Pilot Project 4

Pilot PI: Brenda Douglas, PhD, MSN, RNbrenda_douglas_001-rev-e1449181591524

Title: Self-Management of Hypertension Lifestyle Behaviors Using a Smartphone EMA/I App with Older Adult Black Women

Summary

The prevalence of hypertension (HTN) among communities of color as compared to other communities is disproportionally high (Mozaffarain, Benjamin, Go, Arnett, et al., 2015). For example, national reports (Mozaffarain et al., 2015; Egan et al., 2015) indicate that HTN remains significantly higher among Black adults including HTN-related deaths as compared to White or Hispanic adults (Kung & Xu, 2015). On the regional level, Black Bostonians have more than 70% higher prevalence of HTN than White or Latino Bostonians (BPHC, 2005) and, although the prevalence rate among Black Bostonians reflects a downward trend, Blacks continue to be disproportionately affected by HTN (BPHC, 2013). Likewise, while HTN is generally not well controlled in the United States at 47.5% for those ages 60 and less, and 65.8% for those over age 60, it is less well controlled in Black adults (Navar-Boggan, Pencina, Williams, Sniderman, & Peterson, 2014). Blacks also experience greater disease severity and higher rates of HTN related morbidity (Fryar, Hirsch, Eberhardt, Yoon, & Wright et al., 2010; Sile et al., 2007).

Substantive evidence supports HTN self-management behaviors including physical activity (PA) and dietary modifications as an indispensable part of HTN treatment (James et al., 2014). Yet, despite known effective therapies, achieving success in HTN control and sustained engagement in HTN self-management behaviors is generally poor, particularly among ethnic minority populations such as Blacks (Bosworth, et al., 2006; Ndumele, Shaykevich, Williams, & Hicks, 2010; Warren-Findlow & Seymour, 2011; Kressin et al., 2007). The proposed pilot builds upon previous work of the PI who found significant relationships between characteristics of older adults in Boston and engagement in HTN self-management behaviors, and that older adult Black women are open to engaging in HTN self-management behaviors (Douglas & Howard, 2015). The study seeks to involve participants as active partners in the development and testing of an innovative, technology-based intervention to support engagement in HTN self-management PA behavior. Hence, the specific aims for this project are:

Aim 1: Examine the acceptability and usability of a smartphone-based app to support HTN self-management PA among adult Black women age 60 and older.

Aim 2: Determine social and contextual factors associated with engagement in PA among adult Black women age 60 and older.

Aim 3: Determine to what extent acceptability and usability differ by participants’ demographics (height, weight, age, marital status, living situation, education, employment, and income).

Aim 4: Examine the relationship among the patterns of engagement in HTN self-management behaviors such as diet modifications, PA, and medication adherence, Stage of Change, self-rated physical and mental health, and use of a smartphone app among adult Black women age 60 and older.