This study proposes to development and evaluate a treatment protocol for- Shaping Cognitive Representations for Hypertensive Women. The high incidence of uncontrolled blood pressure (BP) in middle-aged African American women (AAW) who are being treated suggests chronic non-compliance with medical regimens. For some people, compliance is extremely difficult due to knowledge deficits, denial of need for treatment, inadequate access to health care and problems with interacting with health care providers. Studies have shown that individuals use enduring memories or cognitive representations (CRs) of beliefs, attitudes and intentions for behavior to structure knowledge for guiding decisions for behavior. CRs involve integration of perceptual stimuli for the purpose of appraising, coping, adapting, and learning. Research has not thoroughly examined whether cognitive representations of lifestyle behavior (CRLB) may be linked to non-compliance with hypertension (HTN) treatment. Preliminary data demonstrated that AAW manifested higher BP and more maladaptive cognitive representations of medication behavior (CRMB) than White American Women (WAW), and a theoretically-derived cognitive-behavioral intervention (CBI) may be effective in decreasing non-compliance and uncontrolled BP. The purpose of this proposed research is to test the effectiveness of a CBI in the management and modification of lifestyle behavior to improve responsiveness for HTN treatment among diverse populations. This pilot study addresses the following specific aims with measures at baseline and three months post intervention: 1) to evaluate the impact of a CBI on (a) compliance and (b) ambulatory BP measures (ABPM); 2) to evaluate the impact of a CBI on CRLB; 3) to assess subjects' perceived usefulness of a messages; and 4) to test whether the CBI has a greater impact on HTN treatment in AAW than WAW. A Solomon-four group design will be used to randomly assign women (N=28), stratified by racial identity, ages 55-70, with Stages I and II HTN recruited from ambulatory clinics to a CBI or standard medical therapy group. The CBI will require participants to perform a self-monitored in-home-learning program over 90 days. Outcomes that include compliance with life style behavior, CRLB, and ABPM will be measured at baseline and three months post intervention. Data will be analyzed using repeated measures ANOVA. Descriptive, parametric and non-parametric statistical procedures will be used to analyze the results and research hypothesis.
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