yet Recruiting

• 2 other identifiers: TR72217X5599OT2HL158287
• Study Type: interventional
• Target: 300
• Locations: 0 countries
• Sites: N/A

Brief Summary

The research project will involve community health workers (CHWs) that will help participants to better understand their medical conditions and to responsibly manage their medical needs. The project will focus on participants with the greatest medical needs and those that have many different illnesses at the same time. CHWs will help guide participants in focusing on improving their knowledge and confidence to manage their health conditions and to improve their ability to understand how the healthcare system works. This will give participants the opportunity to take charge of their illnesses and possibly improve their health conditions over time. The CHWs will work together with participants to develop a health plan focused on their specific health needs.

Conditions

Diabetes; Hypertension; Cardio Vascular Disease; Infectious Diseases Morbidity; Chronic Kidney Disease; Hypercholesterolemia

Keywords

community health worker, co-morbidities

Outcome Measures

Primary Outcomes (1)

• Patient Activation Measure

  Scored from 0 to 100 with higher scores denoting higher levels of patient activation, it measures participant knowledge, skills, and confidence to manage their own health and healthcare, navigate the healthcare system, and address social barriers that create challenges in their ability to achieve optimal health.

  From enrollment to end of 9 months

Study Arms (2)

Community Health Worker Support - Pre-scheduled sessions

ACTIVE COMPARATOR

Behavioral: Intervention

Community Health Worker Support - Participant-requested sessions

ACTIVE COMPARATOR

Behavioral: Control Group

Interventions

Control Group BEHAVIORAL

Persons in the comparator group will receive support to complete an IHAP and access to an interactive community resource website. CHWs will remain available to comparator group participants in response to communicated need and interest but will not provide active outreach to participants.

Community Health Worker Support - Participant-requested sessions

Intervention BEHAVIORAL

Persons assigned to the intervention group will receive strategic and intentional outreach and support from a CHW for 9 months to carry out the patient activation intervention. CHWs will work with persons in the intervention group to develop an Individual Patient Health Activation Plan (IHAP) that is informed by the participants individual health conditions. The IHAP will address priorities and barriers to obtaining optimal health, access to care, and adherence to a health care plan. CHWs will actively outreach the study participant a minimum of monthly to see how they are doing and to update or modify the IHAP, as needed. They will assist the participant in understanding medical advice, developing chronic disease self-management skills, accessing health care, making appointments, and addressing challenges arising from SDoH. CHWs will also utilize motivational interviewing to assist participants in making

Community Health Worker Support - Pre-scheduled sessions

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years and older,
• Able to speak and understand English
• Have been told by a health care provider that they have two or more, chronic health conditions
• Are classified as medically underserved or socially vulnerable person

Sponsors & Collaborators

• Meharry Medical College: lead
• Baptist Memorial Health Care Corporation: collaborator
• Cherokee Health Systems: collaborator
• National Heart, Lung, and Blood Institute (NHLBI): collaborator

Related Publications (24)

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MeSH Terms

Conditions

Diabetes Mellitus; Hypertension; Renal Insufficiency, Chronic; Hypercholesterolemia

Interventions

Methods; Control Groups

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Vascular Diseases; Cardiovascular Diseases; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Hyperlipidemias; Dyslipidemias; Lipid Metabolism Disorders

Intervention Hierarchy (Ancestors)

Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design

Study Officials

• Stephania M Miller-Hughes, PhD, MS, MSCI

  Meharry Medical College

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Briana Jegier, PhD

CONTACT

(312)498-3411; Briana.Jegier@baptistu.edu

Danielle King, PhD

CONTACT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: December 12, 2025
• Study Start: December 20, 2025
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): September 1, 2027
• Last Updated: December 12, 2025

Record last verified: 2025-12