OPtimizing Technology to Improve Medication Adherence and BP Control (OPTIMA-BP).

项目摘要 高血压差异持续存在，在非洲裔美国人（AA）中尤其严重。亚适性高血压 自我管理，包括坚持服用抗高血压药物仍然是一个主要的公共卫生 关心据估计，43 - 78%的患者对抗高血压药物的依从性较差， 大约50%的患者在一年后停药，AA患者的情况更糟。更令人担忧的是，AA老年人可能不会 在AA人群中，以证据为基础的实践治疗方案更有效。那里 迫切需要可行的行为方法和长期自我管理策略， 可复制和可扩展。移动的健康（mHealth）技术（移动的手机应用程序[app]、文本、视频 信息传递）是促进行为改变和维持自我管理的有前途的工具。 虽然支持使用移动健康技术管理慢性病的报告有所增加， 关于AA老年人的数据有限。在有关移动保健的文献中发现的其他差距 技术包括缺乏理论驱动，临床/流行病学调查主要是 在美国以外进行，限制了普遍性，缺乏长期可持续性的证据， 对临床相关健康结果的影响。此R01应用程序，优化技术以改进 药物依从性和血压控制（OPTIMA-BP）正在测试基于技术的干预措施， 前瞻性随机对照试验（RCT）设计中的等待列表对照（WL）。OPTIMA-BP包括 基于证据的战略，基于网络的教育和行为技能培训，以使用理论驱动的 mHealth药物管理应用程序与指导治疗方案和护士一起 辅导 本研究的目的是：[1]测试OPTIMA-BP与WL对收缩压和血清高血压的影响。 以前瞻性RCT形式研究AA老年高血压患者的密度脂蛋白胆固醇（HDL）;以及[2] 探讨自我管理的态度/知识机制（高血压知识，自我效能， 感知的社会支持）和近端行为目标机制（服用药物以降低收缩压， 饮食，运动）介导OPTIMA-BP与WL对主要和次要结局（收缩压， 舒张压、健康相关生活质量、血脂，至少62%的样本BP <130/80 mmHg） 在12个月的时间里。本研究的次要目的是评估OPTIMA-BP和WL对 主要和次要结果，同时控制协变量/背景变量，如年龄和性别。 这项建议的一个补充和补充特点是定性评价，以确认自我- 管理障碍和干预措施的感知优势或局限性，这将为未来提供信息 如果这些RCT结果为阳性，则应进行改进。

PROJECT SUMMARY Hypertension disparities persist and are particularly worst in African Americans (AA). Suboptimal hypertension self-management, including adherence to medication-taking of antihypertensives remains a major public health concern. Poor adherence to antihypertensive medications is estimated to occur in 43-78% of patients, with approximately 50% discontinuation after a year, and worse in AA. Even more alarming, AA older adults may not be prescribe evidence-based practice treatment regimens known to more efficient in the AA population. There is a critical need for behavioral approaches and long-term self-management strategies that are feasible, replicable, and scalable. Mobile Health (mHealth) technologies (mobile phone applications [app], text, video messaging) are promising tools to facilitate behavioral change and sustain self-management. While reports support using mHealth technologies for the management of chronic diseases have grown, there is limited data specific to AA older adults. Other gaps identified in the literature regarding mHealth technology include the lack of being theoretically driven, the clinical/epidemiologic investigations are primarily conducted outside of the U.S. limiting generalizability, and the lack of evidence on long-term sustainability and impact on clinically relevant health outcomes. This R01 application, OPtimizing Technology to Improve Medication Adherence and BP Control (OPTIMA-BP) is testing a technology-based interventions compared to a wait-listed control (WL) in a prospective, randomized controlled trial (RCT) design. OPTIMA-BP includes evidenced-based strategies, web-based education, and behavioral skills training to use a theoretically driven mHealth medication management app in conjunction with a guideline directed treatment regimen and nurse counseling. The aims of this study are: [1] To test the effects of OPTIMA-BP vs. WL on systolic BP and serum high- density lipoprotein cholesterol (HDL) in AA older adults with hypertension in a prospective, RCT format; and [2] To test if the attitudinal/knowledge mechanisms of self-management (hypertension knowledge, self-efficacy, perceived social support) and proximal behavioral target mechanisms (taking medications to reduce systolic BP, diet, exercise) mediate OPTIMA-BP vs. WL’s impact on the primary and secondary outcomes (systolic BP, diastolic BP, health-related quality of life, serum lipids, and at least 62% of the sample with BP <130/80 mmHg) over a 12-month time period. A secondary aim of this study will assess OPTIMA-BP and WL’s impact on the primary and secondary outcomes while controlling for covariates/contextual variables such as age and gender. A supplemental and complementary feature of this proposal is the qualitative evaluation to confirm self- management barriers and perceived strengths or limitations of the intervention, which will inform future refinements should these RCT findings be positive.