ACT Study (2010-2015)

The Achieving Blood Pressure Control Together (ACT) Study was a single center pragmatic randomized controlled trial designed to study the incremental effectiveness of three hypertension behavioral self-management interventions for socially disadvantaged African Americans receiving primary care.

Using the principles of community based participatory research, three interventions were developed and adapted to literacy levels and community context of people receiving primary care in the East Baltimore community. We sought input from patients, family members, primary care clinic staff and health care providers of the East Baltimore Medical Center where we recruited participants to enhance the clinical relevance and potential sustainability of the interventions. All study participants received a community health worker (CHW) intervention in which patients received a self-blood pressure monitor, training on the use of the monitor during a home visit, and blood pressure self-management counseling. Participants were randomly assigned at enrollment to receive the CHW intervention only; receive both the CHW intervention plus training in how to engage in shared health decision-making about hypertension self-care; or receive both the CHW intervention plus nine weeks of Problem Solving behavioral self-management training in the clinic.

Participants completed questionnaires and physical examinations at baseline, 4 months, and 12 months of follow up. The primary outcome was blood pressure control, defined as systolic blood pressure less than 140mm Hg and diastolic blood pressure less than 90mmHg. Secondarily, we assessed the changes in systolic and diastolic blood pressure. Intermediary outcomes included participants’ blood pressure self-monitoring frequency, clinic visit patient-centeredness, self-reported hypertension knowledge, and hypertension self-efficacy and self-management behaviors. We are currently in the data analysis phase of the primary study outcomes.