Walk Together Efficacy Trial

Hypertension is the most significant risk factor for racial disparities in mortality and life expectancy. African Americans, in particular, are at greater risk of developing hypertension earlier and experiencing worse hypertension-related outcomes. Hypertension is also a modifiable risk factor for cardiovascular disease, in part via self-management behavior which is critical for achieving hypertension control. Black and African American individuals often report difficulties with self-management adherence due in part to challenges in sustaining necessary lifestyle changes, and environmental barriers to engaging in self-care. African Americans also frequently report family emotional and behavioral support is critical for achieving self-management goals, while shared health behaviors, insufficient support, and family stress are often identified as barriers to self-management. Yet, family support has remained an untapped resource in hypertension self-management interventions. This study will test the efficacy of a new family-based hypertension self¬-management intervention which was designed and adapted with and for Black and African American primary care patients living with uncontrolled hypertension and their family support persons via prior community-based participatory research. The intervention -- Walk Together -- includes four dyadic (i.e., patient plus family support person) sessions over approximately eight weeks with the goal of optimizing family relationship quality including family support for hypertension self-management, plus improving hypertension knowledge, while addressing common barriers to hypertension management via referrals to standard of care resources, health information technology, and integration into patients' primary care clinics. Using a randomized controlled trial design, we will (1) identify the extent to which the Walk Together intervention increases hypertension self-management adherence and improves blood pressure control compared to a hypertension education control condition (HypEd); (2) examine family support (i.e., patient-family support person relationship quality, and family support for hypertension management behaviors) and hypertension knowledge as mechanisms of effect through which Walk Together leads to improvements in self-management adherence and blood pressure control outcomes; and, (3) evaluate the family-level positive health impacts of the Walk Together intervention on participating family support persons' hypertension knowledge and health behaviors.