Almost 1 out of 3 American adults has high blood pressure (or hypertension), which increases the chance of developing heart disease, stroke, and other serious conditions. Many people with high blood pressure do not know they have it because it has no noticeable warning signs. Community Health Workers (CHWs) and technology may help people understand this condition, get appropriate medical care, take medicines regularly, and make healthy lifestyle changes.
Over 40% of African Americans have high blood pressure. In Harlem, New York City, which is 77% African American, researchers are studying the effectiveness of an integrated approach to controlling high blood pressure that combines the benefits of CHWs, locally tailored information, and computer technology. In an initiative called Project SHARE (Support for Hypertension Awareness, Reduction and Education), CHWs screen community residents for high blood pressure and help people who have it follow an action plan to make lifestyle changes that can reduce blood pressure.
The researchers are enrolling 450 adults aged 18-70 whose blood pressure is 130/85 mmHg or greater, recruiting them via telephone and at community centers, fairs, and other public places. One-third (150) of the participants receive general educational brochures about high blood pressure and serve as a control group. Another third of the participants are put into a self-directed learning group. They use a computer-based questionnaire program that determines their risk for cardiovascular disease and develops an action plan to change behaviors, such as tobacco use, eating habits, and physical activity, that can improve their blood pressure. They review their action plan with a CHW and receive tools to help improve awareness and self-management of high blood pressure. These tools include a workbook that contains information about high blood pressure and lists of local health care resources. The tools also include access to the GetHealthyHarlem.org website, where participants find culturally sensitive, tailored recommendations for blood pressure maintenance and view narratives about integrating lifestyle changes into busy lives.
The final third of the participants receive the workbook and website tools and use the computer questionnaire program, but in addition, a CHW follows up with participants for six months, guiding them as they learn about behavior changes that can improve their blood pressure. The CHW meets with them in person twice a month for the first two months, then alternates phone and in-person meetings every other week in month three. In months four and five, the CHW calls and emails the participants once per month. In month six, the CHW has their last in-person session with each participant. This gradual decrease in contact is designed to encourage self-learning and to help determine whether participants are making sustainable behavior changes. After six months, participants receive no CHW support.
Participants in all three groups are followed for one year. When participants begin the program, they get their blood pressure checked, and they complete a computer-based evaluation questionnaire that asks what they know about hypertension and its risk factors, what their attitude is about getting medical help for hypertension, and what behaviors they have changed, are changing, or would like to change to improve their blood pressure. Researchers will evaluate the effectiveness of the three approaches (brochures only, self-directed learning and CHW-assisted learning) by re-checking blood pressure and administering the same evaluation survey six months and one year after each participant begins the program. The researchers will determine how many patients lowered their blood pressure, took steps to lower their blood pressure, increased their knowledge about risk factors for high blood pressure, and felt better able to manage those risk factors. The results of this project may help the public health community determine the most effective and cost-effective methods of reducing high blood pressure, especially in communities of color where high blood pressure is most prevalent.