RESEARCH PROJECT #1 Hypertension disproportionately affects and is inadequately controlled among African American and poor populations. Health providers generally lack the skills and resources to address social contextual factors (i.e. health and community services, social networks, social stressors, physical environment, and economic resources) that influence management of hypertension. In prior work, we found that patients identify such social contextual factors as barriers to management of hypertension and are interested in working with lay health advisors to address these factors. We also developed and pilot tested culturally competent methods to train lay health advisors about hypertension and social contextual factors. We now propose to determine the impact of using trained lay health advisors to help patients address social contextual factors that influence hypertension management. Specifically, we propose a cluster randomized controlled trial involving 312 African American patients with poorly controlled hypertension at 8 clinics. Intervention patients will meet monthly in small groups with a trained lay health advisor. Lay health advisors will use an African American heritage theme as a framework to educate patients about blood pressure and hypertension treatment, will help patients better utilize their social networks or access health and social services, and will teach patients how to communicate more effectively with primary care physicians about barriers to hypertension management. Intervention patients within each group will also support each other in accomplishing these tasks. While our intervention is unlikely to eliminate fundamental causes of health disparities such as economic deprivation, segregated housing, or lack of affordable health care, our pilot work suggests that lay health advisors can help patients become more adept at taking advantage of the personal and community resources available to them. Control patients will continue to receive usual care for hypertension. Major outcomes after 12 months will include changes in blood pressure, hypertension knowledge and perceptions, medication adherence, health care interactions, and quality of life. We will also explore mechanisms that explain the relationship between intervention and changes in blood pressure, including the role of hypertension knowledge and perceptions (e.g. self-efficacy), specific health behaviors (e.g. medication adherence), and health care interactions (e.g. patient-provider communication) as mediators. The proposed project is a novel and promising approach to help patients address the social contextual factors that affect their hypertension management. Helping patients address these barriers may lead not only to improved blood pressure but also to increased survival, reduced organ damage, and decreased health care costs. The proposed project may also serve as a model for addressing other health disparity conditions.
