Hypertension disproportionately affects and is inadequately controlled among minority and poor inner city populations. In prior work, we found that social contextual factors (poverty, social networks, social stressors, social services, community knowledge about hypertension) appear to be impediments to management of hypertension and that patients are interested in working with lay health advisors to address these factors. We now propose to 1) determine the social context of hypertension management; 2) train community residents to become hypertension lay health advisors; and 3) perform a pilot randomized controlled trial to test the utility of using lay health advisors to address the social context of hypertension management. To further understand the social context of hypertension management, we will conduct focus groups that are supplemented by pictures taken by subjects of their social context, an innovative methodology called photovoice. These results will be used to develop and implement a lay health advisor training program for 20 community residents. We will then conduct a pilot community-based randomized controlled trial involving 50 control and 50 intervention patients who have poor blood pressure control. Intervention patients will receive education and assistance from lay health advisors to help them become more skilled at managing hypertension within their social context. While it is unlikely that this intervention will change macro factors such as poverty, lay health advisors can help patients become more adept at tasks such as more effectively utilizing their social network or accessing health or social services. Control patients will continue to receive usual care. Major outcomes of interest after 6 months will include progress in addressing social contextual factors, changes in blood pressure and adherence to treatment, quality of life, and satisfaction with care. The proposed project is a novel approach to understand and help patients address the social contextual factors that affect their hypertension management. Future work will involve learning how to make the intervention more potent, conducting a full-scale trial, and determining the cost-effectiveness of lay health advisors as well as their impact on disparities in hypertension outcomes.
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