Storytelling Substantially Improved Blood Pressure in Randomized Trial of African-American Patients

doi: 10.1097/01.NEP.0000395405.66705.d7
In Brief

Listening to stories significantly lowered blood pressure in African-Americans with uncontrolled hypertension, reported a randomized controlled trial published in Annals of Internal Medicine (2011;154:77-84).

“Patients with uncontrolled hypertension who were assigned to the intervention group experienced an 11-mmHg greater reduction in systolic blood pressure than the comparison group,” wrote the authors, led by Thomas K. Houston, MD, MPH, of the University of Massachusetts Medical School. “Meaningful advantages were also found for diastolic pressure among patients with uncontrolled hypertension.”

The trial was conducted at the Cooper Green Mercy Hospital clinics, an inner-city, safety-net health system in Birmingham, AL, that serves a large population of African-Americans with a high burden of cardiovascular disease. The trial was performed as part of Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, with direction and technical assistance provided by the University of Chicago.

Between December 2007 and May 2008, 299 African-American patients with physician-diagnosed hypertension were randomly assigned to receive DVDs that contained patient stories or an attention-control DVD that covered health topics unrelated to hypertension.

The majority of the participants were women—71.4%—and the mean age was 53.7. Of the 299 patients, 76.9% were retained throughout the study. Baseline mean systolic and diastolic pressures were similar in both groups; the mean baseline blood pressure was 133/77 mmHg.

The storytellers were patients from the local community. Patients who represented a range of experiences were selected for six focus groups, and the focus groups were then used to identify high-priority content and screen potential storytellers.

On the basis of their clarity and persuasiveness, 14 hypertensive patients were selected for the video production interviews. Each interview was broken into one-to-three-minute story units focusing on a single message.

The primary outcome was change in blood pressure, with readings taken immediately before randomization (baseline), at short-term follow-up (Month 3), and at the end of follow-up (Months 6 to 9).

While the storytelling intervention led to a significant decrease in blood pressure among patients with uncontrolled hypertension, it did not show any significant effect over time in those with controlled hypertension at baseline. Blood pressure subsequently increased for both groups, though between-group differences remained relatively constant.

“Although the literature on the health benefits of storytelling is sizable, it is largely qualitative and anecdotal in nature,” wrote Kimberly R. Myers, PhD, MA, and Michael J. Green, MD, MS, both of Penn State College of Medicine, in an accompanying editorial (Ann Intern Med 2011;154:129-130). “In contrast, Houston and colleagues' study is notable for its quantitative, experimental methodology.”

However, the clinical implications are not immediate.

“Ultimately, although Houston and colleagues have done much to corroborate anecdotal evidence that storytelling can benefit patients with chronic illness, stories are unlikely to become a routine part of treatment until additional evidence shows that their effect is both sustainable and generalizable,” Drs. Myers and Green wrote.

© 2011 Lippincott Williams & Wilkins, Inc.