A proposed intervention to improve knowledge of self-management of hypertension for Kenneth Young and C4 community mental health center staff in Cook County, Illinois

Community mental health centers (CMHCs) provide psychiatric services and link Medicaid clients/members to both primary and specialty care within the community for people with serious mental illness (SMI), such as major depressive disorder, schizophrenia, and bipolar disorder. CMHCs help transition patients safely into the community from nursing facilities and rehabilitation centers. Patients diagnosed with an SMI have a higher incidence of cardiovascular diseases (CVDs), such as hypertension, and need management in the community to prevent further complications. CMHC staff lack knowledge to help their clients to manage medical conditions in the community, which can worsen hypertension management, potentially leading to complications for this population. The conceptual framework used to guide this project is the health belief model. The planning model used to guide the intervention is the PRECEDE-PROCEED model. Twenty-two staff from two CMHCs participated in a one-hour educational session on hypertension management and accurate blood pressure demonstration, with pre and post session measures of hypertension knowledge and blood pressure skills checklist. Staff were re-evaluated for hypertension and blood pressure monitoring skills 8 weeks from the implementation of the intervention with a 30-min booster session, completing an additional post intervention hypertension knowledge questionnaire and blood pressure skills checklist. A hypertension management tool was developed for staff to use as a resource in the community for clients with hypertension. The tool covered accurate blood pressure measurement and documentation, red flag symptoms, medication, and physician appointment adherence. Ordinal data were evaluated from the Likert scale to compare the percentage score from baseline to post intervention measuring hypertension knowledge. Twenty-two staff participated from both agencies, comprising 17 females and 5 males, of which 38% had their Bachelors of Science degree and 62% had their Master’s degree. The pre and post assessment of knowledge increased by 33% from baseline after the intervention. Nominal data were used to collect responses from staff based on pre and post intervention blood pressure demonstration checklist and to capture staff attendance through the sign-in sheets at the intervention training. The results showed an improvement of 133% from baseline with the blood pressure demonstration checklist after the intervention and demonstration. There was a 14% decrease of blood pressure skills checklist at the 8-week booster session compared to the post intervention results. The recommendations based on this project include addressing content missed from the knowledge test and the blood pressure skills checklist in the booster session, and reviewing the hypertension management information resource tool. Continually monitoring the use of the resource tools and incorporating booster sessions with the agencies can address any gaps in hypertension knowledge and changing guidelines in hypertension management. Recommendations to stakeholders of the agencies will include budgeting for training resources and participation incentives, monitoring sustainability of the intervention with use of the sustainability tool, and long-term monitoring of the impact of the intervention tool on blood pressure management outcomes in clients.