African Americans represent a particulariy 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 pafients' 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 pafient, 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 hvpertension 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 resolufion by providing pafients 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.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Specialized Center (P50)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-3)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
United States
Zip Code
Ameling, Jessica M; Ephraim, Patti L; Bone, Lee R et al. (2014) Adapting hypertension self-management interventions to enhance their sustained effectiveness among urban African Americans. Fam Community Health 37:119-33
Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A et al. (2014) Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships. Obesity (Silver Spring) 22:1952-5
López, Lenny; Golden, Sherita Hill (2014) A new era in understanding diabetes disparities among U.S. Latinos--all are not equal. Diabetes Care 37:2081-3
Ephraim, Patti L; Hill-Briggs, Felicia; Roter, Debra L et al. (2014) Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial. Contemp Clin Trials 38:370-82
Crews, Deidra C; Liu, Yang; Boulware, L Ebony (2014) Disparities in the burden, outcomes, and care of chronic kidney disease. Curr Opin Nephrol Hypertens 23:298-305
Price-Haywood, Eboni G; Harden-Barrios, Jewel; Cooper, Lisa A (2014) Comparative effectiveness of audit-feedback versus additional physician communication training to improve cancer screening for patients with limited health literacy. J Gen Intern Med 29:1113-21
Jackson, Chandra L; Yeh, Hsin-Chieh; Szklo, Moyses et al. (2014) Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes. J Gen Intern Med 29:25-33
Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A et al. (2014) Patients who feel judged about their weight have lower trust in their primary care providers. Patient Educ Couns 97:128-31
Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A et al. (2014) Perceived judgment about weight can negatively influence weight loss: a cross-sectional study of overweight and obese patients. Prev Med 62:103-7
Golden, Sherita Hill; Purnell, Tanjala; Halbert, Jennifer P et al. (2014) A community-engaged cardiovascular health disparities research training curriculum: implementation and preliminary outcomes. Acad Med 89:1348-56

Showing the most recent 10 out of 20 publications