The Effect of a Targeted Video Intervention on Beliefs Regarding Hypertension
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      Researchers have linked media messages such as television programs to multiple problematic
      health behaviors. The narrative style of many television programs-involving a plot, recurrent
      characters, entertaining situations, and familiar settings-makes them compelling and likely
      contributes to the powerful influence these programs can have on behavior. However, narrative
      messages are not frequently utilized for prosocial purposes. In particular, health education
      embedded in a narrative context has been neither commonly utilized nor carefully evaluated.
      Using constructs from two complementary theories of health behavior, family physicians in a
      large metropolitan region have developed a situation comedy entitled "White Coats" that aims
      to provide quality patient education. The program currently airs on a local public access
      channel. The objective of this project is to evaluate the effect of one particular episode of
      "White Coats" on patient beliefs regarding hypertension.
    

Detailed description: 
      1. Design Randomized, single-blinded controlled trial.

        2. Participants/Setting Permission from our Institutional Review Board has already been
           granted for this project (IRB #PRO07020003), but we are in the process of reapplying
           based on our revisions in response to the JGAP's initial review (please see section Q
           below). Participants will be recruited from the patient population of our largest
           residency family health center. The family health center cares for a pool of
           approximately 5000 patients with low to moderate income. Its population is roughly 40%
           male and 60% female. The population is racially diverse (Caucasian=60%; African
           American=20%; Other=20%). In order to recruit our study sample, we will generate a
           random list of patients from this health center's electronic records. All selected
           individuals will be contacted to assess whether they meet study criteria. As listed in
           Appendix 2, only persons with a history of hypertension or risk factors for hypertension
           will be included. In this way, we will recruit 80 volunteers aged 18-65.

        3. Procedure Selected individuals will participate in two sessions. The first will consist
           of the intervention with pre-testing and immediate post-intervention testing, and the
           second will consist of a follow-up survey two months after the intervention. We will
           offer a $15 incentive (local grocery store gift card) to participate at each of these
           two steps for a total incentive of $30. Study personnel will contact those patients
           identified in the random sample by telephone and will read them a complete recruitment
           form. Recruited subjects will make an appointment to meet the research assistant for the
           initial survey testing and intervention exposure. At this appointment, study personnel
           will obtain verbal assent. Participants will be randomized using block randomization,
           stratifying for gender and age, into control and treatment arms. The entire
           randomization scheme will be completed a priori. Subjects will not be informed of their
           status as either a control or intervention group participant (single-blinded).

           All subjects will be led to a private room and will be given 15 minutes to complete the
           pre-test (Appendix 3). Participants in the intervention group will watch a twenty-five
           minute episode of "White Coats." Participants in the control group will watch a
           twenty-five minute educational video about depression. Immediately following the
           interventions, all subjects will be administered post-tests (Appendix 4). The research
           assistant will contact participants two months later by telephone to schedule a time to
           return to the family health center to take the delayed post-test (Appendix 5).

        4. Intervention The intervention will consist of a twenty-five minute episode of a local
           health education situation comedy television series. Two physicians affiliated with a
           Family Medicine Residency and Fellowship Program created and currently produce this
           television series, entitled "White Coats," which currently airs on a local cable public
           access channel. The series features a fictional married couple of Family Medicine
           physicians who work in the same practice, located in our community. In both their
           professional and private lives and, in moments both humorous and serious, these doctors
           teach patients about a wide variety of health topics. The intervention episode
           addressing hypertension will focus on three different patient-physician plot lines,
           which were developed to specifically address each of the beliefs about hypertension
           highlighted in the theoretical model (susceptibility, seriousness, etc.).

        5. Measures Evaluation will consist of pre- and post-testing, both immediate and at a
           two-month follow-up, with a self-administered written survey. The primary outcome
           measures will consist of five items (Q15-Q19) representing constructs from the health
           belief model and social cognitive theory: (1) perceived seriousness of hypertension
           (Q15), (2) perceived susceptibility to hypertension (Q16), (3) barriers to hypertension
           control (Q17), (4) self-efficacy regarding hypertension control (Q18), and (5) outcome
           efficacy regarding hypertension control (Q19). All outcomes will be scored on a 1 to 7
           point Likert scale. We have modeled question items from existing reliable, valid
           instruments,23-25 although no complete previously validated instrument exists to
           specifically measure these five constructs as they relate to hypertensive control.

      We will collect demographics including age as a continuous variable (based on date of birth),
      gender, race/ethnicity, and socioeconomic status. Race/ethnicity will be collected in the
      manner suggested by the National Institutes of Health, allowing participants to select more
      than one race/ethnicity. Socioeconomic status will be approximated with highest level of
      education achieved.
    

Intervention name(s): 24-minute video episode of patient education TV sitcom "White Coats"; Placebo video
Intervention type(s): Other; Other
Intervention description(s): The series features a fictional married couple of Family Medicine physicians who work in the same practice, located in our community. In both their professional and private lives and, in moments both humorous and serious, these doctors teach patients about a wide variety of health topics. The intervention episode addressing hypertension will focus on three different patient-physician plot lines, which were developed to specifically address each of the beliefs about hypertension highlighted in the theoretical model (susceptibility, seriousness, barriers, self-efficacy and outcome efficacy.).; The control group watched a 25-minute patient education video on depression.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Keywords: Health Behavior Theory; Patient Education; Hypertension; Health beliefs related to hypertension and hypertension treatment