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A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans
Gbenga O. Ogedegbe, MD;
Carla Boutin-Foster, MD, MS;
Martin T. Wells, PhD;
John P. Allegrante, PhD;
Alice M. Isen, PhD;
Jared B. Jobe, PhD;
Mary E. Charlson, MD
Arch Intern Med. Published online January 23, 2012. doi:10.1001/archinternmed.2011.1307
Background Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes.
Methods This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months.
Results The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P = .049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P = .98) and diastolic BP (–1.59 mm Hg vs –0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant.
Conclusions A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care.
Trial Registration clinicaltrials.gov Identifier: NCT00227175
Author Affiliations: Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine (Dr Ogedegbe), Division of General Internal Medicine and Center for Complementary and Integrative Medicine, Weill Medical College, Cornell University (Drs Boutin-Foster and Charlson), and Department of Health and Behavior Studies, Teachers College (Dr Allegrante), and Department of Sociomedical Sciences, Mailman School of Public Health (Dr Allegrante), Columbia University, New York, New York; Departments of Statistical Sciences (Dr Wells) and Psychology (Dr Isen) and Johnson School of Management (Dr Isen), Cornell University, Ithaca, New York; and National Heart, Lung, and Blood Institute, Bethesda, Maryland (Dr Jobe).
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