Culturally Adapted Hypertension Education (CAHE) to Improve Blood Pressure Control and Treatment Adherence in Patients of African Origin with Uncontrolled Hypertension: Cluster-Randomized Trial

Abstract

ObjectivesTo evaluate the effect of a practice-based, culturally appropriate patient education intervention on blood pressure (BP) and treatment adherence among patients of African origin with uncontrolled hypertension.MethodsCluster randomised trial involving four Dutch primary care centres and 146 patients (intervention n = 75, control n = 71), who met the following inclusion criteria: self-identified Surinamese or Ghanaian; ≥20 years; treated for hypertension; SBP≥140 mmHg. All patients received usual hypertension care. The intervention-group was also offered three nurse-led, culturally appropriate hypertension education sessions. BP was assessed with Omron 705-IT and treatment adherence with lifestyle- and medication adherence scales.Results139 patients (95%) completed the study (intervention n = 71, control n = 68). Baseline characteristics were largely similar for both groups. At six months, we observed a SBP reduction of ≥10 mmHg -primary outcome- in 48% of the intervention group and 43% of the control group. When adjusted for pre-specified covariates age, sex, hypertension duration, education, baseline measurement and clustering effect, the between-group difference was not significant (OR; 0.42; 95% CI: 0.11 to 1.54; P = 0.19). At six months, the mean SBP/DBD had dropped by 10/5.7 (SD 14.3/9.2)mmHg in the intervention group and by 6.3/1.7 (SD 13.4/8.6)mmHg in the control group. After adjustment, between-group differences in SBP and DBP reduction were −1.69 mmHg (95% CI: −6.01 to 2.62, P = 0.44) and −3.01 mmHg (−5.73 to −0.30, P = 0.03) in favour of the intervention group. Mean scores for adherence to lifestyle recommendations increased in the intervention group, but decreased in the control group. Mean medication adherence scores improved slightly in both groups. After adjustment, the between-group difference for adherence to lifestyle recommendations was 0.34 (0.12 to 0.55; P = 0.003). For medication adherence it was −0.09 (−0.65 to 0.46; P = 0.74).ConclusionThis intervention led to significant improvements in DBP and adherence to lifestyle recommendations, supporting the need for culturally appropriate hypertension care.Trial RegistrationControlled-Trials.com ISRCTN35675524

How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

“…We observed that 89% of the patients completed all educational sessions. Studies of similar educational interventions in primary care settings in Europe and the USA recorded lower attendance rates, namely 79% and 58% [23] [41]. The high attendance rate in this study suggests that CHEP responded to patients' needs, which is plausible in the light of a previous qualitative study that was conducted in the area [29].…”

“…The content of CHEP was inspired by a hypertension education program that was developed by Beune et al [23], and results of a previous interview study with hypertensive patients of OOH [29]. All patients were randomly assigned to a group of 12 -15 "trainees" which held the same composition throughout the program.…”

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…Telemonitoring interventions included use of SMBP and telephone counseling, 37 SMBP plus weight and exercise self-monitoring, 30 SMBP in combination with telecounseling that targeted blood pressure [BP] goals, 27 use of medication protocol adjustments that targeted BP goals and BP transmitted from SMBP by participants, 38 and SMBP plus tailored lifestyle modification (eg, DASH [Dietary Approaches to Hypertension] diet, medication use). 29 Behavioral interventions reported in 6 articles 28,34,36,[39][40][41] did not include the use of SMBP. Nurses most frequently provided the TPE to patients with hypertension, delivering TPE by telephone or in person.…”

“…Nurses most frequently provided the TPE to patients with hypertension, delivering TPE by telephone or in person. Behavioral research interventions included hypertension self-management-tailored education based on stage of change, 34 culturally appropriate nurse-led lifestyle interventions for African immigrants, 28 Mediterranean diet counseling and ambulatory BP monitoring, 36 and the use of self-affirmation to overcome medication adherence barriers. 39 Two studies implemented team-led and team-delivered behavioral interventions.…”

“…37 Treatment group participants also had an increased titration of hypertensive medications over time to meet target BP goals. 38 Behavioral interventions in 6 articles 28,34,36,[39][40][41] did not include the use of SMBP. Findings from these studies demonstrated greater improvements in outcomes than with usual care.…”