Controlling Hypertension in Native American and Other Populations
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      The study evaluates the use of automated motivational messages, visit reminders, and
      medication reminders (using interactive voice response technology or text messages) to
      improve blood pressure control among adults with hypertension that receive their care at the
      First Nations Community Healthsource clinic in Albuquerque, New Mexico. Half of the
      participants will receive usual care, while the other half will receive the automated calls
      or text messages and have the option to receive home blood pressure monitors and/or designate
      a care partner who will also receive messages. Participants will be followed for 12 months.
    

Detailed description: 
      American Indians and Alaskan Natives (AI/ANs) face pervasive health disparities in comparison
      to other racial and ethnic groups in the United States. Treatment of hypertension is a pillar
      of cardiovascular disease prevention. Hypertension is the most common chronic health
      condition in the U.S. Uncontrolled hypertension increases the risk of acute myocardial
      infarction, stroke, kidney failure, and congestive heart failure. Hypertension rates are
      high, levels of control are low, and disparities in care are evident in AI/AN populations.

      This study will take place at First Nations Community Healthsource (FNCH) in Albuquerque, New
      Mexico. FNCH provides primary medical care to urban AI/AN and other socially disadvantaged
      residents of the Albuquerque, New Mexico area. Approximately 40% of FNCH clients are AI/AN;
      Diné (Navajo) is the most common tribal affiliation. Many other clients served by FNCH are
      undocumented immigrants. Housing insecurity and homelessness are common.

      This study will use a FNCH hypertension registry to identify all clients with hypertension
      (regardless of race or ethnicity). From this group, the study will recruit 512 clients, and
      randomize the participants without stratification to receive automated messages using an
      interactive voice recognition and text message intervention or to continue in usual care.
      Consistent with the principles of pragmatic randomized clinical trials, the study has few
      exclusion criteria in order to maximize inclusion of clients and generalizability of
      findings. Potentially eligible clients will be contacted by letter and phone. Those who
      express interest will complete a baseline visit where they provide informed consent, complete
      a baseline survey, and have blood pressure measured. The participants will then be randomized
      either to the intervention or usual care arms. Individuals randomized to the intervention arm
      will receive: reminders of upcoming appointments at FNCH; requests to reschedule missed
      appointments; reminders to refill medications; and weekly motivational messages to encourage
      self-care, appointment keeping, and medication-taking for hypertension. These participants
      will be offered a home blood pressure monitor and trained to use it if they accept, and will
      be asked if they wish to nominate a care partner to also receive notices of upcoming and
      missed appointments. In additional to their usual visits at FNCH, all participants will
      complete research visits with our study coordinators at 6 and 12 months, where they will
      again have BP measured and complete brief surveys.
    

Intervention name(s): Automated messages; Home BP monitors; Care partner reminders
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Automated motivational messages and visit and medication reminders will be provided via interactive voice response calls or text messages.; Participants will have the option of receiving home blood pressure monitors.; Participants will have the option of designating a care partner who will also receive automated reminder calls or text messages.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research