Cardiovascular disease is the leading cause of death for all persons living in the United States, and hypertension (HTN) is a strong risk factor. Uncontrolled HTN is more likely among Blacks, Hispanics, and the poor. We need new interventions to improve HTN control and narrow persistent racial/ethnic gaps. Community health workers (CHWs) represent patient groups they serve in terms of language, culture, and social situation. While there is tremendous potential for CHWs to assist patients with adherence to chronic disease self-management regimens, this potential has yet to been fully realized. This project builds on our prior research demonstrating that CHWs in community health centers can work directly with people with diabetes to improve self-management goal setting for diet, exercise, and medication adherence. More specifically, we will integrate a new and powerful behavior-change tool in the CHWs'armamentarium: storytelling by "patients like me." CHWs, sharing a common cultural background with their communities, are well-suited to share these stories and use them in discussion grounded in motivational interviewing.
Our Specific Aims are to: (1) Based on interviews with patients who have brought previously uncontrolled HTN under control, create four interactive storytelling DVDs, two in English and two in Spanish, to be used as a tool for CHWs to (a) engage participants to make behavioral changes appropriate for HTN management (2 DVDs) and (b) sustain these changes (2 DVDs);(2) Enhance our CHW training to (a) focus on long-term HTN control, (b) use storytelling DVDs by CHWs as a behavior-change tool, and (c) increase motivational interviewing skill building;and (3) At each of two CHCs serving minority and low income patients, recruit and follow for 18 months 126 randomly selected participants (total intervention N=252) to evaluate changes in blood pressure and, secondarily, in self-management goal setting and overall CVD risk attributable to the enhanced CHW intervention. Using propensity score approaches, a comparison group unexposed to the intervention will account for secular changes and willingness to participate in the study. Because storytelling is an innate human ability, our approach is relevant for other conditions and settings.
Uncontrolled hypertension is a leading cause of morbidity and mortality, substantially contributing to well described health disparities. Using community health workers in federally qualified health centers, this project will develop and test an innovative storytelling intervention to improve hypertension control among patients from under-represented groups.
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