MyHEART: A Non Randomized Feasibility Study of a Young Adult Hypertension Intervention

Abstract

BackgroundIn the United States, young adults (18–39 year-olds) have the lowest hypertension control rates (35%) compared to middle-aged (58%) and older (54%) adults. Ambulatory care for hypertension management often focuses on medication with little time for self-management and behavioral counseling. This study was designed to evaluate the feasibility of MyHEART, a telephone-based health coach self-management intervention for young adults. The goals were to determine the intervention’s ability to: 1) recruit young adults with uncontrolled hypertension, 2) maintain ongoing communication between the coach and participants, 3) increase participants’ engagement in self-management, 4) document coach-patient communication in the electronic health record, and 5) assess patient acceptability.MethodsEligible participants were identified through the electronic health record. Inclusion criteria included 18–39 year-olds, with ICD-9 hypertension diagnoses and uncontrolled hypertension (≥ 140/90 mmHg), receiving regular primary care at a large multispecialty group practice. The intervention consisted of 6 telephone self-management sessions by a health coach targeting lifestyle modifications. Patients completed an open-ended acceptability survey.ResultsStudy uptake was 47% (9 enrolled/19 eligible). Mean (SD) age was 35.8 (2.6) years, 78% male, and 33% Black. Over 85% of enrolled young adults maintained communication with their health coach. At baseline, 11% reported checking their blood pressure outside of clinic; 44% reported blood pressure monitoring after the study. All coach-patient encounters were successfully documented in the electronic health record for primary care provider review. Open-ended responses from all surveys indicated that participants had a positive experience with the MyHEART intervention.ConclusionsThis study demonstrated that MyHEART was feasible and acceptable to young adults with uncontrolled hypertension. Health coaches can effectively maintain ongoing communication with young adults, document communication in the electronic health record, and increase engagement with home blood pressure monitoring. The results of this study will inform a multi-center young adult randomized controlled trial of MyHEART.

The importance of frequent return visits and hypertension control among US young adults: a multidisciplinary group practice observational study

“…Unfortunately, young adults may have difficulty in adhering to the recommended frequency as a result of visit copayments, childcare needs, school, and/or work schedules. Prior studies have suggested using telephone follow‐up and team‐based care to bridge follow‐up visits and support hypertension care delivery in this hard‐to‐reach population.…”

My Hypertension Education and Reaching Target (MyHEART): Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension

“…Prior studies [ 31 , 32 , 37 ] that informed the MyHEART website development were approved by the University of Wisconsin-Madison Health Sciences Institutional Review Board (IRB) and informed consent was obtained from patient and clinician stakeholders. Neither IRB approval nor written consent were needed to design or implement this website because the data that informed MyHEART development was already described in the original IRB submission for the prior studies.…”

Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

“…The names and contact information of potentially eligible patients were made available to the respective study coordinators at each site. The site coordinators will mail an introductory research packet, which was designed by racially/ethnically diverse patient stakeholders, approved by primary care leaders, and used in the pilot study [48]. The introductory packet includes a flyer summarizing MyHEART and a pre-paid opt-out postcard.…”

“…To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension [48]. MyHEART is a patient-centered program that uses evidence-based health behavior approaches to lower blood pressure.…”

“…SDT acknowledges that young adults are more likely to adopt and maintain health behaviors with: 1) autonomous (internal) motivation, instead of external motivation (i.e., external pressure), 2) relatedness (i.e., supportive healthcare interactions), and 3) perceived self-competence (i.e., perceived self-efficacy [51,52]; confidence in starting and maintaining behaviors to reach a goal) [50,[53][54][55][56][57][58][59]. We successfully conducted a 3-month pilot study of MyHEART to establish feasibility and participant satisfaction [48], which informed the design of this multisite randomized controlled trial.…”