Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial

Boulware, L. Ebony; Ephraim, Patti L.; Hill-Briggs, Felicia; Roter, Debra; Bone, Lee R.; Wolff, Jennifer L.; Lewis-Boyér, LaPricia; Levine, David M.; Crews, Deidra C.; Gudzune, Kimberly A.; Albert, Michael; Ramamurthi, Hema C.; Ameling, Jessica M.; Davenport, Clemontina A.; Lee, Hui Jie; Pendergast, Jane; Wang, Nae Yuh; Carson, Kathryn A.; Sneed, Valerie; Gayles, Debra; Flynn, Sarah; Monroe, Dwyan; Hickman, Debra L.; Purnell, Leon; Simmons, Michelle; Fisher, Annette; DePasquale, Nicole; Charleston, Jeanne; Aboutamar, Hanan J.; Cabacungan, Ashley; Cooper, Lisa A.

doi:10.1007/s11606-019-05396-7

Cited by 27 publications

(55 citation statements)

References 41 publications

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“…67 Three additional SDM intervention studies measured clinical outcomes. 62,64,72 Two studies saw no differences, and 1 study found that blood pressure improved more in the intervention arm. 62…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

et al. 2021

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Background The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. Purpose To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. Data Sources MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. Study Selection Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. Data Extraction Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. Data Synthesis Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I2 = 0%]). PtDAs reduced decisional conflict (mean difference = −9.59; 95% CI −18.94, −0.24 [I2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI −0.22, 0.26 [I2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. Limitations Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. Conclusions PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective. [Box: see text]

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Section: Resultsmentioning

confidence: 99%

“…36–60 An additional 13 studies of SDM interventions were included in the secondary analysis (Figure 1). 61–73…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

et al. 2021

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“…The ACT study was a blood pressure control self-management comparative effectiveness trial conducted from September 2013 to July 2015 among African Americans with uncontrolled hypertension in Baltimore, Maryland. [22][23][24] This study was a three-arm randomized comparative effectiveness trial that sought to determine the relative effectiveness of behavioral interventions to improve blood pressure control among low-income African Americans with uncontrolled hypertension receiving primary care at a community-based clinic affiliated with a large health system in Baltimore. Intervention components included use of community health workers (all arms), a brief patient and family activation intervention delivered one-on-one in the clinical setting (one arm), and a problem-solving intervention delivered in groups (one arm).…”

Section: The Parent Study: the Achieving Blood Pressure Control Togetmentioning

confidence: 99%

“…Intervention components included use of community health workers (all arms), a brief patient and family activation intervention delivered one-on-one in the clinical setting (one arm), and a problem-solving intervention delivered in groups (one arm). [22][23][24] Of the 11 index patients, 3 participated in the CHW-only intervention, 2 in the CHW intervention plus the patient and family activation intervention, and 6 in the CHW intervention plus group problem-solving intervention.…”

Section: The Parent Study: the Achieving Blood Pressure Control Togetmentioning

confidence: 99%

“…20,21 However, these interventions focus on an index patient Leveraging Family Dynamics to Impact Behavior Change -Yang et al regarding these interventions. 22,24 All participants in the parent study were followed by a community health worker (CHW). That is, at least one of the two CHWs had contact with each of the parent study participants across all three arms of the disease management comparative effectiveness trial.…”

Section: The Parent Study: the Achieving Blood Pressure Control Togetmentioning

confidence: 99%

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Leveraging Delivery of Blood Pressure Control Interventions among Low-income African American Adults: Opportunities to Increase Social Support and Produce Family-level Behavior Change

et al. 2019

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Purpose: Few family-oriented cardiovascular risk reduction interventions exist that leverage the home environment to produce health behavior change among multiple family members. We identified opportunities to adapt disease self-management interventions included in a blood pressure control comparative effectiveness trial for hypertensive African American adults to address family-level factors.Methods: We conducted and analyzed semi-structured interviews with five intervention study staff (all study interventionists and the study coordinator) between December 2016 and January 2017 and with 11 study participants between September and November 2015.1 All study staff involved with intervention delivery and coordination were interviewed. We sampled adult participants from the parent study, and we analyzed interviews that were originally obtained as part of a previous study based on their status as a caregiver of an adolescent family member.1Results: Thematic analysis identified family influences on disease management and the importance of relationships between index patients and family members, between index patients and study peers, and between index patients and study staff through study participation to understand social effects on healthy behaviors. We identified four themes: 1) the role of family in health behavior change; 2) the impact of family dynamics on health behaviors; 3) building peer relationships through intervention participation; and 4) study staff role conflict.Conclusions: These findings inform development of family-oriented interventions to improve health behaviors among African American index patients at high risk for cardiovascular disease and their family members.Ethn Dis. 2019;29(4):549-558; doi:10.18865/ed.29.4.549

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Association of Perceived Neighborhood Health With Hypertension Self-care

et al. 2023

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ImportanceHypertension self-management is recommended for optimal blood pressure (BP) control, but self-identified residential contextual factors that hinder hypertension self-care are understudied.ObjectiveTo quantify perceived neighborhood health and hypertension self-care and assess interactions with the area deprivation index (ADI) and healthy food availability at home.Design, Setting, and ParticipantsA cross-sectional study was conducted in Baltimore, Maryland, including primary care adults enrolled in the Achieving Blood Pressure Control Together trial between September 1, 2013, and June 30, 2014. Participants were Black and had at least 2 BP readings greater than or equal to 140/90 mm Hg in the 6 months before enrollment. Analyses were conducted from August 5, 2021, to January 28, 2022.ExposuresParticipants’ perceived neighborhood health, defined as the mean standardized score across 4 subdomains of aesthetic quality, walkability, safety, and violence, with a higher score signifying better neighborhood health.Main Outcomes and MeasuresHypertension self-care behavior and self-efficacy. Multivariable generalized linear models were fit regressing each outcome on perceived neighborhood health (higher scores on each domain signify better perceived neighborhood health), adjusted for confounders, and interaction terms between neighborhood health and potential modifiers (ADI [higher percentiles correspond to more deprivation] and healthy food availability [higher scores indicate greater availability]) of the primary association were included.ResultsAmong 159 participants (median [IQR] age, 57 [49-64] years; mean [SD] age, 57 (11) years; 117 women [74%]), median (IQR) hypertension self-care behavior was 50 (45-56) and self-efficacy was 64 (57-72). Better perceived neighborhood health was associated with greater hypertension self-care behavior (β, 2.48; 95% CI, 0.63-4.33) and self-efficacy (β, 4.42; 95% CI, 2.25-6.59); these associations persisted for all neighborhood health subdomains except aesthetic quality. There were no statistically significant interactions between perceived neighborhood health or its subdomains with ADI on self-care behavior (P = .74 for interaction) or self-efficacy (P = .85 for interaction). However, better perceived neighborhood aesthetic quality had associations with greater self-care behavior specifically at higher healthy food availability at home scores: β at −1 SD, −0.29; 95% CI, −2.89 to 2.30 vs β at 1 SD, 2.97; 95% CI, 0.46-5.47; P = .09 for interaction). Likewise, associations of perceived worse neighborhood violence with lower self-care behavior were attenuated at higher healthy food availability at home scores (β for −1 SD, 3.69; 95% CI, 1.31-6.08 vs β for 1 SD, 0.01; 95% CI, −2.53 to 2.54; P = .04 for interaction).Conclusions and RelevanceIn this cross-sectional study, better perceived neighborhood health was associated with greater hypertension self-care among Black individuals with hypertension, particularly among those with greater in-home food availability. Thus, optimizing hypertension self-management may require multifaceted interventions targeting both the patients’ perceived contextual neighborhood barriers to self-care and availability of healthy food resources in the home.

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Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial

Cited by 27 publications

References 41 publications

A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

Leveraging Delivery of Blood Pressure Control Interventions among Low-income African American Adults: Opportunities to Increase Social Support and Produce Family-level Behavior Change

Association of Perceived Neighborhood Health With Hypertension Self-care

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