This proposal requests funds for involving two minority students in research which utilizes a biopsychosocial model involving self-help groups in an effort to promote health care for hypertension and depression among the elderly. The model will include a treatment group of 40 hypertensive elderly (age >60) and a matching, randomly selected control group of 40 subjects each year for a total of 240 subjects over the three-year period. Subjects will be screened by the P.I. and two student trainees who will be designated as Community Health Counselors (CHCs) at churches where all self-help group meetings will also be held. A pre-test and post-test measure for high blood pressure and depression will be taken from all subjects. Hypertension will be defined as a systolic pressure of 160 mm. Hg or higher, a diastolic pressure equal to or above 95 mm. Hg, or both, and/or a verified physician's diagnosis that the subject is hypertensive and has been placed on medication. Treatment will consist of 40 subjects participating in a self-help group (20 subjects to a group) for hypertension which will be led (though not controlled) by a CHC team member (the P.I. and one student trainee. Two such teams will exist. As group members, subjects will experimentally learn the skills and knowledge necessary for the establishment of hypertensive self-help groups with self-governance once their 20 one-hour self-help group meetings are over. During the sessions subjects will discuss educational and technical materials related to hypertension, problem solving strategies for coping with stress, and ways to achieve higher drug compliance rates while providing support and reassurance to each other. Group cohesion and self-governance skills will be emphasized. Pill counts from prescription bottles will be done at each meeting. The matched control group will be asked to simply continue their usual treatment for hypertension. A follow-up of 3-6-9 months will determine if new self-help groups are to be formed. Three hypotheses will be experimentally tested at a .05 level of significance.
