Promoting Self-Management in Low Income African Americans Living With Hypertension

Health outcomes of chronically ill low-income adults are costly in both fiscal and human
terms. Although advances have been made in understanding how nurse case management (NCM) can
contribute to self-management (SM) behaviors, the factors that contribute to sustained SM
behaviors in low-income African American populations are not well understood. This study
will examine the impact of Ecological Nurse Case Management (ENCM) on self-management
behaviors, health status, and self-efficacy of poor, chronically ill, African American
adults. In addition, we will explore moderating effects to determine if the ENCM
intervention is differentially effective based on gender or perceived stress. The study will
use the UWM Automated Community Health Information System, a relational electronic health
record, to document the individualized ECNM intervention and dose of the intervention. The
specific study aims are to: 1) examine differences between an ENCM treated group and a
comparison group on self-efficacy, SM behaviors, and health status to establish effect sizes
needed for a future large randomized controlled trial; 2) explore the dose-response of
specific elements of the ENCM intervention; and 3) examine moderating effects of gender and
perceived stress on the intervention effect. This is a two-group randomized experimental
study with repeated measurements. Clients in the treatment group (n=25) will receive the
individualized ENCM and those in the comparison group (n=25) will receive usual clinic care.
Data will be collected at baseline, 1, 3, and 6 months to capture the immediate, short and
longer term effects of the intervention. Acknowledging the small sample size, mixed models
for repeated measures data (at baseline and M1, 3, and 6 post-intervention) will be fit to
interactions involving moderating variables of gender and stress. The ENCM intervention
draws on evidence that given the proper tools (i.e., knowledge, skills and support),
individuals can learn to better self-manage their symptoms on a day to day basis and better
utilize the health care resources available to them.

Inclusion Criteria:

- Hypertension diagnosis Attend Bread of Healing Clinic

Exclusion Criteria:

- No Hypertension diagnosis Do not Attend Bread of Healing Clinic