• L Ebony Boulware, Patti L Ephraim, Felicia Hill-Briggs, Debra L Roter, Lee R Bone, Jennifer L Wolff, LaPricia Lewis-Boyer, David M Levine, Raquel C Greer, Deidra C Crews, Kimberly A Gudzune, Michael C Albert, Hema C Ramamurthi, Jessica M Ameling, Clemontina A Davenport, Hui-Jie Lee, Jane F Pendergast, Nae-Yuh Wang, Kathryn A Carson, Valerie Sneed, Debra J Gayles, Sarah J Flynn, Dwyan Monroe, Debra Hickman, Leon Purnell, Michelle Simmons, Annette Fisher, Nicole DePasquale, Jeanne Charleston, Hanan J Aboutamar, Ashley N Cabacungan, and Lisa A Cooper.
• Division of General Internal Medicine, Department of Medicine,  Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA. ebony.boulware@duke.edu.
• J Gen Intern Med. 2020 Jan 1; 35 (1): 142152142-152.

BackgroundEffective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others.ObjectiveWe studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans.DesignRandomized comparative effectiveness trial.ParticipantsOne hundred fifty-nine African Americans at an urban primary care clinic.InterventionsParticipants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving").Main MeasuresWe assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy.Key ResultsBP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months.ConclusionA context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control.Trial RegistryClinicalTrials.gov Identifier: NCT01902719.

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