Interactive Web Program and Health Coaching for Prehypertensive Adults

描述(由申请人提供)：大约三分之一(31%)的美国成年人患有高血压前期(SBP 120-139和/或DBP 80-89)。医疗保健提供者努力为降压行为的改变提供有效的支持，而患者继续进展到完全高血压和使用降压药。可以访问电子医疗记录和其他医疗数据的保险公司和提供商处于独特的地位，可以识别高血压前期成年人，并以他们为目标进行血压自我管理计划。预防或延迟高血压应该会降低抗高血压药物的中期成本，更重要的是，降低心脏病和中风的长期护理成本。这个项目将为患有高血压前期的成年人开发和评估一个由教练指导的、交互式的血压自我管理计划。该计划将针对血压自我监测和JNC-7推荐的五种经过验证的生活方式调整：减肥、停止高血压的饮食方法(DASH)、减少钠、体力活动和饮酒。这项多模式的计划结合了简短的励志健康指导、定期参与电子邮件和一个强大的互动网站，以激励人们在需要药物治疗之前负责他们的血压管理。所有项目内容的设计都符合激励性面试的基本原则。计划的主要组成部分包括使用电子邮件和基于网络的社交网络、个人故事和简短的励志辅导课程，以吸引参与者并鼓励内在动机的行为改变。自我评估和跟踪工具与教育内容相结合，帮助参与者将他们的日常生活方式选择与他们的个人目标相结合。第一阶段的原型计划提倡适度的体力活动，并将水果和蔬菜作为DASH饮食的一部分。组内评估(n=39)的结果显示，治疗前后动机、准备行为、自我效能感、态度和知识的变化有中到大的影响，体力活动有小幅显著增加。参与者对在线课程的满意度和可用性给予了很高的评价，并报告称，由于辅导课程的结果，他们在信心、准备程度、清晰度、变化策略和访问网站的兴趣方面都有所改善。完全开发的第二阶段产品将在一个大型随机试验(N=450)中进行评估，为期3个月的集约期、3个月的维护期和3个月的随访期。第二阶段试验预计将显示JNC推荐的降低血压的健康行为有所改善。这些结果测量的变化预计将通过知识、态度、自我效能、行为意图、动机和患者激活度的变化来调节。第二阶段的产品将向同时拥有保险和健康产品的大型综合健康福利提供商(如我们的第二阶段评估合作伙伴Aetna)以及综合医疗服务交付系统(如我们的第一阶段和第二阶段评估合作伙伴普罗维登斯健康)进行营销。 公共卫生相关性：近三分之一的美国成年人患有高血压前期(SBP120-139和/或DBP 80-89)，因此心脏病发作和中风的风险更高。可以访问电子医疗记录的保险公司和提供商处于独特的地位，可以识别高血压前期成年人，并以他们为目标进行血压自我管理计划。一个有效的预防或延迟高血压的计划应该会降低心脏病和中风的个人和经济成本。

DESCRIPTION (provided by applicant): Approximately a third (31%) of adult Americans are prehypertensive (SBP 120-139 and/or DBP 80-89). Health care providers struggle to provide effective support for blood-pressure-lowering behavior changes, while patients continue to progress to full hypertension and the use of antihypertensive medications. Insurers and providers with access to electronic medical records and other medical data are in a unique position to identify prehypertensive adults and target them with a blood pressure self-management program. Preventing or delaying hypertension should reduce mid-term costs of antihypertensive medications and, more importantly, long-term costs of care for heart disease and stroke. This project will develop and evaluate a coach-guided, interactive blood pressure self-management program for adults with prehypertension. The program will target 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 multi-modal program uses a combination of brief motivational health coaching, periodic engagement emails, and a robust interactive website to motivate people to take charge of their blood pressure management before they require medication. All program components were designed to conform to the underlying principles of motivational interviewing. Key program components include the use of email and Web-based social networking, personal stories, and brief motivational coaching sessions to engage participants and encourage intrinsically motivated behavior changes. Self-assessment and tracking tools are combined with educational content to help participants align their daily lifestyle choices with their personal goals. The Phase I prototype program promoted moderate physical activity and eating fruits and vegetables as part of the DASH diet. Results from the within-group (n = 39) evaluation showed moderate-to-large effect sizes for pre-to-post change in motivation, preparation behavior, self-efficacy, attitudes, and knowledge, and a small significant increase in physical activity. Participants gave the online program high ratings on satisfaction and usability, and reported improvements in confidence, readiness, clarity, change strategies, and interest in visiting the Website as a result of the coaching session. The fully developed Phase II product will be evaluated in a large randomized trial (N = 450) with a 3-month intensive period, a 3-month maintenance period, and a 3-month follow-up period. The Phase II trial is expected to show improvements in JNC-recommended BP-lowering health behaviors. These changes in the outcome measures are expected to be mediated by changes in knowledge, attitudes, self-efficacy, behavioral intention, motivation, and patient activation. The Phase II product will be marketed to large, integrated health benefits providers with both insurance and wellness products, like our Phase II evaluation partner Aetna, and to integrated health service delivery systems, like our Phase I and II evaluation partner, Providence Health. PUBLIC HEALTH RELEVANCE: Almost a third of adult Americans are prehypertensive (SBP 120-139 and/or DBP 80-89), and thus at higher risk for heart attack and stroke. Insurers and providers with access to electronic medical records are in a unique position to identify prehypertensive adults and target them with a blood pressure self-management program. An effective program to prevent or delay hypertension should reduce the personal and financial costs of heart disease and stroke.