African Americans represent a particularly vulnerable subgroup of persons with hypertension, as they are more likely than Whites to have hypertension, equally as likely to be aware of it and to be treated for it, but less likely to achieve blood pressure control while receiving treatment. African Americans are also more likely than Whites to suffer end organ damage as a result of hypertension. Patients' hypertension self-management behaviors (including adherence to prescribed care, self-blood pressure monitoring, lifestyle changes, and shared medical decision-making) represent a cornerstone of hypertension therapy. Evidence suggests some African Americans with hypertension may experience difficulties carrying out positive self-management behaviors, in part due to cultural beliefs and practices, knowledge and perceptions regarding the nature and consequences hypertension, and lack of systems to support ongoing engagement in prescribed care within their communities. Substantial evidence has demonstrated the important role of family and community support in improving patients' management of a variety of chronic illnesses. However, studies of multilevel interventions designed to specifically improve African American patients' blood pressure self-management by simultaneously harnessing patient, family and community strengths are lacking. Rigorously designed and tested interventions to enhance and sustain African American patients' blood pressure self-management are needed. The goal of this study is to develop and rigorously test the effectiveness of an intervention that simultaneously engages patient, family and community-level strengths to improve African American hypertensive patients' blood pressure by enhancing their sustained performance of hypertension self-management behaviors. A patient-centered intervention will be developed using principles of community-based participatory research and will address predisposing factors that pose barriers to patients' performance of self-management behaviors. The intervention will enable patients' self-management behaviors by providing patients skills in self-management and problem solving to help them overcome barriers to self-management. The intervention will reinforce patients' self-management behaviors through the additional training of family members in self-management and problem solving and by encouraging families to support and reinforce patients' self-management behaviors. Community health workers will also reinforce self-management and problem-solving skills learned by patients and will enable barrier resolution by providing patients with information regarding community resources to overcome common barriers to self-management behaviors. We will assess the interventions' clinical effectiveness as well as its cost-effectiveness and long-term sustainability. Our team, which has extensive expertise in the areas of educational and behavioral interventions in hypertension self-management and community based participatory research methods is well-poised for the successful attainment of study goals.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Specialized Center (P50)
Project #
5P50HL105187-03
Application #
8378262
Study Section
Special Emphasis Panel (ZCA1-SRLB-3)
Project Start
Project End
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
3
Fiscal Year
2012
Total Cost
$370,471
Indirect Cost
$150,057
Name
Johns Hopkins University
Department
Type
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Cooper, Lisa A; Purnell, Tanjala S; Ibe, Chidinma A et al. (2016) Reaching for Health Equity and Social Justice in Baltimore: The Evolution of an Academic-Community Partnership and Conceptual Framework to Address Hypertension Disparities. Ethn Dis 26:369-78
Hussain, Tanvir; Franz, Whitney; Brown, Emily et al. (2016) The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study. Ethn Dis 26:285-94
Miller 3rd, Edgar R; Cooper, Lisa A; Carson, Kathryn A et al. (2016) A Dietary Intervention in Urban African Americans: Results of the ""Five Plus Nuts and Beans"" Randomized Trial. Am J Prev Med 50:87-95
Smith, Caren E; Fullerton, Stephanie M; Dookeran, Keith A et al. (2016) Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities. Health Aff (Millwood) 35:1367-73
Kan, Athena Wing-ga; Hussain, Tanvir; Carson, Kathryn A et al. (2015) The Contribution of Age and Weight to Blood Pressure Levels Among Blacks and Whites Receiving Care in Community-Based Primary Care Practices. Prev Chronic Dis 12:E161
Siddiqui, Mona; Cooper, Lisa A; Appel, Lawrence J et al. (2015) Recruitment and enrollment of African Americans and Caucasians in a health promotion trial for persons with serious mental illness. Ethn Dis 25:72-7
Hayward, Erin; Ibe, Chidinma; Young, Jeffery Hunter et al. (2015) Linking social and built environmental factors to the health of public housing residents: a focus group study. BMC Public Health 15:351
Hararah, Mohammad Khalid; Pollack, Craig Evan; Garza, Mary A et al. (2015) The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries. J Racial Ethn Health Disparities 2:176-83
Hussain, Tanvir; Allen, Allyssa; Halbert, Jennifer et al. (2015) Provider perspectives on essential functions for care management in the collaborative treatment of hypertension: the P.A.R.T.N.E.R. framework. J Gen Intern Med 30:454-61
Cooper, Lisa A; Ortega, Alexander N; Ammerman, Alice S et al. (2015) Calling for a bold new vision of health disparities intervention research. Am J Public Health 105 Suppl 3:S374-6

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