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.
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