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Adapting Hypertension Self-Management Interventions to Enhance Their Sustained Effectiveness Among Urban African Americans

Ameling, Jessica M. MPH; Ephraim, Patti L. MPH; Bone, Lee R. MPH, RN; Levine, David M. MD, ScD, MPH; Roter, Debra L. DrPH, MPH; Wolff, Jennifer L. PhD; Hill-Briggs, Felicia PhD, MS; Fitzpatrick, Stephanie L. PhD; Noronha, Gary J. MD; Fagan, Peter J. PhD; Lewis-Boyer, LaPricia BS, LPN; Hickman, Debra M.Div; Simmons, Michelle BA; Purnell, Leon MS; Fisher, Annette MBA; Cooper, Lisa A. MD, MPH; Aboumatar, Hanan J. MD, MPH; Albert, Michael C. MD; Flynn, Sarah J. BA; Boulware, L. Ebony MD, MPHfor the ACT Study Investigators

doi: 10.1097/FCH.0000000000000020
Original Articles

African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions' cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community members. The process required substantial time and resources, and the adapted interventions will be tested in a randomized controlled trial.

Departments of Medicine (Mss Ameling, Bone, Flynn, and Lewis-Boyer and Drs Levine, Hill-Briggs, Fitzpatrick, Noronha, Cooper, Aboutamar, Albert and Boulware) and Psychiatry and Behavioral Sciences (Dr Fagan) and Division of Geriatric Medicine and Gerontology (Dr Wolff), Johns Hopkins University School of Medicine, Baltimore Maryland; Welch Center for Prevention, Epidemiology and Clinical Research (Mss Ameling, Ephraim, Lewis-Boyer, and Flynn and Drs Hill-Briggs, Fitzpatrick, Cooper, and Boulware) and Johns Hopkins Community Physicians (Dr Albert), Johns Hopkins Medical Institutions, Baltimore, Maryland; Departments of Epidemiology (Ms Ephraim and Drs Cooper and Boulware), Health Behavior and Society (Ms Bone and Drs Roter, Hill-Briggs, and Cooper) and Health Policy and Management (Drs Levine and Wolff) Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland; Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois (Dr Fitzpatrick); Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, New York (Dr Noronha); Johns Hopkins Health Care, LLC, Glen Burnie, Maryland (Drs Noronha and Fagan); Sister Together and Reaching, Inc, Baltimore, Maryland (Ms. Hickman); Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland (Mss Hickman, Simmons, and Fisher and Mr Purnell); The Men and Families Center Inc., Baltimore, Maryland (Mr Purnell); American Heart Association, Baltimore Branch, Baltimore, Maryland (Ms Fisher); Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland (Dr Aboutamar); and Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina (Dr Boulware).

Correspondence: L. Ebony Boulware, MD, MPH, Division of General Internal Medicine, Duke University School of Medicine, 411 W. Chapel Hill Street, NC Mutual Building, Suite 500, Durham, NC 27710 (

The ACT Study Investigator Team includes Jessica M. Ameling, Patti L. Ephraim, Lee R. Bone, David M. Levine, Debra L. Roter, Jennifer L. Wolff, Felicia Hill-Briggs, Stephanie L. Fitzpatrick, Gary J. Noronha, Peter J. Fagan, Debra Hickman, Michelle Simmons, Leon Purnell, Annette Fisher, Lisa A. Cooper, LaPricia Lewis-Boyer, Hanan J. Aboumatar, Noreen Krause, Kimberly A. Gudzune, J. Hunter Young, Richard Matens, Michael C. Albert, Jeanne Charleston, Sarah J. Flynn, Jeffrey Barbers, Dwyan Monroe, Hema C. Ramamurthi, Tanjala S. Purnell, and L. Ebony Boulware.

The authors thank everyone who contributed to the planning phase of this study, patients and their families, members of the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities Community Advisory Board, and clinical practice staff, providers, and administrators.

Support came from grant # 1P50 HL0105187 from the National Heart, Lung, and Blood Institute. Support for Dr Wolff came from grant #K01MH082885 “Optimizing Family Involvement in Late-Life Depression Care” from the National Institute of Mental Health.

The authors declare that they have no competing interests.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins