M ore than 65 million American adults have hypertension.1 Diet, exercise, and drugs are mainstays of hypertension management. 2 The efficacy of hypertension treatment in preventing cardiovascular events is established.2 Although the system and provider interventions have improved blood pressure (BP) control rates from the previous low rate (27% 3 ) to more respectable rates (51% 1 to 79% 4,5 ), the substantial proportion remains uncontrolled. However, we may have reached the maximum control achievable with nontailored interventions targeting clinics or hospitals with growing concerns that such interventions may lead to overtreatment and adverse outcomes. 4,6 To optimize hypertension control further, approaches to identify and target patients at risk, to whom appropriately tailored therapy can then be offered, are needed.Suboptimal adherence is a common, but modifiable, problem leading to inadequate hypertension control. Fewer than 10% of adults with hypertension adhere fully to diet recommendations, 7 ≈35% exercise regularly, 8 and only 50% to 60% are fully medication adherent.9 In-person counseling to improve adherence requires time and is labor-intensive and costly. Telephone counseling offers a promising alternate approach, 10 and such counseling can be delivered at a convenient time and setting. 11Telephone interventions have improved medication adherence, 12,13 physical activity, 14 and diet, 15 all key to lowering BP. It is not known, however, whether novel theory-based behavioral interventions can be delivered by telephone and whether they are effective in busy, clinical settings.We conducted a randomized controlled trial to evaluate the effectiveness of targeting patients with repeated uncontrolled hypertension with either a tailored or a nontailored intervention in improving hypertension control and systolic blood pressure (SBP). Methods Design, Setting, and ParticipantsThe study was a randomized controlled trial to evaluate whether a telephone-delivered, behavioral stage-matched intervention (SMI) or a nontailored health education intervention (HEI) would lead to better BP control than usual care (UC) in patients with uncontrolled BP.The study was approved by the institutional review board. All participants provided written informed consent. Procedures were See Editorial Commentary, pp 273-275Abstract-Blood pressure (BP) control rates are suboptimal. We evaluated the effectiveness of 2 behavioral interventions to improve BP control via a 3-arm, randomized controlled trial of 533 adults with repeated uncontrolled BP, despite antihypertensive drug treatment for ≥6 months. The interventions were a tailored stage-matched intervention (SMI) or a nontailored health education intervention (HEI) of 6 monthly calls targeting diet, exercise, and medication. Control was usual care (UC). There were no baseline group differences.

BackgroundAlthough early intervention (EI) practitioners emphasise the importance of individualised family‐centred services for families of children with developmental delay (DD), few empirical studies have evaluated whether EI can improve family quality of life (FQOL). This study aimed to investigate the trajectory of FQOL and its predictors among families of children with DD during the first 12 months of EI.MethodsThis study employed a prospective cohort design. Data were collected using structured questionnaires at the placement meeting before the commencement of EI, as well as 3, 6 and 12 months later. We recruited 142 primary caregivers of children with DD in northern Taiwan from March 2015 to August 2016. FQOL was measured using the Mandarin Chinese version of the Beach Centre FQOL Scale. Family resilience (FR) was measured using the Mandarin Chinese version of the FR Assessment Scale. Other independent variables included socio‐demographics, type of DD and EI services. Generalised estimating equations were used to perform multivariate analysis.ResultsFamily quality of life exhibited a significant quadratic trend in the 12 months surrounding EI. The score was the lowest before EI started (89.85), then increased to peak (94.87) at 6 months and then decreased slightly to 92.34 at 12 months. FR followed a significantly increased linear trend during the period. There were significant and positive correlations between FQOL and FR across all time points. Multivariate analysis showed that employed caregivers, FR, sufficient caregiving manpower and satisfaction with marital quality were positively associated with FQOL. Receiving more types of EI services and having fathers who were not Taiwanese nationals were negatively associated with FQOL.ConclusionsFamily quality of life and FR increased significantly after receiving EI, revealing the latter's effectiveness. Unemployment, poor marital quality, father being an immigrant, low FR and insufficient family caregiving manpower were associated with lower FQOL, suggesting that these families require more assistance.