PROMOTING PATIENT HYPERTENSION SELF-MANAGEMENT BEHAVIORS WITH THE EVIDENCE-BASED PROGRAM, HEALTH COACHES FOR HYPERTENSION CONTROL

Abstract

Objective: To improve patient self-management of hypertension with a peer-led, community-based educational program which activates participants to make lifestyle changes by delivering personally relevant and meaningful information addressing psychosocial determinants of self-management behaviors. Design and method: The eight-session educational curriculum, Health Coaches for Hypertension Control (HCHC), was developed using the US National Institute of Health Stage Model approach to behavioral intervention development. In Stage II and III it was tested for efficacy through implementation with 146 participants using a pre- and posttest evaluation design including process, impact, and outcome measures. In Stage IV, it was evaluated for changes in knowledge and psychosocial measures using a batch randomization to intervention or wait-control group with 185 participants. Results: Stage IV research revealed that compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P < .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005. The US Department of Health and Human Services, Administration for Community Living designated HCHC as an Evidence-Based Program in 2018. Since that time, Stage V (“implementation and dissemination”) research has demonstrated that HCHC has been successfully disseminated both in-person and on-line in 15 US states. Conclusions: HCHC is recommended as an extension of clinical patient education to support increasing health system interest in promoting sustainable patient outcomes through effective self-management. An agency wishing to disseminate HCHC would need to secure a license agreement to use copyrighted materials and arrange for certification of Master Trainers by the HCHC program manager. Master Trainers may then offer HCHC themselves or train lay leaders to offer the program.