The objective of this population based clinical trial is to investigate whether a health education program, developed in partnership with the community and delivered by nurse supervised community health workers (CHWs), lowers high blood pressure (HBP) in inner city African American adults. This two and a half year intervention trial seeks to extend and test the generalizability of our prior work, in a similar inner city African American community, which demonstrated the efficacy of planned health education programs that are culturally-sensitive, community-based and owned, and built upon appropriate behavioral and community activation theory and principles, in improving the control of HBP and decreasing related morbidity and mortality. Participants will be recruited from households in neighborhood blocks randomly assigned to a more less intensive educational-behavioral intervention. Both groups will receive usual medical care, community HBP education, and HBP patient education materials. In addition, the more intensive group will receive 1) individualized educational counseling sessions with the CHW to increase understanding of HBP and to address barriers to control of HBP; 2) outreach and follow-up to address inadequate health care resources and health behavior related skills through interim monitoring and education """"""""booster"""""""" sessions; and 3) mobilization of social support from a family member/friend identified by the participant as the primary source of daily reinforcement. Five hundred males and five hundred females will be recruited. Statistical analysis will focus on BP change in all adults with HBP on randomized blocks whether or not they participated in either of the intervention groups (program effectiveness), as well as BP change in all adults participating in the two interventions regardless of their level of compliance (intervention efficacy). In addition, the analysis will focus on differences in the two groups regarding individuals' adherence to HBP lowering recommendations to enter/re-enter care, remain in care, modify lifestyle, and take HBP medication. Multiple regression will be done to determine the contribution of the changes in the major independent variables (perceived barriers, use of health care resources and health care skills, and social support) to changes in the outcome and intervening variables which include adherence to HBP lowering recommendations. This population based study is significant because it offers a multidisciplinary, community HBP control program to help close the gap in health status for African Americans.
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| Kim, M T; Hill, M N; Bone, L R et al. (2000) Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Prog Cardiovasc Nurs 15:90-6 |
