Interactive Program to Prevent Hypertension in Prehypertensive Seniors

预防高血压前期老年人高血压的互动项目

• 批准号: 7611849
• 负责人: AMELIA J BIRNEY
• 金额: $ 22.96万
• 依托单位: OREGON CENTER FOR APPLIED SCIENCE, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2010-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7611849
• 关键词: Address; Adopted; Adult; Alcohol consumption; American; Antihypertensive Agents; Behavior; Blood Pressure; Body Weight decreased; Cardiovascular system; Caring; Charge; Computerized Medical Record; DASH diet; Data; Databases; Detection; Diastolic blood pressure; Diet; Drops; Eating; Eating Behavior; Effectiveness of Interventions; Elements; Evaluation; Event; Exercise; Focus Groups; Goals; Guidelines; Health; Health Knowledge, Attitudes, Practice; Health Personnel; Health Planning; Healthcare; Hypertension; Individual; Insurance; Internet; Intervention; Interview; Joints; Learning; Life Style; Literature; Medical; Medical Electronics; Medical Records; Modeling; Modification; Myocardial Ischemia; Older Population; Outcome; Pharmaceutical Preparations; Phase; Physical activity; Physicians; Positioning Attribute; Prevention; Problem Solving; Randomized Controlled Clinical Trials; Readiness; Reporting; Research; Risk; Risk Behaviors; Screening procedure; Self Assessment; Self Blood Pressure Monitoring; Self Efficacy; Self Management; Site; Sodium; Staging; Stroke; System; Techniques; Testing; TimeLine; Weight maintenance regimen; base; behavior change; cost; design; disability; evidence base; experience; health belief; high risk; human old age (65+); innovation; instrument; interactive multimedia; intervention program; meetings; motivated behavior; motivational enhancement therapy; peer; prevent; programs; prototype; public health relevance; quality assurance; repository; research and development; social cognitive theory; theories; therapy design; usability

DESCRIPTION (provided by applicant): Nearly a quarter (24%) of older Americans (>60 yrs) have prehypertension (SBP 120-139 mm Hg and/or DBP 80-89 mm Hg). Half of those 65 years and older with blood pressure in the top of the prehypertensive range (130 mm Hg and/or 85-89 mm Hg) will develop hypertension within four years, if this progression is not prevented. Notably, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommends that prehypertensive individuals implement the lifestyle modifications that have been shown to reduce blood pressure: weight reduction, the DASH diet, reduction in sodium and alcohol consumption, and regular physical activity. Thus, a comprehensive lifestyle modification program that is tailored to the needs of prehypertensive seniors would help meet JNC-7's goals. Physicians and other health care providers often do not provide effective support for non-medical behavior change interventions, resulting in progression to hypertension and the use of antihypertensive medications. However, health plans and healthcare organizations with electronic medical records and online medical record repositories, like Microsoft HealthVault, Google Health, and Revolution Health, are in a unique position to identify prehypertensive seniors and direct them to an interactive blood pressure intervention. Preventing or delaying hypertension should reduce mid-term costs of antihypertensive medications and long-term cost of care for the initial events and long-term disability and management of ischemic heart disease and stroke. This project will develop and test an interactive multimedia (IMM) program for seniors with prehypertension. The Internet-based intervention will be designed to motivate people to take charge of their blood pressure management. The program will address blood pressure self-monitoring and the five proven lifestyle modifications recommended by JNC-7: weight reduction, the Dietary Approaches to Stop Hypertension (DASH) diet, sodium reduction, physical activity, and alcohol consumption. The program will draw from the Health Belief Model, Transtheoretical Model, Social Cognitive Theory, and Motivational Interviewing concepts. The program will include a Blood Pressure Management Self-Assessment to identify users' highest-risk hypertension-related behaviors and their readiness to change those behaviors and stage-tailored content to motivate the behavior changes that are most likely to be adopted and/or result in a drop in blood pressure. The Phase I prototype will consist of the Blood Pressure Management Self-Assessment and the Sodium Reduction module. When complete, each module will include: (a) stage-tailored information on change strategies, (b) stage-tailored motivational video peer testimonials, (c) a goal setting activity, (d) a barrier identification and problem-solving activity, and (e) an action plan activity. The Phase I evaluation will use a within-subject design to demonstrate pre-post change in blood pressure management knowledge, attitudes, behaviors, self-efficacy and intentions. In Phase II, the complete program will be developed and evaluated in a larger randomized trial on the Internet. PUBLIC HEALTH RELEVANCE: Half of Americans 65+ years with blood pressure above 130 mm Hg (systolic) and/or 85-89 mm Hg (diastolic) will develop hypertension within four years. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that prehypertensive individuals implement lifestyle modifications to reduce blood pressure: weight reduction, the DASH diet, reduction in sodium and alcohol consumption, and regular physical activity. This project will create and test an interactive lifestyle modification program tailored to the needs of prehypertensive seniors.

描述（由申请人提供）：近四分之一（24%）的美国老年人（50 - 60岁）有高血压前期（收缩压120- 139mmhg和/或舒张压80- 89mmhg）。65岁及以上血压处于高血压前期范围（130毫米汞柱和/或85-89毫米汞柱）顶部的人中，如果不加以预防，有一半将在4年内发展为高血压。值得注意的是，高血压预防、检测、评估和治疗全国联合委员会第七次报告（JNC-7）建议高血压前期个体实施已被证明可以降低血压的生活方式改变：减轻体重、DASH饮食、减少钠和酒精消费以及定期体育活动。因此，针对高血压前期老年人的需求制定一个全面的生活方式改变计划将有助于实现JNC-7的目标。医生和其他卫生保健提供者往往不能为非医疗行为改变干预提供有效的支持，从而导致高血压的进展和抗高血压药物的使用。然而，拥有电子医疗记录和在线医疗记录存储库的健康计划和医疗保健组织，如Microsoft HealthVault、谷歌health和Revolution health，在识别高血压前期老年人并指导他们进行互动血压干预方面处于独特的地位。预防或延缓高血压应降低抗高血压药物的中期费用和缺血性心脏病和中风的初始事件、长期残疾和管理的长期护理费用。本项目将为高血压前期老年人开发和测试交互式多媒体（IMM）程序。基于互联网的干预将旨在激励人们负责他们的血压管理。该计划将解决血压自我监测和JNC-7推荐的五种已证实的生活方式改变：减肥、停止高血压的饮食方法（DASH）饮食、减少钠、体育活动和饮酒。该计划将借鉴健康信念模型、跨理论模型、社会认知理论和动机访谈的概念。该项目将包括一项血压管理自我评估，以确定用户高血压相关的最高风险行为，以及他们改变这些行为的准备情况，并提供量身定制的内容，以激励最有可能被采用和/或导致血压下降的行为改变。第一阶段的原型将包括血压管理自我评估和钠减少模块。完成后，每个模块将包括：(a)阶段定制的变革策略信息，(b)阶段定制的激励视频同伴推荐，(c)目标设定活动，(d)障碍识别和解决问题活动，以及(e)行动计划活动。第一阶段的评估将使用受试者内设计来展示血压管理知识、态度、行为、自我效能和意图的前后变化。在第二阶段，完整的计划将在互联网上的一个更大的随机试验中开发和评估。公共卫生相关性：65岁以上血压高于130毫米汞柱（收缩压）和/或85-89毫米汞柱（舒张压）的美国人中，有一半会在四年内患上高血压。高血压预防、检测、评估和治疗全国联合委员会第七次报告建议高血压前期个体实施生活方式改变以降低血压：减轻体重、DASH饮食、减少钠和酒精消费以及定期体育活动。该项目将根据高血压前期老年人的需要，创建并测试一种互动式生活方式改变方案。