A Community and Technology-Based Approach for Hypertension Self-Management (COACHMAN) to Improve Blood Pressure Control in African Americans: Results from a Pilot Study

Carolyn H Still,1 Seunghee Margevicius,2 Carla Harwell,3,4 Ming-Chun Huang,5 LaTonya Martin,6 Phuong B Dang,1 Jackson T Wright Jnr3,7 1Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA; 2Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 3Department of Internal Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 4University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 5Department of Electrical Engineering and Computer Science, Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA; 6Community Partners, Cleveland Council of Black Nurses, Cleveland, OH, USA; 7Department of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USACorrespondence: Carolyn H StillFrances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USATel +1 216 368 6338Fax +1 216 368 3452Email cwh11@case.eduPurpose: Adoption of technology has increased to support self-managing chronic diseases. However, behavioral interventions evaluating such technology have been understudied in African Americans with hypertension. The aim of this study was to explore a community and technology-based intervention for hypertension self-management (COACHMAN) intervention on blood pressure (BP) control and health-related quality of life (HRQoL) in African Americans with hypertension.Methods: Sixty African Americans (mean age 60; 75% females) who were prescribed antihypertensive medications and owning a smartphone were randomized to the COACHMAN (n = 30) or enhanced usual care (n = 30) group for 12 weeks. COACHMAN is comprised of four components: web-based education, home BP monitoring, medication management application, and nurse counseling. Hypertension knowledge, self-efficacy, technology adoption/use, medication adherence, BP, and HRQoL scores were assessed.Results: Mean systolic and diastolic BP at baseline was 150.49 (SD = 13.89) and 86.80 (SD = 13.39), respectively. After completing the 3-month intervention to improve hypertension self-management, the groups did not significantly differ in BP control and HRQoL. Clinically relevant BP reduction was observed in the intervention group. Paired t-test showed that mean medication-taking adherence scores significantly improved in the intervention group (P = 0.023) compared to the control group (P = 0.075).Conclusion: Using technology may have a positive impact on supporting hypertension self-management, particularly in medication-taking adherence. Further research is warranted in a larger sample and should include standardization of medication management to isolate the effects of behavioral interventions on changes in BP.Clinicaltrials.gov Identifier: NCT03722667.Keywords: African Americans, hypertension, minority health, technology, self-management