Interactive Web Program and Health Coaching for Prehypertensive Adults

描述（由申请人提供）：大约三分之一（31%）的美国成年人处于高血压前期（收缩压120-139和/或舒张压80-89）。卫生保健提供者努力为降低血压的行为改变提供有效的支持，而患者继续发展为完全高血压并使用抗高血压药物。拥有电子医疗记录和其他医疗数据的保险公司和供应商在识别高血压前期成年人并针对他们制定血压自我管理计划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，更重要的是，降低心脏病和中风的长期护理费用。该项目将开发和评估一个教练指导的、互动的高血压前期成人血压自我管理项目。该项目将以血压自我监测和JNC-7推荐的五种已证实的生活方式改变为目标：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。这个多模式的项目结合了简短的激励健康指导、定期的参与电子邮件和一个强大的互动网站，激励人们在需要药物治疗之前负责自己的血压管理。所有项目的组成部分都被设计成符合动机性访谈的基本原则。项目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、个人故事和简短的激励指导课程，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结合起来。第一阶段的原型计划促进适度的身体活动和食用水果和蔬菜作为DASH饮食的一部分。来自组内（n = 39）评估的结果显示，动机、准备行为、自我效能、态度和知识在事前到事后的变化有中等到较大的影响，体力活动有轻微的显著增加。参与者对在线课程的满意度和可用性给予了很高的评价，并报告说，作为指导课程的结果，他们在信心、准备程度、清晰度、改变策略和访问网站的兴趣方面都有了提高。完全开发的II期产品将在一项大型随机试验（N = 450）中进行评估，其中包括3个月的强化期、3个月的维持期和3个月的随访期。II期试验预计将显示jnc推荐的降血压健康行为的改善。结果测量的这些变化预计是由知识、态度、自我效能、行为意图、动机和患者激活的变化所介导的。第二阶段的产品将销售给大型综合医疗福利提供商，包括保险和健康产品，如我们的第二阶段评估合作伙伴Aetna，以及综合医疗服务提供系统，如我们的第一阶段和第二阶段评估合作伙伴Providence health。

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.