Hypertension (HTN) accounts for the greatest portion of racial disparities in mortality between blacks and whites. Poor BP control in blacks is attributed to higher prevalence of adverse lifestyle behaviors such as lack of physical activity, high sodium intake, poor intake of fruits and vegetables. Despite compelling evidence of the beneficial effects of therapeutic lifestyle changes (TLC) on BP reduction, their effectiveness in community-based settings remains untested, particularly in churches - an influential institution for health promotion in black communities. We address this gap in the literature by testing the effect of a church-based lifestyle intervention on BP reduction in 400 hypertensive blacks (BP>140/90 mm hg). The intervention, delivered through group classes and motivational interviewing (MINT-TLC) will be compared to an attention control condition (CC). 20 churches will be randomly assigned equally to either group. We hypothesize that subjects in MINT-TLC group will exhibit at 6 months, greater BP reduction;more physical activity;increased intake of fruits and vegetables;greater within-participant weight reduction;a higher proportion with adequate BP control (9 months). Subjects in the CC group will receive group health education classes that will be delivered by experts on various health topics unrelated to hypertension. In addition to the lectures, participants in the churches randomized to the health education CC condition will receive print versions of the NHLBI publications "Your Guide to Lowering Blood Pressure";and "Facts about the DASH Eating Plan." Those in the MINT-TLC will attend weekly group classes focused on TLC for 12 weeks (intensive phase);plus monthly individual motivational interviewing sessions for three months (maintenance phase). MINT-TLC is designed to help participants make appropriate TLC and develop skills to maintain these changes long-term. MINT-TLC will be delivered by trained Lay Health Advisors recruited from the churches. The primary outcome is within-subject change in BP from baseline to 6 months. Secondary outcomes are levels of targeted lifestyle behaviors;and proportion with adequate BP control at 9 months (BP<140/90 mm Hg). Regardless of group assignments, all outcomes will be assessed at baseline, 3, 6, and 9 months (for BP control only) with well-validated procedures and measures. BP will be assessed with an automated digital BP monitor. Lifestyle behaviors will be assessed with NCI's brief fruit/vegetable and fat dietary assessment questionnaires and the 7-day physical activity recall. Weight loss will be the difference in weight between baseline and 6 months. The long-term goal is to refine and integrate MINT-TLC into standard practices delivered by LHA in black churches.
If successful, the findings from this study will provide much-needed information on the translation and sustainability of therapeutic lifestyle modification in hypertensive patients in community-based settings, particularly within churches, which represent the most influential institution in the community lives of blacks. We believe that the concept of testing the effectiveness of well-proven efficacious lifestyle interventions in community-based settings utilizing a collaborative partnership approach in addition to a multi-disciplinary team of investigators is innovative and addresses the goals of the NIH road map concerning the translation of research into public health practice.
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