Houston Thomas K, Fix Gemmae M, Shimada Stephanie L, Long Judith A, Gordon Howard S, Pope Charlene, Volkman Julie, Allison Jeroan J, DeLaughter Kathryn, Orner Michelle, Bokhour Barbara G
*Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford †Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester ‡Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA §Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz/Philadelphia VAMC ∥Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA ¶Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center #Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL **Ralph H. Johnson VA Medical Center ††Medical University of South Carolina College of Nursing, Charleston, SC ‡‡Bryant University Communications Department, Smithfield, RI.
Med Care. 2017 Sep;55 Suppl 9 Suppl 2:S50-S58. doi: 10.1097/MLR.0000000000000766.
Disparities in hypertension control persist for African American Veterans.
To enhance cultural relevance of hypertension control self-management education, in a multisite, stratified randomized trial, we tested an interactive Veteran-to-Veteran storytelling digital video disk (DVD) intervention created with Veteran partners, versus an education-only DVD comparison.
At 3 VA facilities, African American Veterans with uncontrolled hypertension were randomized to storytelling DVD intervention or didactic comparison DVD and followed for 6 months. We hypothesized that follow-up blood pressure (BP) would be lower among Veterans in the intervention group.
African American Veterans (N=619) were 92% male, 39% over age 65, most had a high-school education, over 50% of both the intervention and comparison group reported a household income of <$20,000, and 40% had less than adequate health literacy. At baseline, mean intervention and comparison group BPs were 138/80 and 139/81 mm Hg, respectively; at 6 months, mean systolic BP (SBP) increased by 0.1 in the intervention group and by 1.9 for the comparison group; diastolic BP fell by 0.1 in the intervention group and rose by 0.2 in the comparison group. No differences between the intervention and control groups were statistically significant (all P>0.3). Site differences were large; at one, the intervention group improved while the comparison groups deteriorated, resulting in 6.3 and 3.9 mm Hg more improvement for the intervention group in SBP and diastolic BP (P=0.06 and 0.04), respectively; at the other 2 sites, there were positive and negative changes, all small, in the 2 measures, with minimal differences-one site favored the comparison group and the other, the intervention (these comparisons did not approach statistical significance (all P>0.20). In a secondary analysis stratified by baseline BP, there was no intervention effect among those with uncontrolled BP, but intervention patients who were in control at baseline were more likely to stay in control, compared with comparison [SBP increase by 6.3 mm Hg (SD=14.4) among intervention, and by 10.9 mm Hg (SD=16.9) in comparison, P=0.02].
In this multisite trial, we did not find a significant overall storytelling intervention effect (Clinicaltrials.gov Reg. #NCT01276197).
非裔美国退伍军人在高血压控制方面仍存在差异。
在一项多中心、分层随机试验中，为提高高血压控制自我管理教育的文化相关性，我们测试了一种与退伍军人伙伴共同制作的交互式退伍军人对退伍军人讲故事的数字视频光盘（DVD）干预措施，并与仅提供教育内容的DVD对照组进行比较。
在3个退伍军人事务部（VA）设施中，将患有未控制高血压的非裔美国退伍军人随机分为讲故事DVD干预组或说教式对照DVD组，并随访6个月。我们假设干预组退伍军人的随访血压（BP）会更低。
非裔美国退伍军人（N = 619）中92%为男性，39%年龄超过65岁，大多数人接受过高中教育，干预组和对照组中均有超过50%的人报告家庭收入低于20,000美元，40%的人健康素养不足。基线时，干预组和对照组的平均血压分别为138/80和139/81 mmHg；6个月时，干预组的平均收缩压（SBP）升高了0.1，对照组升高了1.9；干预组的舒张压下降了0.1，对照组升高了0.2。干预组和对照组之间的差异无统计学意义（所有P>0.3）。各地点差异很大；在一个地点，干预组有所改善而对照组恶化，干预组的SBP和舒张压分别比对照组多改善6.3和3.9 mmHg（P = 0.06和0.04）；在另外2个地点，这两项指标有正有负的变化，且都很小，差异极小——一个地点有利于对照组，另一个有利于干预组（这些比较均未达到统计学意义（所有P>0.20）。在按基线血压分层的二次分析中，血压未得到控制的患者中没有干预效果，但基线时血压得到控制的干预组患者比对照组更有可能维持血压控制状态[干预组SBP升高6.3 mmHg（标准差 = 14.4），对照组升高10.9 mmHg（标准差 = 16.9），P = 0.02]。
在这项多中心试验中，我们未发现讲故事干预措施有显著的总体效果（Clinicaltrials.gov注册号：NCT01276197）。
