The nature and efficacy of intervention studies in the National High Blood Pressure Education Research Program.

Results from seven research projects funded by the National Heart, Lung and Blood Institute are reviewed. These methodologically advanced studies employed a variety of intervention strategies intended to improve blood pressure control and patient adherence to therapeutic recommendations. The strategies are categorized as representing four themes. The 'active patient' theme emphasizes the need to increase patient responsibility for self-care. The 'social support' theme is represented in interventions in which another person provides various resources for meeting the illness challenge. The 'fear arousal' theme is seen in manoeuvres that attempt to heighten patient concern about the dire consequences of illness. Finally, the 'patient instruction' theme is expressed as transmittal of information about the nature of the illness or therapeutic regimen. Studies using the 'active patient' theme, especially contingency contracting, and those employing 'social support' approaches, especially those involving home visitation of patients by members of the health care team, were found to be most effective.