Multilevel, Multidisciplinary, Faith-Based Participatory Interventions to Reduce COVID-19 Related-Risks Among Underserved African Americans
Phase: NA
Conditions: Coronavirus
Sponsor: Charles Drew University of Medicine and Science

 
 
Multilevel, Multidisciplinary, Faith-Based Participatory 
Interventions to Reduce COVID-19 Related-Risks 
among Underserved African Americans 
 
NCT04542343 
 
Study Protocol/SAP 
 
Document Date: April 23, 2021 

Multilevel, Multidisciplinary, Faith-Based Participatory Interventions to Reduce COVID-19 Related-
Risks among underserved African Americans
SPECIFIC AIMS: This multilevel, multidisciplinary, theoretically-based, culturally sensitive, community 
participatory intervention addresses two major COVID-19 related challenges in underserved and under-
resourced African American (AA) communities. One major challenge, at the community level, is preventing 
outbreaks of COVID-19 at faith-based gatherings. A recent Morbidity and Mortality Weekly Report (MMWR) 
highlights the potential for widespread transmission of COVID-19 at group gatherings during faith-based 
events. This report revealed that 38% of 92 parishioners at one church developed COVID-19, along with three 
deaths.1 The Center for Disease Control and Prevention (CDC) takes the position that “faith-based 
organizations should work with local health officials to determine how to implement the U.S. 
Government guidelines for modifying activities during the COVID-19 pandemic to prevent transmission 
of the virus to their members and their communities.” Among AAs, religion and its institutions have been 
integral to their culture for centuries, as AAs are  more religiously engaged than the general US population.2 
Higher levels of religiosity are documented among AAs, including prayer, religious service attendance, and 
involvement of religion in daily life routine.3-5 The high levels of religious service attendance may present 
a major challenge in protecting the health and safety of AAs with underlying chronic conditions.6 
In addition to the risks of COVID-19 infection among AAs, another major challenge is the negative impact of 
this pandemic on the management of chronic conditions, particularly older adults with co-morbidities and 
underlying conditions. AA older adults, specifically those managing comorbidities and social isolation, are one 
of the most vulnerable groups susceptible to COVID-19 infection and have the most severe and critical 
consequences of this pandemic.7-9 AA older adults with co-morbidities, who heavily rely on county-based 
safety-net facilities, have had to change their patterns of seeking required medical care to manage their 
chronic conditions, including delaying, reducing, or stopping visits to primary and specialty providers, or to a 
pharmacy to obtain medication and treatment. Reduced routine access to health care providers and prescribed 
medications, coupled with risky health behaviors during the pandemic, may substantially exasperate existing 
disparities in healthcare utilization, non-adherence to management of chronic conditions, unhealthy lifestyles, 
and poorer health outcomes among underserved AA older adults.
Restrictions due to COVID-19have also negatively affected peoples’ dietary and lifestyle behaviors10-13 and 
worsened the health of older adults. A recent international study reported that the COVID-19 restrictions had a negative 
impact on the amount, frequency and type of food and snacks eaten. Physical activity had reduced, with daily sitting 
time increasing from 5 to 8 h per day11 It is plausible that older adults in South LA adopted similar behaviors. Many adults 
in South LA willingly or unwillingly lost employment, lowering their ability to purchase healthy foods. Opportunities for 
obtaining meals in community settings reduced. Fear of interacting with others reduced the ability to shop for food or 
exercise outside or in communal settings. It is not yet known how these factors affected dietary intake, access to quality 
foods, and participation in physical activity among older adults in South LA. 
Through our well-established collaboration with AA church leaders in South Los Angeles, we continually ensure 
that AA ministerial leaders are at the forefront of our efforts to assist in the development of a healthy 
community. With over 50 years of close partnership and interaction with AA faith-based organizations in Los 
Angeles, the strong partnership and mutual trust Charles R. Drew University of Medicine & Science (CDU) has 
developed within the community stands out as one of the defining characteristics of the university. 
The specific aims of this study are: 
1.
Community Strategizing: To collaborate with 10 AA church leaders on implementing Federal and State 
(California) public health guidelines for churches for reducing COVID-19 risk in predominantly AA churches 
in South Los Angeles; 
2.
Community Building and Sustainability: To collaborate with 10 AA churches to train 30 church-based AA 
young adults as health advisors to master information about COVID-19 and its impact on the daily life of 
underserved AAs, particularly, older adults with underlying multimorbidity or social isolation; and  
3.
Individualized Management of Care: To jointly implement and evaluate a telehealth-based, 
multidisciplinary, culturally-sensitive intervention with 265 AA older parishioners: (i) To mitigate the negative 
impact of COVID-19 on the management of chronic health conditions, and (ii) to reduce healthcare 
avoidance behaviors and psychological distress. 
There are at least three substantial outcomes that will result from this proposed intervention. First, as a result 
of this community participatory intervention, ten predominantly AA churches in South Los Angeles (one of the 
most challenged underserved and under-resourced areas in California with a population of over 1 million), will 
fully adopt Federal and State of California guidelines for COVID-19 preventative practices within their church. 
By fully implementing these guidelines, we expect that over 3,000 parishioners will be impacted. Second, 
 
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this study will recruit and train young church-based health advisors to support AA older adults with underlying 
conditions for COVID-19 to safely manage their chronic conditions during the COVID-19 pandemic. This 
intervention is targeting underserved AA older adults, one of the most vulnerable populations impacted by 
COVID-19. Lastly, this proposed project will recruit 265 AA older parishioners to receive a telehealth-based 
culturally and spiritually sensitive intervention that will provide health coaching and support. This study builds 
sustainability for the AA community with the training of 30 AA church-based health advisors who will continue to 
be a valuable community resource as they can continue to provide coaching and support after the intervention. 
This proposed study is strongly endorsed by the California Black Health Network.
Administrative Supplements for Community Interventions: This proposed application directly linked to one 
of the four research aims of the Accelerating Excellence in Translational Science (AXIS) program, the 
Community Engagement Core (U54 program Award #: 2U54MD007598 - PI: JV Vadgama). This core is 
specific in its design to develop partnerships and collaborations with community organizations and institutions 
that will integrate community knowledge and experience in the exploration of reducing health disparities and 
mitigating disease risk and burden in underserved communities. The project will fulfill the objective of the 
Community Engagement Core by establishing new community collaborations in this shared academic-
community collaborative grant proposal. 
RESEARCH STRATEGY
1. Significance: COVID-19 among African Americans (AAs): COVID-19 death rates are disproportionately 
higher among AAs compared to the general population.8,14-19 COVID-19 outcomes are worse in US counties 
that are predominantly AA, with AA infection rates three times higher and death rates five times higher than 
predominantly White counties.20  Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases 
reported in a press conference that COVID-19 is 'shining a bright light' on 'unacceptable' health disparities for 
AAs. He attributed these inequalities to a higher burden of underlying medical conditions among AAs.21 The 
susceptibility for COVID-19 is heightened among AAs due to increased rates of CVD, diabetes, hypertension, 
and obesity.22-24 These underlying conditions and outcomes are rooted in structural racism via increasing 
exposures to risks, increasing biological vulnerability, and decreasing access to protective factors.25-28
COVID-19 and AA Churches: AA churches have played a role in ameliorating the impact of structural racism 
for centuries, with religious and spiritual worship being embraced as an essential part of life. However, the 
COVID-19 pandemic has interrupted the functions and impact of the church, with the cancellation of services 
and activities. With both the CDC and the State of California releasing guidelines to reopen community 
institutions, churches must modify their own faith traditions and policies in preparation of reconvening in-person 
gatherings to reduce the spread of COVID-19. The CDC “scaling up operation” strongly recommends that 
faith-based organizations establish and maintain communications with local authorities and work closely with 
health organizations to determine how to effectively implement their guidelines. The CDC recommends that 
all clergy and staff members in the church be trained with implementing and maintaining safe practices for 
COVID-19 risk reduction. Safety actions includes the following topics: 1) promotion of healthy hygiene 
practices, 2) personal protective equipment, 3) cleaning, disinfection, and ventilation protocols, 4) social 
distancing measures, 5) minimizing sharing of worship materials, and 6) increasing preventative practices 
against spread of COVID-19 in childcare setting and youth and summer camps. The guidelines provides 
detailed information on “Monitoring and Preparing” when staff or parishioners get infected including 1) 
recognizing signs and symptoms, 2) plan for when a staff member or parishioner becomes sick, 3) promotion 
of communication and messaging by posting cultural competent signs and media and 5) disinfecting areas and 
the building before resuming activities.29
COVID-19 and AA Older Adults: COVID-19 related hospitalization and death rates increase with age and are 
highest among older adults, with the majority of hospitalized patients having underlying conditions.30 In addition 
to older age, underlying health conditions, including cardiac and respiratory diseases, will lead to more severe 
and aggressive management of COVID-19.31 Older AA adults with comorbidities are strongly encouraged to 
practice social distancing and isolation as a prevention measure. Yet, this may lead to decreased healthcare 
utilization and treatments which is required for management of their chronic conditions. Risk reduction of 
COVID-19 and chronic disease management for AA older adults with multimorbidity are highlighted as difficult 
challenges due to the high vulnerability of this group, a fact which warrants critical attention.20,32-35 
Collaborating with AA Churches: Historically, AA churches support their families economically, spiritually, 
socially, and culturally, through programs unmatched by other social institutions.36 Studies show that the church 
and its leaders in the AA community can increase effectiveness of health programs.37,38 AA church leaders 
perceive that their endorsement of health information and communication can empower positive health 
behaviors and promotion among AA populations.39 Several studies show that the church and its leaders in the 
 
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AA community can increase the effectiveness of health programs.37,38 Using church-based health advisors for 
community health outreach studies is strongly recommended for AAs due to medical mistrust and institutional 
racism in healthcare settings.40 Community health advisors are highly regarded as trusted members and 
stakeholders in minority communities, especially since they are trained to improved facilitation of care, and 
cultural appropriateness of service delivery.41 These types of roles have been effective in closing gaps of unmet 
needs and decreasing health disparities for minority communities in post-disaster environments.42 
Intergenerational Collaboration in AA Church to Reduced Risk of COVID-19:  Numerous studies show 
that AA consistently report higher levels of mistrust in their providers and the health care system than Whites.43-
49 It is also well-documented that AA older adults have significantly less trust in their own physicians and 
greater trust in informal health information sources than their White counterparts. Greater mistrust in one's own 
physician is associated with lower level of utilization of health care utilizations.47 AA churches promote 
intergenerational collaboration and empower young adults in AA churches.50 Incorporating AA young adults in 
intergenerational contact to improve the health of older adults is entirely welcomed by church leaders.17 In 
addition, older people willingness to modify their adherence behaviors are influenced by the communication 
skills of, and the degree to which they trust their providers.51 Therefore, using AA church-based health 
educators for community health outreach is strongly recommended.40 
2. Innovation: This multilevel, multidisciplinary, theoretically-based, culturally sensitive, community 
participatory intervention to mitigate the risk of COVID-19 at faith-based community and parishioner levels 
(particularly among older AAs) is innovative in several ways.  First, we will collaborate with ten predominantly 
AA churches in South Los Angeles (one of the most challenged underserved and under-resourced areas in 
California with a population of over 1 million), to fully adopt Federal and State of California guidelines for 
COVID-19 preventative practices within their church which could easily impact over 3,000 AA parishioners. 
Second, this study empowers young adults in African American churches and promotes intergenerational 
collaboration between young and older AA adults, which is strongly supported by church leaders, community 
advocates, and families. Third, this project incorporates the collaboration of both academic and church leaders 
for a community partnered participatory intervention that builds community capacity. This proposed project will 
build sustainability for the AA community with the training of young adult church-based health educators, who 
can continue providing health coaching and support that is culturally and spiritually sensitive following this 
intervention. Fourth, it addresses the national call for studies focused on assessing the health status and care 
of minority older populations during the COVID-19 pandemic, with particular attention to improving health 
equity. Lastly, the proposed project team integrates both experienced researchers and established community 
stakeholders and leaders for a strong collaborative study that can inform various sectors of the AA population. 
Moreover, by engaging AA churches in South Los Angeles, this project adds a pioneering aspect of chronic 
disease management by assessing the types of support older AA adults need during an infectious pandemic.
3. Approach: Overview - This study includes two parts that will be implemented concurrently. Part one 
includes assisting church leaders to fully implement the CDC/State guidelines and part two includes training 30 
church-based advisors to mitigate the negative impact of COVID-19 on the management of chronic health 
conditions, and reduce healthcare avoidance behaviors and psychological distress among AA older 
parishioners. 
3.1. The ongoing or potential future public health restrictions (e.g., closures, physical distancing) has no 
impact on the research approach.
3.2. Multidisciplinary Investigators: One unique feature of this application is that the intervention be will 
implemented by a multidisciplinary team of community-faculty, church leaders, academic scholars, and health 
care providers. Our research team includes: an experienced gerontologist; an AA community faculty (who 
also is a church leader); six AA health care practitioners and researchers (an infectious disease specialist, a 
family medicine physician, a nursing specialist, a pharmacist, a community health prevention specialist, and a 
public health specialist).
3.1. Part One:  Specific Aim 1 - Community Strategizing: To collaborate with 10 AA church leaders on 
implementing Federal and State (California) public health guidelines for churches for reducing COVID-19 risk 
in predominantly AA churches in South Los Angeles. 
Implementation of Aim 1: We will employ various strategies to assist predominately AA churches with 
implementing and adhering to federal and state public health guidelines, which include 1) create a 
multidisciplinary taskforce with clergy members and church leaders to develop a surveillance protocol focused 
on COVID-19 infection prevention and measure progress of COVID-19 prevention efforts, 2) conducting 
environmental assessments and scans of churches to identify high risk infection areas, 3) developing culturally 
sensitive communication media and messages with clergy members to deliver to church parishioners, 4) 
 
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hosting six monthly seminars to discuss COVID-19 updates for church parishioners, and 5) creating a 
telephone hotline for church leaders and parishioners to call or text COVID-19 related questions. All of these 
strategies will occur online, with the exception of the environmental assessment and scan, which will occur in-
person with clergy leaders with members of our research team. The development of the surveillance protocol 
will also be created between the research team and clergy members, with continual updating based on 
COVID-19 infection rates and federal/state guidelines.  The workshops and seminars will be conducted online 
and involve distance-learning activities and classroom-based discussions for clergy members and church 
leaders, staff, and parishioners. The six workshops will be conducted by the members of our multidisciplinary 
research team who will lead 1-2-hour workshop sessions based on their expertise and content area (i.e. 
geriatric conditions, mental health challenges).  Flyers and emails for the workshops will be distributed 
throughout the digital environment, faith-based organizations and churches, and local community 
organizations. At each workshop, there will be invited guests who are experts of the workshop topic that will 
provide additional information about COVID-19. We will work with clergy and church leaders to ensure that the 
guidelines are adapted to the needs of each participating church. To address any challenges to adopting these 
guidelines, whether lack of acceptability, adoptability, or understanding of their necessity, we will collaboratively 
engage the church community’s concerns in order to brainstorm ideas and methods of implementation that fit 
their unique needs (i.e. townhall meetings). 
Recruitment of Church Leaders was already conducted by Rev. Waller an AA church and community leader 
in South Los Angeles who has worked on various projects to reduce risky behaviors and improve health 
outcomes for the AA population as community faculty (See the Letter of Support from Watts Area Ministers).
Evaluation: There are various strategies we will employ to conduct evaluation and quality improvement for 
implementation of guidelines. We will work with clergy members to conduct bi-monthly assessments of church 
services by scoring specific elements of recommended guidelines for churches by surveying church leaders 
and observational assessment of each church’s environment. Based on the environmental scans and the 
multidisciplinary taskforce, we will develop a checklist that will include, but not limited to assessment and 
observation of: 1) social distancing during worship services (i.e. no hugging, close seating), 2) use of face 
coverings by everyone in the church, 3) disinfection of facilities, 4) personal use of worship hymnals, Bible, and 
other items, 4) church staff preparedness of staff to identified signs and symptoms of infected individuals, 5) 
messaging during service regarding COVID-19. The results of bi-weekly checklist and survey will be shared 
with church leaders for modification of operations and analyzed after 6 months to evaluate adherence of 
COVID-19 prevention practices. As a result of this intervention, it is expected that the participating churches 
will meet or exceed 80% of the checklist criteria for the 6-month duration. Additionally, all questions received 
during the monthly seminars and telephone hotline will be ranked based on the quality as a criterion for 
improvement of COVID-19 knowledge and practice. 
3.2. Part Two:  Specific Aims 2 & 3 - Community Building and Sustainability and Individualized 
Management of Care -  Aim 2: To collaborate with 10 AA churches to train 30 church-based AA young adults 
as health advisors to master information about COVID-19 and its impact on the daily life of underserved AAs, 
particularly, older adults with underlying multimorbidity or social isolation; and Aim 3: To jointly implement and 
evaluate a telehealth-based, multidisciplinary, culturally-sensitive intervention with 265 AA older parishioners: 
(i) To mitigate the negative impact of COVID-19 on the management of chronic health conditions, and (ii) to 
reduce healthcare avoidance behaviors and psychological distress. This part includes two phases. Phase 1 
will utilize a community partnered participatory approach that will be specifically tailored to the education of 
church-based advisors. Phase 2 will implement “one group pretest–posttest” design to improve COVID-19 
associated health outcomes of AA older parishioners in collaboration with trained health advisors. Due to the 
disproportionate burden of COVID-19 on the AA community, every older adult who participates in this study 
would be identified as being at high risk for COVID-19 diagnosis and poor health outcomes associated with the 
disease. We cannot deprive or prevent this intervention for anyone at risk for COVID-19. Moreover, conducting 
a non-equivalent or a quasi-experimental design would be unethical. 
Preliminary Studies: Our team has conducted similar intervention studies among AA older adults focused on 
reducing non-adherence to medication regimens, polypharmacy, and inappropriate use of medication among 
underserved 740 AA older adults.  Dr. Bazargan has conducted several community-based cross-sectional 
surveys and interventional studies among older AA adults and specifically 47 out of his 170 manuscripts 
directly examine the health status and health care utilization of underserved older AA adults.52-98 The co-
investigators of this proposed project have worked together for the last four years and collectively published 
numerous manuscripts, which 63 of which focused on health disparities and 19 manuscripts focused on health 
 
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care utilization, physical and mental health, medication-related challenges, and management of pain and 
chronic conditions among older AA adults.52,54,57-59,61,63-71,73,74,81,99 
Theoretical Framework: We propose to use the Information, Motivation, and Behavioral Skills (IMB) 
framework.100  We selected the IMB model because there is significant empirical evidence demonstrating its 
effectiveness.101-107 Specifically, this model is an appropriate, comprehensive health behavior change 
framework for management of chronic conditions and self-care.108-111 This model hypothesizes that information, 
motivation, and behavioral skills, are the critical elements of behavior change. According to the IMB model, 
adherence to management of chronic conditions is determined by the extent to which an individual is informed 
about his/her conditions and needs, is motivated to adhere, and possesses the necessary behavioral skills to 
adhere in a variety of situations. Providing facts, advice, and guidance about chronic conditions and adherence 
strategies, is seen as capable of bolstering older adults’ self-efficacy and knowledge of their chronic health 
conditions.17 The IMB model provides a multivariate explanation of non-adherence and guide to promoting self-
care and health care utilization, such as physician visits and adherence to drug regimens and life-style 
modifications, among people with chronic conditions.110 
Design for Phase One of Part Two: 3.3.1. Target Population: We will enroll 30 AA young adults from 10 
predominantly AA churches in South Los Angeles to be trained and become a church-based health advisor 
with expertise in COVID-19. It is expected that 30 young AA advisors to: 1) master information about COVID-
19; 2) understand its impact on the daily life of AA older adults, particularly, those with underlying comorbidities; 
and 3) support older AA adults to reduce COVID-19 risk and improve management of their chronic conditions. 
For recruiting AA young adults, we will give special focus to 1) those AA young parishioners who regularly 
attend the church and work closely with health ministry leaders; 2) college student or graduate in health care 
field; 3) those with strong commitments to the program and are willing to work and support older adults; and 4) 
have a laptop/desktop computer or iPad to manage telehealth. 
Strategies to Train AA Advisors: The workshop training will occur bi-weekly over a 3-month period to 
prepare them for delivering the intervention to AA older adults. Detailed information on the content areas are 
described in Table 1. The training curriculum will cover the following components: 1) minimize risk of COVID-
19 infection and transmission; 2)  utilizing remote learning platforms to train older adults on effective use of 
telehealth; 3) gain extensive knowledge regarding COVID-19 and its impact on individuals with underlying 
chronic conditions; 4) identify over-reacting (obsessive) and under-reacting behaviors to COVID-19, physical 
and social distancing, and other measures; 5) assessment of social needs and consequences of long-term 
social isolation; 6) delivery of extensive knowledge regarding the importance of adherence to medication refills 
and regimens, as well as adherence to lifestyle recommendations for older adults with chronic conditions; 7) 
providing functional support to older adults, particularly those who are socially isolated, to manage their 
activities of daily living; 8) assisting older adults in the use of online services for making medical appointments, 
obtaining medication refills, etc. and finally, 9) learn administering survey and collect data from older adults. In 
addition, we will discuss the functions and role expectations of health advisors, including care coordination, 
health coaching, education, and assessment, social support, and case management and resource linking.112,113 
Evaluation of Training: Following each training session, health advisors will complete a standardized survey 
that assesses the knowledge, self-efficacy, and skills for every workshop. If there are areas that are concerning 
to the research team based on the answers from health advisors, the subject topic will be repeated further 
explanation to the group. Within the last session, health advisors will demonstrate their training through a role-
playing exercise. In addition, a structured survey lasting about 30 minutes which will be conducted at two time 
points (pre- and post- trainings) to evaluate church-based advisors’ knowledge, attitude, and skills gained from 
the bi-weekly workshops over the period of 3 months. We will arrange the bi-weekly workshop sessions at 
times that are convenient to the trainers and trainees.  All health advisors will be provided a monetary incentive 
(a total of $200 for attending six 2-3 hours workshops) for participating in the program and completing study 
responsibilities for both phase 1 and 2 (see below). In addition, they will receive a certificate of completion and 
community recognition as church-based young adult health advisors for minority faith-based institutions. During 
the program ceremony commencement, three church-based young adult health advisors with the highest 
satisfaction scores will receive a $1,000, $500, and $300 credit card gifts, respectively. Remediation will be 
conducted for those advisors who need additional assistance. As a result of this training, it is expected that AA 
advisors will: 1) score 90-100% on tests that assesses COVID-19 disease, transmission, symptoms, treatment 
prevention, and its impact on older adults with co-morbidities; 2) understand the use and application of 
telehealth, apps, and computer-based software to help AA older adults use telehealth and on-line services; 3) 
gain additional knowledge regarding the importance of adherence to medication refills and regimens, as well 
as adherence to life-style recommendations for older adults with chronic conditions; 4) support older adults, 
 
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particularly those with comorbidities or socially isolated, to manage their activities of daily living and assist 
them in the use of online services for making medical appointments, obtaining medication refills, etc.; and 5) 
learn to conduct survey and collect health-related data from older adults as a young adult health educator.
Research Strategies for Phase Two: Recruitment: Recruitment of participants will be from the 10 
collaborating churches in South Los Angeles. Recruitment will be conducted by our research team and church-
based health advisors trained in phase 1 of this study. We aim to recruit a total of 265 AA aged 65 years and 
older parishioners. In addition to digital announcements publicizing the proposed project at respective 
churches, our research team member who is church leader (Reverend Joe Waller) will assist clergy member to 
convene pre- or post-Sunday sermon meetings to introduce the program to the parishioners. They will also 
offer the contact information or referral to the church-based health educator, which will allow potential 
Table 1. Group Intervention (IMB Framework)
Information

Explain COVID-19 sign & symptoms & treatment.

How to minimize risk of COVID-19 infection & 
infecting others.

Skills for COVID-19 self-assessment.

When to sick medical advise.

Explain connection between age, chronic 
conditions & COVID-19 risks.

Discuss OTC, COM, & Alternetive medicine.

 Timely screening for COVID-19

Explain risks of non-adherence to disease 
surveillance & monitoring (i.e., lab tests, routine & 
required screening procedures, etc.

Discuss high risk of non-adherence to medications

Discuss new initiatives for home-based health care 
delivery

Discuss Telehealth and its importance

Discuss internet-based & mail order servicses 
(medication etc.)
Attitudes

Reduce anxiety & fear about COVID-19

Recognize & modify over-reacting (obsessive) & 
under-reacting behaviors to COVID physical & social 
distancing & other requirements.

Discuss health status with nonadherence to 
medications (stroke, amputation, etc.).

Appreciate social needs & consequences of long-
term social isolation among older adults

Modify cultural beliefs about testing, vaccination, & 
adherence to drug regimens & focus on culturally 
acceptable points that promote adherence.

Enhance communication with providers in order to 
understand relevant information. 

Encourage the involvement of companions & 
family in illness mangegment.
Motivations

Invites participants to identify their own 
challenges & find solutions for their concerns in 
preventing COVID-19 infection. 

Enhance self-efficacy of management of chronic 
health conditions.

Self-identified support for self-management (such 
as religion or spirituality) 

Motivate to discuss the medication-related options, 
& their benefits & risks, with both physicians & 
pharmacists.
Behavior Skills/Facilitators

Provide skills for specific needs regarding 
telehealth & online access to services

Objective & perceived abilities for minimizing risk 
of contracting COVID-19 while performing daily 
activities

Train self-monitoring for COVID-19 symptoms

Connect patients with community resources.

Develop skills & habits to visit providers continually 
using telehealth.

Promote adherence to a healthy life style. 

Objective & perceived abilities for acquring, self-
cueing, & conducting tasks for self-management of 
chronic conditions.
Adherence Behaviors

Getting presciption filled/refilled on time.

On-time surveillance & monitoring (i.e., lab tests, 
routine & required screening procedures, etc.)

Access to pharmacies & getting prescription 
filled/refilled on time 

Safe & effective use of primary care  services

Use of on-line services for making medical 
appointments, obtaining medication refills, etc.

Adhere to special instructions for life-style 
modification, diet etc.

Adhere to vaccination schedules for older adults

Adhere to COVID-19 testing
participants to sign up for the study or provide the contact information of other potential AA older adults 
(parishioners’ parents, siblings, etc.) who would be eligible and benefit from this intervention. Exclusion 
criteria: A resident in a care facility and those with cognitive deficits (identified by short version of mini-mental 
state examination instrument). In addition, we will assess the participants’ physical ability in terms of sight, 
hearing, and literacy (good, fair understanding, illiterate), which is necessary since this intervention will be 
conducted online and we will need to assess which participants may need additional support. Participants will 
be informed that this intervention will be conducted over three months and will involve three broad activities: 1) 
participation in pre-intervention (made up of Parts A and B) and post-intervention (made up of Part A only) 
surveys lasting about 100 and 50 minutes respectively. Part A will include validated measures of health, health 
 
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behaviors, healthcare utilization and other COVID-19 related variables. Part B will solely focus on dietary 
intake, access and physical activity utilizing validated instruments from DHQ-III, Food Insecurity (FI) and Yale 
Physical Activity (PA) surveys, respectively. (copies of the three additional questionnaires to be used in Part B 
of the pre-intervention survey are provided in Appendices 1, 2 and 3).Participants will be paid $25 for each of 
the 2-part pre intervention survey and $ 25 for the post-intervention survey; totaling a possible $75 payment for 
completion of all three parts. Research staff will be trained and properly instructed to administer both parts of 
the survey.; 2) attendance at six bi-weekly online workshops that will provide targeted information on reducing 
risk for COVID-19; and 3) participation in individualized online visits with AA health advisors to discuss 
management of chronic conditions, in addition to receiving timely health assessment, coaching, and education. 
Intervention Strategies: We collaborate with AA church-based advisors trained in Phase 1 to deliver three-
month longitudinal intervention to 265 older AA Parishioners. This intervention is composed of six 2-hour bi-
weekly sessions that include lectures, discussions, followed by one-on-one “problem solving” consultations. 
Instead of an in-person approach, this intervention will be provided via telehealth. Table 1 shows the 
curriculum of the proposed bi-weekly seminars/ intervention. This intervention uses a participatory, culturally 
sensitive, theoretical based (IMB), and multidisciplinary approach to reduce risk and enhance health for AA 
older adults. The longitudinal intervention includes: 1) Telehealth training; 2) COVID-19 risk reduction and 
testing; 3) health screening; 4) adherence to disease surveillance and monitoring (i.e., lab tests, routine and 
required screening procedures, etc.); 5) promoting adherence to medication refill and regimens; 6) promoting 
adherence to recommended life style behaviors; and 7) flu, pneumonia, & COVID (once available) vaccination. 
Individualized Meeting: Trained health advisors will offer individualized monthly meetings to an assigned 
caseload of AA older participants, in addition to bi-weekly seminars, for individualized health assessments, 
coaching, and support meetings with the participants. The health advisors will assess the older participant’s 
management of their chronic conditions by utilizing a standardized visit form during these meetings (for 
example, a diabetic patient must see and ere specialist every year – depending on type of chronic conditions, 
there is a standard recommendation for physician visits. They will also encourage and assist the participants in 
making appointments and/or facilitating communication with their primary care provider, getting their 
medication refiled, and getting tested for COVID-19. If the participant does not have a physician, we will 
provide a referral located in close proximity to the participant. 
Informing Primary Care Providers: The primary care provider of participants will be notified in case of 
positive depression or high anxiety severity following screening; non-adherence to treatment or inability to 
access their treatment; and clinical presentation warranting emergent care. If the participant does not have a 
primary care provider, they will be referred to a one that is located in proximity of their location. 
Church-based Health Advisors and our Health Practitioner to Deliver Seminar and Workshop (Phase 2): 
The bi-weekly seminars will be peer-led and conducted by each church-based health educator within their 
church. In each seminar, one of our specialists will participates in delivering the main component of 
intervention. For example, the infectious disease expert will help individuals reduce the risk of acquiring 
COVID-19; the pharmacist will work with participants to enhance their medication adherence and remove 
barriers related to their refills; and the lifestyle coach will help improve participants’ lifestyles; etc. 
Hypotheses: As a result of this intervention, it is expected that: 1) A 30% improvement of chronic physical and 
mental disease management among AA older adults; 2) A 80% increase in knowledge, attitude, and behaviors 
of COVID risk among AA older adults; and 3) a 40% increase in COVID-19 testing and 4) a 70% increase in 
uptake of influenza and pneumococcal vaccinations among participants.
Survey Instruments: Per the instruction of this NOSI, we will adopt survey instruments recommended by the 
phenX Toolkit and Public Health Emergency and Disaster Research Response.114 The survey (developed 
by the Aging and Geriatric Research Institute on UF) includes Covid-19 related measures and Health status 
and health care utilization, quality of life, and other related variables. In addition, we will include several 
validated survey instruments that our research team has recently used among AA older adults to investigate 
health status, health care utilization, and adherence to drug regimes in South Los Angeles.
Sample Size and Data Analysis (Phase 2): We will use a pretest–posttest design, comparing our outcomes 
before and after the intervention, with a three-month interval. Since our outcomes are binary (COVID infection 
status, use of services, medication non-adherence, 
etc.), we will use the McNemar test, the test of 
choice for analyzing binary matched-pairs data.115 
For our power calculation, we assume that our 
primary outcome (poor adherence) will show a 36% 
relative change (considering a 22% baseline 
TIMELINE: Activities & Timeline (Months)
1-3
4-6
7-9
10-12
Church leaders recruited  
X
CDC/States Guideline Implementation 
X
X
X
X
Health Advisors recruited & trained
X
X
AA older adults recruited 
X
X
X
Baseline data collection (older AA)
X
X
X
Older AA Intervention implemented 
X
X
Post intervention data collected & analyzed
X
X
Final reports & RO1 preparation 
X
 
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status). Assuming an alpha of 0.05, we calculate that a total sample of 240 study participants will be necessary 
to achieve 80% power.116 With 10% drop-out,117,118 we will need to enroll 265 individuals. We will conduct 
longitudinal follow-up assessments to document changes to compare with baseline measures. At the 
descriptive level, the distribution and frequency of all items will be examined. The main hypothesis of this study 
is significant improvement of binary and continuous outcomes from pre- to post- tests. In bivariate analysis, we 
will apply McNemar’s test as well as parried t-test to examine improvement of the outcome over the course of 
the study. Conducting multivariate analysis, when outcome variables are dichotomous/binary, to explore the 
role of potential confounders and baseline health status, as determinants of response (change), we will apply 
logistic regression. However, for corresponding dependent variables that appear to be ordinal a logit link will be 
used in polytomous or ordinal logistic models. Additionally, for continuous outcomes, we will use GLM to 
determine statistical differences in the primary outcome measures, while controlling for potential confounders 
and covariates associated with the selected outcomes. It should also be noted that missing results over time 
will be accounted for in the analysis using an inverse probability weighting scheme based on a logistic 
regression model. 
References:
1.
James A, Eagle L, Phillips C, et al. High COVID-19 attack rate among attendees at events at a church—Arkansas, 
March 2020. 2020.
2.
Taylor RJ, Chatters LM, Levin J. Religion in the lives of African Americans: Social, psychological, and health 
perspectives. Sage Publications; 2003.
3.
Sahgal N, Smith G. A religious portrait of African Americans. Pew Research Center Religion & Public Life. In:2009.
4.
Barrett RK. Dialogues in diversity: An invited series of papers, advance directives, DNRs, and end-of-life care for 
African Americans. OMEGA-Journal of Death and Dying. 2006;52(3):249-261.
5.
Sanders JJ, Robinson MT, Block SD. Factors impacting advance care planning among African Americans: results of 
a systematic integrated review. Journal of palliative medicine. 2016;19(2):202-227.
6.
Escher Jr AR. An Ounce of Prevention: Coronavirus (COVID-19) and Mass Gatherings. Cureus. 2020;12(3).
7.
Garg S KL, Whitaker M, et al.,. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-
Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly 
Rep. 2020;69:458-464. doi:http://dx.doi.org/10.15585/mmwr.mm6915e3.
8.
Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. The Lancet 
Respiratory Medicine. 2020.
9.
Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: 
what we may expect regarding pathogenesis, immune responses, and outcomes. Geroscience. 2020;42(2):505-
514.
10.
Mayasari NR, Ho DKN, Lundy DJ, et al. Impacts of the COVID-19 Pandemic on Food Security and Diet-Related 
Lifestyle Behaviors: An Analytical Study of Google Trends-Based Query Volumes. Nutrients. 2020;12(10).
11.
Ammar A, Brach M, Trabelsi K, et al. Effects of COVID-19 Home Confinement on Eating Behaviour and Physical 
Activity: Results of the ECLB-COVID19 International Online Survey. Nutrients. 2020;12(6).
12.
Marty L, de Lauzon-Guillain B, Labesse M, Nicklaus S. Food choice motives and the nutritional quality of diet 
during the COVID-19 lockdown in France. Appetite. 2021;157:105005.
13.
Martinez-Ferran M, de la Guia-Galipienso F, Sanchis-Gomar F, Pareja-Galeano H. Metabolic Impacts of 
Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits. Nutrients. 
2020;12(6).
14.
van Dorn A, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. The Lancet. 
2020;395(10232):1243-1244.
15.
Yu Q, Salvador C, Melani I, Berg M, Kitayama S. The lethal spiral: Racial segregation and economic disparity 
jointly exacerbate the COVID-19 fatality in large American cities. 2020.
16.
Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? In: British 
Medical Journal Publishing Group; 2020.
17.
Almagro M, Orane-Hutchinson A. The differential impact of COVID-19 across demographic groups: Evidence from 
NYC. The differential impact of COVID-19 across demographic groups: Evidence from NYC (April 10, 2020). 2020.
18.
Borjas GJ. Demographic determinants of testing incidence and COVID-19 infections in New York City 
neighborhoods. National Bureau of Economic Research;2020. 0898-2937.
 
IRBNet #: 1663247-2
Approved by: CDU IRB
Approval Period: April 23, 2021 to  

19.
Laurencin CT, McClinton A. The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic 
Disparities. J Racial Ethn Health Disparities. 2020;7(3):398-402.
20.
Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? BMJ. 
2020;369:m1548.
21.
Dyer O. Covid-19: Black people and other minorities are hardest hit in US. In: British Medical Journal Publishing 
Group; 2020.
22.
Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and 
meta-analysis. J Infect. 2020.
23.
Dietz W, Santos-Burgoa C. Obesity and its Implications for COVID-19 Mortality. Obesity.n/a(n/a).
24.
Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. American Journal of 
Physiology-Endocrinology and Metabolism. 2020;318(5):E736-E741.
25.
Williams DR, Lawrence JA, Davis BA, Vu C. Understanding how discrimination can affect health. Health Serv Res. 
2019;54 Suppl 2(Suppl 2):1374-1388.
26.
Brediceanu M, Williams DH, Central College (Pella Iowa), Des Moines Symphony. Celebrating George Enescu : a 
symposium. Washington, D.C.: Education for Peace; 1997.
27.
Simons RL, Lei MK, Beach SRH, et al. Discrimination, segregation, and chronic inflammation: Testing the 
weathering explanation for the poor health of Black Americans. Dev Psychol. 2018;54(10):1993-2006.
28.
Gee GC, Ford CL. STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions. Du Bois Rev. 
2011;8(1):115-132.
29.
Center for Disease Control and Prevention. Interim Guidance for Communities of Faith. Accessed June 18, 2020. 
https://wwwcdcgov/coronavirus/2019-ncov/community/faith-basedhtml. 2020.
30.
Garg S. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus 
disease 2019—COVID-NET, 14 States, March 1–30, 2020. MMWR Morbidity and Mortality Weekly Report. 
2020;69.
31.
Applegate WB, Ouslander JG. COVID-19 Presents High Risk to Older Persons. J Am Geriatr Soc. 2020;68(4):681-
681.
32.
Dyer O. Covid-19: Black people and other minorities are hardest hit in US. BMJ. 2020;369:m1483.
33.
Röhr S, Müller F, Jung F, Apfelbacher C, Seidler A, Riedel-Heller SG. [Psychosocial Impact of Quarantine Measures 
During Serious Coronavirus Outbreaks: A Rapid Review]. Psychiatr Prax. 2020;47(4):179-189.
34.
Assari S, Habibzadeh P. The COVID-19 Emergency Response Should Include a Mental Health Component. Arch 
Iran Med. 2020;23(4):281-282.
35.
Pareek M, Bangash MN, Pareek N, et al. Ethnicity and COVID-19: an urgent public health research priority. 
Lancet. 2020;395(10234):1421-1422.
36.
Williams OA. Effects of faith & church involvement on African American female adolescents. Michigan Family 
Review. 2003;8(1).
37.
DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. Health programs in faith-based organizations: are they 
effective? American journal of public health. 2004;94(6):1030-1036.
38.
Campbell MK, Resnicow K, Carr C, Wang T, Williams A. Process evaluation of an effective church-based diet 
intervention: Body & Soul. Health Education & Behavior. 2007;34(6):864-880.
39.
Lumpkins CY, Greiner KA, Daley C, Mabachi NM, Neuhaus K. Promoting healthy behavior from the pulpit: Clergy 
share their perspectives on effective health communication in the African American church. Journal of religion 
and health. 2013;52(4):1093-1107.
40.
Mouzon DM, Taylor RJ, Nguyen AW, Ifatunji MA, Chatters LM. Everyday Discrimination Typologies Among Older 
African Americans: Gender and Socioeconomic Status. The Journals of Gerontology: Series B. 2019.
41.
Wennerstrom A, Haywood C, Wallace M, et al. Creating Safe Spaces: A Community Health Worker-Academic 
Partnered Approach to Addressing Intimate Partner Violence. Ethn Dis. 2018;28(Suppl 2):317-324.
42.
Scheib HA, Lykes MB. African American and Latina community health workers engage PhotoPAR as a resource in 
a post-disaster context: Katrina at 5 years. J Health Psychol. 2013;18(8):1069-1084.
43.
Mattocks KM, Gibert C, Fiellin D, et al. Mistrust and Endorsement of Human Immunodeficiency Virus Conspiracy 
Theories Among Human Immunodeficiency Virus-Infected African American Veterans. Mil Med. 
2017;182(11):e2073-e2079.
44.
Alpers L-M. Distrust and patients in intercultural healthcare: A qualitative interview study. Nursing ethics. 
2018;25(3):313-323.
 
IRBNet #: 1663247-2
Approved by: CDU IRB
Approval Period: April 23, 2021 to  

45.
Lincoln KD, Chow T, Gaines BF, Fitzgerald T. Fundamental causes of barriers to participation in Alzheimer's clinical 
research among African Americans. Ethn Health. 2018:1-15.
46.
Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ, Jr. High Levels of Medical Mistrust Are 
Associated With Low Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control. 
2017;24(1):72-77.
47.
Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive 
health services by older black and white adults. American journal of public health. 2009;99(7):1293-1299.
48.
Diamantidis CJ, Davenport CA, Lunyera J, et al. Low use of routine medical care among African Americans with 
high CKD risk: the Jackson Heart Study. BMC nephrology. 2019;20(1):11.
49.
Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical Mistrust, Racism, and Delays in 
Preventive Health Screening Among African-American Men. Behavioral Medicine. 2019;45(2):102-117.
50.
Allen HC. InterGenerate: Transforming Churches through Intergenerational Ministry. ACU Press; 2018.
51.
Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared 
decision making. BMJ: British Medical Journal (Online). 2016;353.
52.
Yazdanshenas H, Bazargan M, Jones L, et al. Engaging Gatekeeper-Stakeholders in Development of a Mobile 
Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly 
Patients With Hypertension. JMIR Mhealth Uhealth. 2016;4(4):e116.
53.
Yazdanshenas H, Bazargan M, Smith J, Martins D, Motahari H, Orum G. Pain Treatment of Underserved Older 
African Americans. J Am Geriatr Soc. 2016;64(10):2116-2121.
54.
Bazargan M, Smith J, Movassaghi M, et al. Polypharmacy among Underserved Older African American Adults. J 
Aging Res. 2017;2017:6026358.
55.
Bazargan M, Smith J, Yazdanshenas H, Movassaghi M, Martins D, Orum G. Non-adherence to medication 
regimens among older African-American adults. BMC Geriatr. 2017;17(1):163.
56.
Bazargan M, Smith JL, King EO. Potentially inappropriate medication use among hypertensive older African-
American adults. BMC Geriatr. 2018;18(1):238.
57.
Assari S, Smith J, Bazargan M. Health-Related Quality of Life of Economically Disadvantaged African American 
Older Adults: Age and Gender Differences. Int J Environ Res Public Health. 2019;16(9).
58.
Assari S, Smith J, Mistry R, Farokhnia M, Bazargan M. Substance Use among Economically Disadvantaged African 
American Older Adults; Objective and Subjective Socioeconomic Status. Int J Environ Res Public Health. 
2019;16(10).
59.
Assari S, Smith JL, Saqib M, Bazargan M. Binge Drinking among Economically Disadvantaged African American 
Older Adults with Diabetes. Behav Sci (Basel). 2019;9(9).
60.
Assari S, Smith JL, Zimmerman MA, Bazargan M. Cigarette Smoking among Economically Disadvantaged African-
American Older Adults in South Los Angeles: Gender Differences. Int J Environ Res Public Health. 2019;16(7).
61.
Assari S, Wisseh C, Bazargan M. Obesity and Polypharmacy among African American Older Adults: Gender as the 
Moderator and Multimorbidity as the Mediator. Int J Environ Res Public Health. 2019;16(12).
62.
Bazargan M, Mian N, Cobb S, Vargas R, Assari S. Insomnia Symptoms among African-American Older Adults in 
Economically Disadvantaged Areas of South Los Angeles. Brain Sci. 2019;9(11).
63.
Bazargan M, Smith J, Saqib M, Helmi H, Assari S. Associations between Polypharmacy, Self-Rated Health, and 
Depression in African American Older Adults; Mediators and Moderators. Int J Environ Res Public Health. 
2019;16(9).
64.
Bazargan M, Smith JL, Cobb S, et al. Emergency Department Utilization among Underserved African American 
Older Adults in South Los Angeles. Int J Environ Res Public Health. 2019;16(7).
65.
Bazargan M, Smith JL, Robinson P, et al. Chronic Respiratory Disease and Health-Related Quality of Life of African 
American Older Adults in an Economically Disadvantaged Area of Los Angeles. Int J Environ Res Public Health. 
2019;16(10).
66.
Cobb S, Bazargan M, Smith J, Del Pino HE, Dorrah K, Assari S. Marijuana Use among African American Older 
Adults in Economically Challenged Areas of South Los Angeles. Brain Sci. 2019;9(7).
67.
Evans MC, Cobb S, Smith J, Bazargan M, Assari S. Depressive Symptoms among Economically Disadvantaged 
African American Older Adults in South Los Angeles. Brain Sci. 2019;9(10).
68.
M CE, Bazargan M, Cobb S, Assari S. Pain Intensity among Community-Dwelling African American Older Adults in 
an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants. Int J Environ 
Res Public Health. 2019;16(20).
 
IRBNet #: 1663247-2
Approved by: CDU IRB
Approval Period: April 23, 2021 to  

69.
Assari S, Smith J, Bazargan M. Poor Self-Rated Health Is Associated with Hospitalization and Emergency 
Department Visits in African American Older Adults with Diabetes. J Racial Ethn Health Disparities. 2020.
70.
Assari S, Wisseh C, Saqib M, Bazargan M. Polypharmacy Is Associated with Lower Memory Function in African 
American Older Adults. Brain Sci. 2020;10(1).
71.
Bazargan M, Cobb S, Castro Sandoval J, Assari S. Smoking Status and Well-Being of Underserved African 
American Older Adults. Behav Sci (Basel). 2020;10(4).
72.
Bazargan M, Cobb S, Wisseh C, Assari S. Psychotropic and Opioid-Based Medication Use among Economically 
Disadvantaged African-American Older Adults. Pharmacy (Basel). 2020;8(2).
73.
Bazargan M, Ekwegh T, Cobb S, Adinkrah E, Assari S. Eye Examination Recency among African American Older 
Adults with Chronic Medical Conditions. Healthcare (Basel). 2020;8(2).
74.
Cobb S, Bazargan M, Sandoval JC, Wisseh C, Evans MC, Assari S. Depression Treatment Status of Economically 
Disadvantaged African American Older Adults. Brain Sci. 2020;10(3).
75.
Evans MC, Bazargan M, Cobb S, Assari S. Mental and Physical Health Correlates of Financial Difficulties Among 
African-American Older Adults in Low-Income Areas of Los Angeles. Front Public Health. 2020;8:21.
76.
Bazargan M, Kang TS, Bazargan S. A multivariate comparison of elderly African Americans and Caucasians voting 
behavior: how do social, health, psychological, and political variables effect their voting? Int J Aging Hum Dev. 
1991;32(3):181-198.
77.
Bazargan M. Self-reported sleep disturbance among African-American elderly: the effects of depression, health 
status, exercise, and social support. Int J Aging Hum Dev. 1996;42(2):143-160.
78.
Bazargan M, Baker RS, Bazargan S. Correlates of recency of eye examination among elderly African-Americans. 
Ophthalmic Epidemiol. 1998;5(2):91-100.
79.
Bazargan M, Bazargan S, Baker RS. Emergency department utilization, hospital admissions, and physician visits 
among elderly African American persons. Gerontologist. 1998;38(1):25-36.
80.
Bazargan M, Bazargan S, King L. Paranoid ideation among elderly African American persons. Gerontologist. 
2001;41(3):366-373.
81.
Yazdanshenas H, Bazargan M, Orum G, Loni L, Mahabadi N, Husaini B. Prescribing patterns in the treatment of 
hypertension among underserved African American elderly. Ethn Dis. 2014;24(4):431-437.
82.
Bazargan M, Yazdanshenas H, Gordon D, Orum G. Pain in Community-Dwelling Elderly African Americans. J Aging 
Health. 2016;28(3):403-425.
83.
Bazargan M, Yazdanshenas H, Han S, Orum G. Inappropriate Medication Use Among Underserved Elderly African 
Americans. J Aging Health. 2016;28(1):118-138.
84.
Bazargan M, Barbre AR, Torres-Gil F. Voting behavior among low-income black elderly: a multielection 
perspective. Gerontologist. 1992;32(5):584-591.
85.
Bazargan M, Barbre AR, Hamm V. Failure to have prescriptions filled among Black elderly. J Aging Health. 
1993;5(2):264-282.
86.
Bazargan M. The effects of health, environmental, and socio-psychological variables on fear of crime and its 
consequences among urban black elderly individuals. Int J Aging Hum Dev. 1994;38(2):99-115.
87.
Bazargan M, Hamm-Baugh VP. The relationship between chronic illness and depression in a community of urban 
black elderly persons. J Gerontol B Psychol Sci Soc Sci. 1995;50(2):S119-127.
88.
Bazargan M, Barbre AR. The effects of depression, health status, and stressful life-events on self-reported 
memory problems among aged blacks. Int J Aging Hum Dev. 1994;38(4):351-362.
89.
Assari S, Smith J, Bazargan M. Depression Fully Mediates the Effect of Multimorbidity on Self-Rated Health for 
Economically Disadvantaged African American Men but Not Women. Int J Environ Res Public Health. 2019;16(10).
90.
Adinkrah E, Bazargan M, Wisseh C, Assari S. Medication Complexity among Disadvantaged African American 
Seniors in Los Angeles. Pharmacy (Basel). 2020;8(2).
91.
Bazargan M, Baker RS, Bazargan SH. Sensory impairments and subjective well-being among aged African 
American persons. J Gerontol B Psychol Sci Soc Sci. 2001;56(5):P268-278.
92.
Assari S, Cobb S, Bazargan M. Race by Gender Differences in the Protective Effects of Education and Income 
Against Subsequent Changes in Self-rated Health, Physical Activity, and Body Mass Index Among Older 
Americans. J Health Econ Dev. 2019;1(2):9-21.
93.
Assari S, Bazargan M. Race/Ethnicity, Socioeconomic Status, and Polypharmacy among Older Americans. 
Pharmacy (Basel). 2019;7(2).
 
IRBNet #: 1663247-2
Approved by: CDU IRB
Approval Period: April 23, 2021 to  

94.
Bazargan M, Barbre AR. Self reported memory problems among the Black elderly. 
‐
Educational Gerontology: An 
International Quarterly. 1992;18(1):71-82.
95.
Bazargan M, Barbre AR. Knowledge of medication use among black elderly. Journal of Aging and Health. 
1992;4(4):536-550.
96.
Hamm VP, Bazargan M, Barbre AR. Life-style and cardiovascular health among urban Black elderly. Journal of 
applied gerontology. 1993;12(2):155-169.
97.
Bazargan M, Bazargan S. Self-reported memory function and psychological well-being among elderly African 
American persons. Journal of Black Psychology. 1997;23(2):103-119.
98.
Bazargan M, Bazargan SH, Akanda M. Gambling habits among aged African Americans. Clinical Gerontologist. 
2001;22(3-4):51-62.
99.
Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a 
systematic review protocol. BMJ Open. 2016;6(3):e010989.
100.
Fisher WA, JD Fisher JD, Harman J, eds. The information-motivation-behavioral skills model: A general social 
psychological approach to understanding and promoting health behavior. MA  -  pp. 82–106: Blackwell Publisher; 
2003. Suls J, Wallston KA, eds. Social Psychological Foundations of Health and Illness.
101.
Mayberry LS, Osborn CY. Empirical validation of the information-motivation-behavioral skills model of diabetes 
medication adherence: a framework for intervention. Diabetes care. 2014;37(5):1246-1253.
102.
Osborn CY, Egede LE. Validation of an Information-Motivation-Behavioral Skills model of diabetes self-care (IMB-
DSC). Patient education and counseling. 2010;79(1):49-54.
103.
Zarani F, Besharat MA, Sarami G, Sadeghian S. An information-motivation-behavioral skills (IMB) model-based 
intervention for CABG patients. International journal of behavioral medicine. 2012;19(4):543-549.
104.
Jacobs RJ, Caballero J, Ownby RL, Kane MN. Development of a culturally appropriate computer-delivered tailored 
Internet-based health literacy intervention for Spanish-dominant Hispanics living with HIV. BMC medical 
informatics and decision making. 2014;14:103.
105.
Spoelstra SL, Given CW, Sikorskii A, et al. A randomized controlled trial of the feasibility and preliminary efficacy 
of a texting intervention on medication adherence in adults prescribed oral anti-cancer agents: study protocol. 
Journal of advanced nursing. 2015.
106.
Alexander DS, Hogan SL, Jordan JM, DeVellis RF, Carpenter DM. examining whether the information–motivation–
behavioral skills model predicts medication adherence for patients with a rare disease. Patient preference and 
adherence. 2017;11:75.
107.
Moral RR, Torres LA, Ortega LP, et al. Effectiveness of motivational interviewing to improve therapeutic 
adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care. 
Patient education and counseling. 2015;98(8):977-983.
108.
Osborn CY, Egede LE. Validation of an information–motivation–behavioral skills model of diabetes self-care (IMB-
DSC). Patient education and counseling. 2010;79(1):49-54.
109.
Wells AA, Shon E-J, McGowan K, James A. Perspectives of low-income African-American women non-adherent to 
mammography screening: the importance of information, behavioral skills, and motivation. Journal of Cancer 
Education. 2017;32(2):328-334.
110.
Mayberry LS, Osborn CY. Empirical validation of the information–motivation–behavioral skills model of diabetes 
medication adherence: a framework for intervention. Diabetes care. 2014;37(5):1246-1253.
111.
Dean CA, Geneus CJ, Rice S, et al. Assessing the significance of health information seeking in chronic condition 
management. Patient education and counseling. 2017;100(8):1519-1526.
112.
Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann 
Fam Med. 2018;16(3):240-245.
113.
Han HR, Kim K, Murphy J, et al. Community health worker interventions to promote psychosocial outcomes 
among people living with HIV-A systematic review. PLoS One. 2018;13(4):e0194928.
114.
NIH: National Institute of Environmental Health Sciences. NIH Public Health Emergency and Disaster Research 
Response (DR2) (Accessed June 2020). https://dr2nlmnihgov/search/?q=&data_type=10. 2020.
115.
Fagerland MW, Lydersen S, Laake P. The McNemar test for binary matched-pairs data: mid-p and asymptotic are 
better than exact conditional. BMC medical research methodology. 2013;13(1):91.
116.
Rosner B. Fundamentals of biostatistics. 2011. Brooks/Cole, Boston. 2011.
 
IRBNet #: 1663247-2
Approved by: CDU IRB
Approval Period: April 23, 2021 to  

117.
Thomson JL, Tussing-Humphreys LM, Landry AS, Goodman MH. No Improvements in Postnatal Dietary Outcomes 
Were Observed in a Two-Arm, Randomized, Controlled, Comparative Impact Trial among Rural, Southern, 
African-American Women. J Acad Nutr Diet. 2018;118(7):1196-1207.
118.
Wilbur J, McDevitt J, Wang E, et al. Recruitment of African American women to a walking program: eligibility, 
ineligibility, and attrition during screening. Res Nurs Health. 2006;29(3):176-189.
 
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