Using Lay Health Advisors to Improve Hypertension Management

Study Overview
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Brief Summary
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Hypertension disproportionately affects and is inadequately controlled among African American and poor populations. The investigators propose to determine the impact of using trained lay health advisors to help patients address social contextual factors that influence the management of hypertension.

Detailed Description
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Hypertension disproportionately affects and is inadequately controlled among African American and poor populations. Health providers generally lack the skills and resources to address social contextual factors (i.e. health and community services, social networks, social stressors, physical environment, and economic resources) that influence management of hypertension. Instead, providers tend to focus on adjusting antihypertensive medication prescriptions and exhorting patients to exercise and eat better. The investigators propose to determine the impact of using trained lay health advisors to help patients address social contextual factors that influence the management of hypertension. Helping patients address these barriers may lead not only to improved blood pressure but also to increased survival, reduced organ damage, and decreased health care costs. This project may also serve as a model of healthcare delivery innovation that could be used to address other health disparity conditions.

Official Title
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Using Lay Health Advisors to Help African Americans Address the Social Context of Hypertension Management

Conditions
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Hypertension

Intervention / Treatment
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* Behavioral: Lay Health Advisor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least 2 outpatient blood pressures with systolic >140 or diastolic >90 mm Hg in last 6 months. Separate occurrences at least 1 day apart Age 18-59 years Non-diabetic Preserved kidney function (glomerular filtration rate >60 ml/min) English speaking Exclusion Criteria: Mentally incompetent Pregnant Terminal illness Active substance abuse Documented coronary, peripheral arterial, or cerebrovascular disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lay Health Advisors<br>Intervention patients will meet monthly in small groups with a trained Lay Health Advisor. | Behavioral: Lay Health Advisor<br>* Patients will meet regularly Lay Health Advisors who will address the social context of their hypertension.<br>|
| No Intervention: Usual Care<br>Control patients will receive usual care from their doctors. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in systolic and diastolic blood pressure | Difference between final and initial systolic and diastolic blood pressure readings | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in quality of life. | Differences in quality of life between final and initial measurements using the 12 item short form survey (SF-12). The SF-12 provides physical and mental health composite scores ranging from 0 (lowest level of health) to 100 (highest level of health) | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hypertension, Community Health Workers, Community-Based Participatory Research, Health Equity