A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: a randomized controlled trial

Abstract

Background: Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking.

Purpose: We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity.

Methods: We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling.

Results: The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p < 0.03) and in energy expenditure (+80 kcal/day, p < 0.03). A decrease in systolic BP between groups was not statistically significant (-2.3 mmHg, p = 0.25).

Conclusions: Given their convenience, scalability, and ability to deliver tailored messages, automated telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.

Conflict of interest statement

Conflict of interest Dr. Friedman has stock ownership and a consulting agreement with InfoMedics, the company that owns commercial rights to the TLC technology used in the computerized intervention. He is also a member of its Board of Directors. None of the other authors has any potential conflicts of interest to disclose.

Figures

Fig. 1

Consort diagram

Fig. 2

Primary and secondary outcomes across all time points. Asterisks difference between groups in change in outcome from baseline to 8 months significant at p <0.05. TLC telephone-linked-care, the name of the automated telephone intervention