Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

Brief Action Planning in Health and Health Care: A Scoping Review

Achieving maximal health outcomes via health promotion and disease prevention requires the adoption of healthy behaviors. Brief action planning (BAP) is a method for patient self-management, health behavior change, and health coaching with potentially broad implications for and clinical applications in health and health care contexts. This scoping review presents 5 major findings about the literature on BAP: the principal geographic locations and the clinical contexts of its application, the types of research evaluations that it has undergone to date, the theoretic frameworks in which it is grounded, and the fidelity of its use in clinical practice.

A hybrid type 2 effectiveness-implementation design to evaluate a community-based, heart-healthy intervention for women of low socio-economic status

BACKGROUND

Women of low socioeconomic status continue to experience a disproportionate burden of cardiovascular disease. To respond to their unique needs, we adapted the intervention and implementation strategy of an effective theory-based psychoeducational intervention for improving heart-healthy behaviors. Study aims were to evaluate implementation (i.e., reach, fidelity, acceptability, appropriateness) and effectiveness (i.e., perceived stress, common physical symptoms in primary care, physical activity, diet) of the adapted program we called mySTEPS.

METHOD

We used a hybrid type 2 effectiveness-implementation approach. To evaluate implementation, we conducted a process evaluation using data from research records, observation rubrics, and pre-/post-intervention surveys. To evaluate potential effectiveness, we used a one-group, pre-/post-test design with three, sequential offerings (16 weeks each) in unique settings, used standardized, quantitative measures at 8 weeks post-intervention, and calculated effect sizes.

RESULTS

Forty-two women were included in the evaluation. For reach, 66 % and 61 % of participants attended adequate numbers of educational and coaching sessions. Supporting fidelity of delivery, nurse implementers addressed 85-98 % of required criteria. Supporting fidelity of receipt, participants' pre- to post- knowledge scores increased and other scores revealed that nurse-implementers had interacted supportively throughout mySTEPS. Participants rated the acceptability and appropriateness of components positively. Effect-sizes revealed moderate decreases in stress, moderate increases in physical activity, and modest decreases in the number of physical symptoms. Dietary scores did not change.

CONCLUSIONS

The effectiveness and implementation of mySTEPS were positive overall. After strengthening the dietary component, more extensive evaluation of mySTEPS can be conducted to explain mechanisms of action.

MESH HEADINGS

Health behavior, prevention, self-determination theory, self-regulation theory, cardiovascular diseases, implementation strategies.

Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults: The MyHEART Randomized Clinical Trial

Importance

Uncontrolled hypertension (ie, a 24-hour ambulatory systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg or clinic systolic blood pressure of ≥140 mm Hg and diastolic blood pressure of ≥90 mm Hg) in young adults is a US public health burden.

Objective

To evaluate the effect of a telephone coaching and blood pressure self-monitoring intervention compared with usual care on changes in systolic and diastolic blood pressures and behaviors at 6 and 12 months.

Design, Setting, and Participants

This randomized clinical trial included male and female participants aged 18 to 39 years with uncontrolled hypertension confirmed by 24-hour ambulatory blood pressure testing. This was a geographically diverse, multicentered study within 2 large, Midwestern health care systems. Data were collected from October 2017 to February 2022 and analyzed from February to June 2022.

Interventions

The My Hypertension Education and Reaching Target (MyHEART) intervention consisted of telephone coaching every 2 weeks for 6 months, with home blood pressure monitoring. Control participants received routine hypertension care.

Main Outcomes and Measures

The co-primary clinical outcomes were changes in 24-hour ambulatory and clinic systolic and diastolic blood pressure at 6 and 12 months. The secondary outcomes were hypertension control (defined as ambulatory systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg or clinic systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and changes in hypertension self-management behavior.

Results

A total of 316 participants were randomized (159 to the control group and 157 to the intervention group) from October 2017 to December 2020. The median (IQR) age was 35 (31-37) years, 145 of 311 participants (46.6%) were female, and 166 (53.4%) were male; 72 (22.8%) were Black, and 222 (70.3%) were White. There were no differences in baseline characteristics between groups. There was no significant difference between control and intervention groups for mean 24-hour ambulatory systolic or diastolic blood pressure or clinic systolic or diastolic blood pressure at 6 or 12 months. However, there was appreciable clinical reduction in blood pressures in both study groups (eg, mean [SD] change in systolic blood pressure in intervention group at 6 months, -4.19 [9.77] mm Hg; P < .001). Hypertension control did not differ between study groups. Participants in the intervention group demonstrated a significant increase in home blood pressure monitoring at 6 and 12 months (eg, 13 of 152 participants [8.6%] checked blood pressure at home at least once a week at baseline vs 30 of 86 [34.9%] at 12 months; P < .001). There was a significant increase in physical activity, defined as active by the Godin-Shephard Leisure-Time Physical Activity Questionnaire, in the intervention group at 6 months (69 of 100 [69.0%] vs 51 of 104 [49.0%]; P = .004) but not at 12 months (49 of 86 [57.0%] vs 49 of 90 [54.4%]; P = .76). There was a significant reduction in mean (SD) sodium intake among intervention participants at 6 months (3968.20 [1725.17] mg vs 3354.72 [1365.75] mg; P = .003) but not 12 months. There were no significant differences in other dietary measures.

Conclusions and Relevance

The MyHEART intervention did not demonstrate a significant change in systolic or diastolic blood pressures at 6 or 12 months between study groups; however, both study groups had an appreciable reduction in blood pressure. Intervention participants had a significant reduction in dietary sodium intake, increased physical activity, and increased home blood pressure monitoring compared with control participants. These findings suggest that the MyHEART intervention could support behavioral changes in young adults with uncontrolled hypertension.

Trial Registration

ClinicalTrials.gov Identifier: NCT03158051.

Concepts from behavioral theories can guide clinicians in coaching for behavior change

OBJECTIVES

Many patients do not engage in health behaviors that can control common, chronic illnesses. Clinicians have opportunities to promote health behaviors yet may lack skills for coaching effectively about health behaviors. Our aims are to: present definitions of coaching, propose concepts for coaching about behavior change from two theories, share theory-guided research on behavior change relevant to ambulatory care settings, and delineate how concepts from these theories can guide coaching.

METHODS

In our discussion, we explain how two behavioral theories are complementary and applicable to coaching, present empirical support for these theories, and describe applications of these concepts for practice.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Self-determination theory can guide clinicians in how to interact with patients to meet patients' psychological needs, to promote health behaviors, and subsequent health status. Self-regulation theory can guide coaches in what concepts to address for behavior change. These complementary theories have been supported in rigorous research with adult populations in ambulatory care settings.

Diet and lifestyle risk factors associated with young adult hypertensives in India - Analysis of National Family Health Survey IV

Background

Young adults with hypertension have a higher lifetime risk of cardiovascular diseases. Global evidence suggests a significant role of diet and lifestyle risk factors on hypertension among the young adult (aged 18-39 years) hypertensive population.

Aim

The purpose of this study was to look for the association of diet and lifestyle risk factors with young adult hypertensives.

Results

This study reports the prevalence of young adult hypertension based on a national representative sample based on the National Family Health Survey (NFHS-4) data and the association of behavioral risk factors with young adult hypertension. The survey adopted a two-stage stratified random sampling. The outcome variable was hypertension, whereas the exposure variables were various diet and lifestyle factors. The prevalence of young adult hypertension in India was 12.4% among men and 8.2% among women. Sikkim had the highest prevalence among both sexes. Lower prevalence was seen in the states of Delhi and Kerala. Marital status, body mass index, eating meat, alcohol intake, and taking coffee or tobacco 30 min before BP measurement were found to be associated factors that put both the sexes at risk of developing hypertension. The wealth index was concluded as a risk factor only in men while the level of education came out to be a risk factor only in females.

Conclusion

This study is the first from India which gives a recent estimate of prevalence of young adult hypertension by state and individual level characteristics in addition to national level estimates for India.

Effects of on-campus and off-campus smartphone overdependence prevention programs among university students

PURPOSE

To evaluate effects of self-determination theory-based on-campus and off-campus prevention programs on smartphone overdependence among university students.

METHODS

This was a pre-posttest quasi-experimental study with a nonequivalent control group. Seventy-eight students were recruited as participants. They were allowed to choose either an experiment group or a control group (CG). On-campus smartphone overdependence prevention program was provided to participants in experimental group 1 (EG1), while on-campus program combined with off-campus prevention camp was provided to those in experimental group 2 (EG2). Instruments used in this study included a smartphone overdependence self-diagnosis scale, a basic psychological needs scale, and a self-regulation ability scale. Data collection was performed at baseline, immediately after intervention, at one month and three months after intervention. Data were analyzed using mixed analysis of covariance (ANCOVA). Focus group interview (FGI) was performed for qualitative evaluation.

RESULTS

After the intervention, smartphone overdependence and basic psychological needs exhibited significant interactions between group and time. Smartphone overdependence scores decreased in EG1 and EG2, but increased in CG (F = 4.56, p = .001). Basic psychological needs improved in EG1 and EG2, but deteriorated in CG (F = 5.04, p = .009). FGIs reveaaled that participants strived to control their smartphone usage through individual efforts and by interacting with new friends in college even after completing the program.

CONCLUSION

In this study, on-campus only program and combined intervention of on- and off-campus programs were both effective in maintaining and managing smartphone use. However, participants perceived that the off-campus program provided an opportunity to apply the theory learned on-campus to the real world.

Interventions for Women Veterans with Mental Health Care Needs: Findings from a Scoping Review

Experts have prioritized research on women veterans' mental health and the delivery of gender-sensitive care. The purpose of this study was to conduct a scoping review of the literature to summarize interventions for women veterans with mental health care needs designed in the Department of Veterans Affairs (VA). We identified 1,073 articles; eight were eligible for full review and represented seven unique interventions. Four studies focused on individual-level interventions; three studies focused on interpersonal-level interventions. Some attributes of gender-sensitive care included modifying the treatment environment and offering same gender clinicians. In designing interventions, clinicians and researchers can: (a) create interprofessional teams which include nurses, (b) use participatory methods to improve study designs, (c) assess participants' barriers to care prior to designing interventions, (d) incorporate and evaluate attributes of gender-sensitive care, and (e) utilize and clearly delineate how theory guides research. With improved intervention research, clinicians and researchers can support women veterans with mental health care needs.

Factors influencing the self-management of kidney transplant patients based on self-determination theory: a cross-sectional study

Background

Self-determination theory is useful for explaining how kidney transplant recipients self-manage their postoperative health, including drug regimens, but few studies have applied this theory to transplant recipients. This study aimed to examine the influence of health professionals’ autonomy support, autonomous motivation and competence on kidney transplant patients’ self-management based on the self-determination theory.

Methods

This study included 79 kidney transplant patients from one outpatient clinic in a general hospital in Seoul, Korea. Data on the health professionals’ support of patient autonomy and the kidney transplant patients’ autonomous motivation, competence, and self-management were collected from self-report questionnaires.

Results

The factors that influenced self-management behavior in kidney transplant patients were competence (β=0.377, P=0.001) and autonomous motivation (β=0.293, P=0.006). The explanatory power of these variables was 30.1%.

Conclusions

This study found that autonomous motivation and competence in kidney transplant patients affected their self-management, indicating that if healthcare professionals enhance patients’ competence and autonomous motivation, their self-management can be improved. The development of intervention programs that assist healthcare professionals in strengthening patients’ autonomous motivation and competence is recommended.

Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group

Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2-day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long-term health. These changes demand a repositioning of existing evidence-based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.