A Community and Technology-Based Approach for Hypertension Self-Management (COACHMAN) to Improve Blood Pressure Control in African Americans: Results from a Pilot Study

Figures & data

Table 1 COACHMAN Intervention Components

Intervention Component	Duration	Content
1. Web-based hypertension education	Six weekly module, <10 minutes in duration	Delivers knowledge about hypertension, including managing the disease, monitoring blood pressure, medication adherence via a web-based module
		Week 1	Overview and understanding hypertension
		Week 2	Self-monitoring your blood pressure
		Week 3	Importance of adherence to your blood pressure medications
		Week 4	Modifying behaviors-Increasing physical activity
		Week 5	Modifying behaviors-Healthy diet
		Week 6	Understanding health consequences of hypertension
2. Self-monitoring blood pressure (BP)	12 weeks	Participants instructed to monitor and record blood pressure two non-consecutive days/week, twice a day, for a total of 12 weeks with an Omron 10 Series home BP monitor, provided by study.
3. Medication management support	12 weeks	Participants were instructed and trained to use the Medisafe medication management application on their smartphone to support medication adherence. Participants were provided daily medication reminders and updates about their antihypertensive medication over the 12-week study period.
4. Nurse counseling sessions	30 minutes phone sessions	Participants received up to four counseling sessions with a research nurse to support self-managing hypertension over 12 weeks.

Table 2 Baseline Sociodemographic Variables of the Sample Stratified by Study Conditions

Characteristics	Control Group (n = 30)	Intervention Group (n = 30)	χ^2/t	p
Age in years, mean ± SD)	58.97 ± 8.37	60.0 ± 9.49	−0.45	0.656
Young (<49), n (%)	4 (13.3)	4 (13.3)	0.746	0.770
Middle (50–64), n (%)	18 (60.0)	15 (50.0)
Older (65 or above), n (%)	8 (26.7)	11 (36.7)
Gender n (%)			2.22	0.136
Males	5 (16.67)	10 (33.33)
Females	25 (83.3)	20 (66.7)
Education in years, mean ± SD	14.70 ± 3.36	14.52 ± 3.38	0.211	0.834
Marital Status, n (%)			6.653	0.248
Single	22 (73.33)	19 (63.33)
Married	8 (26.7)	11 (36.7)
Employment			−0.766	0.45
Unemployed	14 (46.7)	17 (56.7)
Employed	16 (53.3)	13 (43.3)
Income			−0.562	0.576
<$20,000	8 (26.7)	8 (26.7)
$20,000–$59,999	11 (36.7)	9 (30.0)
>$60,000	11 (36.7)	13 (43.3)

Notes: Values are expressed as either n (%) or mean ± SD. The P-value are for χ² and independent two-sample t-test.

Table 3 Hypertension-Related Characteristics

Characteristics	Control Group (n = 30)	Intervention Group (n = 30)	χ^2/t/W	P value
Years diagnosis with hypertension, mean ± SD	15.71 ± 10.34	17.00 ± 9.20	−0.512	0.611
No. of chronic diseases, mean ± SD	3.30 ± 2.15	3.93 ± 2.03	−1.172	0.246
No. of BP medications prescribed, mean ± SD	1.80 ± 1.00	2.00 ± 0.91	−0.812	0.42
Class of BP Medications, n (%)
Diuretic treatment	13 (43.3)	17 (56.7)	1.067	0.302
ACE inhibitor treatment	7 (23.3)	7 (23.3)	0.00	1.00
Angiotensin receptor blocker treatment	11 (36.7)	7 (23.3)	1.270	0.26
Calcium channel blocker treatment	10 (33.3)	15 (50.0)	1.74	0.19
Beta blocker treatment	7 (23.3)	10 (33.3)	0.739	0.390
Smoker, n (%)	7 (23.3)	13 (43.3)	2.70	0.10
BP at Screening visit, mean ± SD
Screening Systolic BP	152.20 ± 12.19	156.67 ± 90.53	−1.140	0.259
Screening Diastolic BP	88.07 ± 13.02	90.53 ± 14.66	−0.689	0.494

Notes: Values are expressed as either n (%) or mean ± SD. The P-value are for χ² and independent two-sample t-test or Wilcoxon rank-sum test.

Table 4 Study Variables, Outcomes, and Clinical Characteristics Stratified by Study Condition

Variables	Control Group (n = 30)					Intervention Group (n = 30)
	Baseline		12 Weeks		P value	Baseline		12 Weeks		P value
	Mean	SD	Mean	SD		Mean	SD	Mean	SD
Health outcomes
Systolic BP, mmHg	141.24	16.92	139.07	16.41	0.55	138.51	14.77	139.06	16.54	0.87
Diastolic BP, mmHg	85.28	12.61	84.24	12.06	0.63	81.97	13.45	81.17	11.45	0.67
Physical health, HRQoL	14.28	2.68	14.17	2.59	0.72	14.52	2.85	14.41	3.01	0.76
Mental health, HRQoL	13.38	2.46	13.72	3.39	0.26	13.83	2.83	13.83	3.13	1.00
Clinical characteristics
Pulse	70.96	11.54	72.71	12.40	0.43	68.13	13.79	73.17	12.39	0.009
Weight, lbs	217.73	47.84	220.21	49.26	0.003	210.15	52.27	211.30	53.12	0.259
Body mass index, kg/m2	35.16	7.60	35.53	7.84	0.005	35.03	8.07	34.73	8.31	0.578
HDL cholesterol, mg/dL	51.75	12.09	52.78	12.53	0.45	53.39	15.09	51.36	15.48	0.060
LDL cholesterol, mg/dL	111.96	32.66	107.54	36.19	0.43	113.08	35.85	105.00	29.35	0.061
Behavioral outcomes
Medication adherence	13.38	6.09	11.93	4.43	0.075	12.00	3.43	10.72	2.20	0.023
Self-management process
Hypertension knowledge	17.93	3.05	18.72	2.27	0.14	19.07	1.69	19.38	1.25	0.38
Self-efficacy	41.65	15.24	45.48	13.92	0.09	46.34	11.24	46.62	10.07	0.88
Contextual factors
Social support	11.90	2.57	11.79	2.47	0.80	12.34	2.00	12.03	2.47	0.37
Spirituality	33.03	10.64	31.21	9.69	0.53	32.00	14.06	33.69	14.52	0.23
Depression	12.45	4.47	12.17	4.61	0.61	13.03	5.78	13.63	5.26	0.17

Note: P-values from paired t-test.

Abbreviations: BP, blood pressure; HRQoL, health-related quality of life.

Table 5 Unadjusted and Adjusted Model of Repeated Measures for Within- and Between-Group Effects of Study Outcomes

Variables		Unadjusted Model			Adjusted Model^a
		df	F	P	df	F	P
Systolic BP	Time	2	0.03	0.9659	2	0.04	0.9639
	Study group	1	0.15	0.7036	1	0.03	0.8661
	Interaction^b	2	0.12	0.8911	2	0.12	0.8903
Diastolic BP	Time	2	0.19	0.8305	2	0.19	0.8260
	Study group	1	1.84	0.1800	1	1.10	0.2979
	Interaction^b	2	0.41	0.6650	2	0.40	0.6708
Physical health, HRQoL	Time	1	0.22	0.6392	1	0.21	0.6475
	Study group	1	0.09	0.7643	1	0.09	0.7606
	Interaction^b	1	0.00	0.9860	1	0.00	0.9867
Mental health, HRQoL	Time	1	0.76	0.3862	1	0.78	0.3807
	Study group	1	0.10	0.7542	1	0.04	0.8513
	Interaction^b	1	0.65	0.4227	1	0.66	0.4214
Medication adherence	Time	2	4.52	0.0130*	2	4.51	0.0131*
	Study group	1	1.80	0.1848	1	1.37	0.2461
	Interaction^b	2	0.04	0.9564	2	0.05	0.9557

Notes: *P value < 0.05. ^aAdjusted for age, gender and years of hypertension. ^bStudy group x time interaction.

Abbreviations: BP, blood pressure; HRQoL, health-related quality of life.