Interactive Program to Prevent Hypertension in Prehypertensive Seniors

预防高血压前期老年人高血压的互动项目

• 批准号: 7611849
• 负责人: AMELIA J BIRNEY
• 金额: $ 22.96万
• 依托单位: OREGON CENTER FOR APPLIED SCIENCE, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2010-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7611849
• 关键词: Address; Adopted; Adult; Alcohol consumption; American; Antihypertensive Agents; Behavior; Blood Pressure; Body Weight decreased; Cardiovascular system; Caring; Charge; Computerized Medical Record; DASH diet; Data; Databases; Detection; Diastolic blood pressure; Diet; Drops; Eating; Eating Behavior; Effectiveness of Interventions; Elements; Evaluation; Event; Exercise; Focus Groups; Goals; Guidelines; Health; Health Knowledge, Attitudes, Practice; Health Personnel; Health Planning; Healthcare; Hypertension; Individual; Insurance; Internet; Intervention; Interview; Joints; Learning; Life Style; Literature; Medical; Medical Electronics; Medical Records; Modeling; Modification; Myocardial Ischemia; Older Population; Outcome; Pharmaceutical Preparations; Phase; Physical activity; Physicians; Positioning Attribute; Prevention; Problem Solving; Randomized Controlled Clinical Trials; Readiness; Reporting; Research; Risk; Risk Behaviors; Screening procedure; Self Assessment; Self Blood Pressure Monitoring; Self Efficacy; Self Management; Site; Sodium; Staging; Stroke; System; Techniques; Testing; TimeLine; Weight maintenance regimen; base; behavior change; cost; design; disability; evidence base; experience; health belief; high risk; human old age (65+); innovation; instrument; interactive multimedia; intervention program; meetings; motivated behavior; motivational enhancement therapy; peer; prevent; programs; prototype; public health relevance; quality assurance; repository; research and development; social cognitive theory; theories; therapy design; usability; Address; Adopted; Adult; Alcohol consumption; American; Antihypertensive Agents; Behavior; Blood Pressure; Body Weight decreased; Cardiovascular system; Caring; Charge; Computerized Medical Record; DASH diet; Data; Databases; Detection; Diastolic blood pressure; Diet; Drops; Eating; Eating Behavior; Effectiveness of Interventions; Elements; Evaluation; Event; Exercise; Focus Groups; Goals; Guidelines; Health; Health Knowledge, Attitudes, Practice; Health Personnel; Health Planning; Healthcare; Hypertension; Individual; Insurance; Internet; Intervention; Interview; Joints; Learning; Life Style; Literature; Medical; Medical Electronics; Medical Records; Modeling; Modification; Myocardial Ischemia; Older Population; Outcome; Pharmaceutical Preparations; Phase; Physical activity; Physicians; Positioning Attribute; Prevention; Problem Solving; Randomized Controlled Clinical Trials; Readiness; Reporting; Research; Risk; Risk Behaviors; Screening procedure; Self Assessment; Self Blood Pressure Monitoring; Self Efficacy; Self Management; Site; Sodium; Staging; Stroke; System; Techniques; Testing; TimeLine; Weight maintenance regimen; base; behavior change; cost; design; disability; evidence base; experience; health belief; high risk; human old age (65+); innovation; instrument; interactive multimedia; intervention program; meetings; motivated behavior; motivational enhancement therapy; peer; prevent; programs; prototype; public health relevance; quality assurance; repository; research and development; social cognitive theory; theories; therapy design; usability

DESCRIPTION (provided by applicant): Nearly a quarter (24%) of older Americans (>60 yrs) have prehypertension (SBP 120-139 mm Hg and/or DBP 80-89 mm Hg). Half of those 65 years and older with blood pressure in the top of the prehypertensive range (130 mm Hg and/or 85-89 mm Hg) will develop hypertension within four years, if this progression is not prevented. Notably, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommends that prehypertensive individuals implement the lifestyle modifications that have been shown to reduce blood pressure: weight reduction, the DASH diet, reduction in sodium and alcohol consumption, and regular physical activity. Thus, a comprehensive lifestyle modification program that is tailored to the needs of prehypertensive seniors would help meet JNC-7's goals. Physicians and other health care providers often do not provide effective support for non-medical behavior change interventions, resulting in progression to hypertension and the use of antihypertensive medications. However, health plans and healthcare organizations with electronic medical records and online medical record repositories, like Microsoft HealthVault, Google Health, and Revolution Health, are in a unique position to identify prehypertensive seniors and direct them to an interactive blood pressure intervention. Preventing or delaying hypertension should reduce mid-term costs of antihypertensive medications and long-term cost of care for the initial events and long-term disability and management of ischemic heart disease and stroke. This project will develop and test an interactive multimedia (IMM) program for seniors with prehypertension. The Internet-based intervention will be designed to motivate people to take charge of their blood pressure management. The program will address blood pressure self-monitoring and the five proven lifestyle modifications recommended by JNC-7: weight reduction, the Dietary Approaches to Stop Hypertension (DASH) diet, sodium reduction, physical activity, and alcohol consumption. The program will draw from the Health Belief Model, Transtheoretical Model, Social Cognitive Theory, and Motivational Interviewing concepts. The program will include a Blood Pressure Management Self-Assessment to identify users' highest-risk hypertension-related behaviors and their readiness to change those behaviors and stage-tailored content to motivate the behavior changes that are most likely to be adopted and/or result in a drop in blood pressure. The Phase I prototype will consist of the Blood Pressure Management Self-Assessment and the Sodium Reduction module. When complete, each module will include: (a) stage-tailored information on change strategies, (b) stage-tailored motivational video peer testimonials, (c) a goal setting activity, (d) a barrier identification and problem-solving activity, and (e) an action plan activity. The Phase I evaluation will use a within-subject design to demonstrate pre-post change in blood pressure management knowledge, attitudes, behaviors, self-efficacy and intentions. In Phase II, the complete program will be developed and evaluated in a larger randomized trial on the Internet. PUBLIC HEALTH RELEVANCE: Half of Americans 65+ years with blood pressure above 130 mm Hg (systolic) and/or 85-89 mm Hg (diastolic) will develop hypertension within four years. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that prehypertensive individuals implement lifestyle modifications to reduce blood pressure: weight reduction, the DASH diet, reduction in sodium and alcohol consumption, and regular physical activity. This project will create and test an interactive lifestyle modification program tailored to the needs of prehypertensive seniors.

描述（由申请人提供）：近四分之一（24％）的年长美国人（> 60岁）具有预发速度（SBP 120-139 mm HG和/或DBP 80-89 mm HG）。在65岁及以上的血压中，有一半的血压（130 mm Hg和/或85-89 mm Hg）在四年内将在四年内发育高血压，如果不阻止这种进展。值得注意的是，高血压（JNC-7）的预防，检测，评估和治疗联合全国预防，评估和治疗联合委员会的第七次报告建议，高血压前的个体实施已证明减少血压的生活方式修饰：减轻体重，减轻体重，减轻饮食，减少钠和酒精消耗以及正常的身体活动。因此，针对前期老年人的需求量身定制的全面生活方式修改计划将有助于实现JNC-7的目标。医师和其他医疗保健提供者通常不会为非医学行为改变干预措施提供有效的支持，从而导致高血压和使用降压药。但是，拥有电子病历和在线病历存储库（如Microsoft HealthVault，Google Health和Revolution Health）具有的健康计划和医疗保健组织处于独特的位置，可以识别出高管前的老年人，并将其引导到互动性血压干预中。预防或延迟高血压应降低降压药物的中期成本以及初始事件的长期护理成本，以及长期残疾以及缺血性心脏病和中风的管理。该项目将针对具有预元素的老年人开发和测试一个交互式多媒体（IMM）计划。基于互联网的干预措施将旨在激励人们负责其血压管理。该计划将解决血压自我监控以及JNC-7推荐的五种经过验证的生活方式修改：减轻体重，饮食中停止高血压（DASH）饮食，减少钠，体育锻炼和酒精消耗的方法。该计划将借鉴健康信念模型，跨理论模型，社会认知理论和动机访谈概念。该计划将包括血压管理的自我评估，以确定用户最高风险的高血压相关行为以及他们准备改变这些行为和阶段尾声的内容，以激发最有可能采用的行为变化和/或导致血压下降。 I期原型将包括血压管理自我评估和钠还原模块。完成后，每个模块将包括：（a）有关变更策略的阶段详细信息，（b）阶段量的动机视频对等见证，（c）目标设定活动，（d）障碍识别和解决问题的活动，以及（e）行动计划活动。第一阶段的评估将使用受试者内设计来证明血压管理知识，态度，行为，自我效能和意图的验证前变化。在第二阶段，将在Internet上的大型随机试验中制定和评估完整的程序。公共卫生相关性：一半的美国人在65岁以上的血压高于130 mm HG（收缩期）和/或85-89毫米汞柱（舒张期）将在四年内发展高血压。国民预防，检测，评估和治疗高血压联合委员会的第七次报告建议，高血压的个体实施生活方式改变以降低血压：减轻体重，减轻饮食，减少钠和饮酒以及常规的体育活动。该项目将创建并测试根据前期老年人的需求量身定制的互动生活方式修改计划。