Despite improvements in hypertension control in VA, disparities remain. Control rates for minority veterans, in particular African-American veterans, are significantly lower. New interventions to improve hypertension control, therefore must focus on this at-risk population of veterans. Our previous qualitative study in hypertension, Communication, Culture and HTN management (CATCH) IIR 05-062) we identified unique patterns of patients'daily lived experience and cultural explanatory models of hypertension among African- American veterans. Daily lived experience includes ways in which patients'daily lives, routines, and habits influence their abilities to manage their HTN. We will evaluate an interactive multimedia intervention targeted to African-American patients, """"""""Stories to Communicate Risk about Hypertension."""""""" The intervention is delivered using an easy-to-use DVD resource and is based on storytelling - actual stories of patient experiences with hypertension. Theoretically, stories increase personal relevance for behavior change and reduce counter-arguing. The branching and interactive menus of the DVD will be used to target the health communication to the individual. Our previous, """"""""Stories"""""""" tool was developed with funding from the Robert Wood Johnson Foundation. This """"""""Stories"""""""" tool was evaluated in a randomized trial (n = 300) and found to result in a dramatic 6mmHg improvement in blood pressure, compared to comparison. In VA stories, we will advance on our prior research. We will collect stories from veterans, from three sites with a high prevalence of African-Americans.
Our Specific Aims are to: 1. Develop a series of interactive, stories-based interventions for African-American veterans that can be delivered on DVDs, to promote hypertension medication and dietary adherence, and patient engagement with providers. We will recruit African-American veterans at three geographically distributed VAMCs to participate in semi- structured qualitative interviews about their experiences managing hypertension. We will videotape these interviews and using the process tested in prior 'stories'studies, select exemplary stories (using convergent qualitative methods and quantitative coding using social cognitive theory), edit them and create the interactive DVDs. 2. Train research assistants to deliver the intervention DVDs in the context of clinical care. 3. Evaluate the impact of the intervention using the impact of the intervention on blood pressure, medication adherence, and doctor-patient communication in a randomized trial of African American veterans with uncontrolled hypertension recruited from three VA sites. Our main hypothesis is that at 6 months after enrollment, veterans randomized to the intervention will have greater reduction in blood pressure, as compared with control.
The Specific Aims of the project are to: 1. Develop a series of two interactive, stories-based interventions for African-American veterans that can be delivered on DVDs, to promote HTN medication and dietary adherence, and patient engagement with providers. 15 African-American veterans at three geographically distributed VAMCs will be interviewed and videotaped talking about their experiences managing HTN. The videotapes will be analyzed and exemplary stories will be selected to create the DVDs. 2. Evaluate the impact on blood pressure, medication adherence, and HTN management behaviors in a randomized controlled trial (RCT) of African- American veterans with uncontrolled HTN recruited from three VA sites. A two-arm RCT will be used to evaluate the effects of the intervention on blood pressure by comparing the stories intervention, and informational control (blood pressure education, non-narrative). The main hypothesis is that at six months after enrollment, veterans randomized to the intervention will have greater reduction in blood pressure, as compared with control.
As many veterans with uncontrolled HTN are African-American, the strategies we use to intervene necessitate cultural tailoring and attention to issues of health literacy and trust in the health care system. We will evaluate an interactive multimedia intervention targeted to African-American patients, Stories to Communicate Risk about Hypertension. The intervention is delivered using an easy-to-use DVD resource and is based on storytelling - actual stories of patient experiences with hypertension. Theoretically, stories increase personal relevance for behavior change and reduce counter-arguing. The branching and interactive menus of the DVD will be used to target the health communication to the individual. Designing interventions to improve on HTN self-management is a high priority. Supporting patient engagement and self-management are key components to the new patient-centered medical home initiatives in VA.
