Science

Most of the racial disparities in mortality experienced by African Americans are tied to hypertension, a chronic health condition that currently impacts more than half of African American adults. Despite the empirically-supported benefits of hypertension self-management, too few African Americans achieve hypertension control. Barriers to hypertension self-management for African Americans include stress and difficulty and incorporating and sustaining necessary lifestyle changes. Family support, however, is regularly identified by African Americans as a self-management facilitator -- one that is not leveraged by current hypertension self-management interventions. Family members can encourage and simultaneously adopt positive health behaviors, and be relied upon to share helpful health information. At the same time, family members may undermine patients' behavior change, and family stress may interfere with self-management implementation. Family members must be incorporated into hypertension self-management interventions in order to effect long-lasting behavioral change -- an approach proven effective for other chronic conditions, including for African Americans.

The purpose of this study is to develop a novel family-based hypertension self-management intervention, Walk Together, adapted from an existing empirically-supported dyadic intervention, for implementation in primary care. Specifically, the research aims of this R21 investigation are: (1) To develop an innovative intervention for hypertension that integrates theoretically-driven research on family support effects on health outcomes, and community-based participatory cultural perspectives in the specifics of the intervention; and, (2) to determine the feasibility, acceptability, and safety of the Walk Together intervention. 

This study is the first-known study of a family-based intervention to improve hypertension self-management among African American adults in primary care. Our multilevel Walk Together program is based on systemic, biopsychosocial evidence of the impact of families on health, and will target (a) individual patient health behavior and (b) interpersonal family functioning via (c) integration into primary care. We incorporate culturally-specific perspectives of African American patient-family member dyads and will use iterative development and a community-based participatory approach to design and refine the protocol over the course of the project.