A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans

Abstract

Background Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes. Methods This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months. Results The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P =.049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P =.98) and diastolic BP (−1.59 mm Hg vs −0.78 mm Hg; P=.45) for the PA group and PE group, respectively, was not significant. Conclusions A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration clinicaltrials.gov Identifier: NCT00227175

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…Telemonitoring interventions included use of SMBP and telephone counseling, 37 SMBP plus weight and exercise self-monitoring, 30 SMBP in combination with telecounseling that targeted blood pressure [BP] goals, 27 use of medication protocol adjustments that targeted BP goals and BP transmitted from SMBP by participants, 38 and SMBP plus tailored lifestyle modification (eg, DASH [Dietary Approaches to Hypertension] diet, medication use). 29 Behavioral interventions reported in 6 articles 28,34,36,[39][40][41] did not include the use of SMBP. Nurses most frequently provided the TPE to patients with hypertension, delivering TPE by telephone or in person.…”

“…Behavioral research interventions included hypertension self-management-tailored education based on stage of change, 34 culturally appropriate nurse-led lifestyle interventions for African immigrants, 28 Mediterranean diet counseling and ambulatory BP monitoring, 36 and the use of self-affirmation to overcome medication adherence barriers. 39 Two studies implemented team-led and team-delivered behavioral interventions. Team approaches in 2 studies included participants' use of a hypertension selfmanagement tool kit (eg, pedometer, BP monitoring wallet card) 40 and use of motivational interviewing in the clinic and with follow-up telephone peer coaching.…”

Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial (Preprint)

“…In two studies comparing an education control (i.e., educational workbook and behavioral contract) to a positive affect intervention (i.e., selfaffirmation inducement over bi-monthly telephone sessions with staff and unexpected gifts prior to calls), positive affect improved medication adherence in hypertensive African American patients [51], and physical activity in patients following a percutaneous coronary procedure [52].…”

Positive affect and incident dementia among the old

“…[15] In another randomized controlled trial in medical care settings, researchers demonstrated that patient education intervention enhanced with positive-affect induction and self-affirmation was more effective than patient education alone in improving medication adherence and blood pressure reduction among 256 hypertensive African Americans. [16] Positive affect is also associated with better health. For example, Hirosaki et al demonstrated the effect of positive affect against functional decline.…”