Skip to main content
Log in

An educational and behavioral approach toward increasing patient activation in hypertension management

  • Research Reports
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

The shift in patterns of disease toward chronic illness necessitates greater patient participation in its management and in their own rehabilitation, and they require greater social support over longer peiods. Patient activation, or the enhancement of patient and support group involvement in personal health care through teaching management techniques and problem-solving skills, has emerged in health education in response to this need. This paper will examine combined educational and behavioral approaches to increasing social support and patient activation in hypertension management. Activation in this study involves increased feelings of personal control over the contingencies surrounding the management of medical regimens. Both family support intervention and small group sessions oriented to changing compliance behavior by changing expectancy frames were offered to a randomized sample of 200 inner city, black, hypertensive patients who were part of a larger study. Patients were examined within a pretest—posttest randomized factorial design on measures of locus of control, belief in seriousness, efficacy of treatment, medication compliance, and blood pressure control. This combined approach showed small differences on the attitude and behavioral measures but displayed a significant effect on the program outcome variableblood pressure control (62% in control among intervention groups versus 46% in nonintervention groups).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sackett DL, Haynes RB:Compliance with Therapeutic Regimens. Baltimore, Johns Hopkins University Press, 1976.

  2. Weinstein MC, Stason WB:Hypertension: A Policy Perspective. Cambridge, Harvard University Press, 1976.

    Google Scholar 

  3. Green LW, Werlin SH, Schauffler HH, et al:Research and Demonstration Issues in Self Care: Measuring the Decline of Mediocentrism. Consumer Self-Care in Health. U.S. Department of Health, Education and Welfare, HRA 77-3181, 20–36, August, 1977.

  4. Caplan RD, Robinson EA, French JR, et al:Adhering to Medical Regimens. Ann Arbor, Michigan: The Institute for Social Research, 1976.

    Google Scholar 

  5. Green LW, Levine DM, Wolle J, et al: Development of randomized patient education experiments with urban poor hypertensives.Patient Couns Health Educ 1 106–111, 1979.

    Google Scholar 

  6. Green LW, Levine DM, Deeds SG: Clinical trials of health education for hypertensive outpatients: Design and baseline data.Prev Med 4 417–425, 1976.

    Google Scholar 

  7. Levine DM, Green LW, Deeds SG, et al: Behavioral and clinical effects of health education in randomized trials with hypertensive patients.JAMA 241 1700–1703, 1979.

    Google Scholar 

  8. Christensen DB: “Drug-taking Compliance: A Review and Synthesis”Health Serv Res 13171–186, Summer 1978.

    Google Scholar 

  9. Becker MH, Maiman LA: Strategies for enhancing patient compliance.J Community Health 6 113–132, 1980.

    Google Scholar 

  10. Cobb S: Social support as a moderator of life stress.Psychosom Med 38 300–317, 1976.

    Google Scholar 

  11. Lefcourt HM:Locus of Control: Current Trends in Theory and Research. New York, John Wiley and Sons, 1976.

    Google Scholar 

  12. Henderson JB, Enlow A: The coronary risk factor pespective: A behavioral perspective.Prev Med 5 128–148, 1976.

    Google Scholar 

  13. Katz A, Bender E: Self-help groups in western society: History and prospects.Appl Behav Sci 2 265–281, 1974.

    Google Scholar 

  14. Crowne D:Internal Versus External Control of Reinforcement: The Experimental Study of Personality. New York, John Wiley, 1979, 184–220.

    Google Scholar 

  15. Bohrnstedt GW: Reliability and validity assessment in attitude measurement. ed: G Summers, InAttitude Measurement. Chicago, Rand McNally & Co, 1970, 80–99.

    Google Scholar 

  16. Wallston BS, Wallston KA, Kaplan GO: Development and validation of the Health Locus of Control (HLC) scale.J Consult Clin Psychol 44 580–585, 1976.

    Google Scholar 

  17. Lewis FM, Morisky DE, Flynn BS: A test of construct validity of health locus of control: Effects on self-reported compliance for hypertensive patients.Health Educ Monogr 6 138–148, 1978.

    Google Scholar 

  18. Fletcher SW, Appel FA, Bourgeois MA. Management of hypertension: Effects of improving patient compliance for follow-up care.JAMA 233 242–244, 1975.

    Google Scholar 

  19. Inui TS, Yountee EI, Williamson JW: Improved outcomes in hypertension after physician tutorial.Ann Inter Med 84 646–651, 1976.

    Google Scholar 

  20. Wang VL, Green LW, Ephross P:Not Forgotten but Still Poor. College Park, Md, University of Maryland Cooperative Extension Service, Monograph No 2, 1972.

    Google Scholar 

  21. Morisky DE, Levine DM, Green LW: The long-term effects of health education interventions on hypertensive outpatients. Presented at the National Conference on HBP Control, New York, 1981.

Download references

Authors

Additional information

Dr. Morisky is with the Johns Hopkins University Division of Health Education and Health Services Research and Development Center, 624 North Broadway, Baltimore, Maryland 21205; Dr. Bowler is with the George Mason University, Fairfax, Virginia; and Dr. Finlay is with the Agency for International Development, Washington, D.C..

This work was supported by NHLBI grant numbers 1R25 HL 17016-10, and 1T32 HL 07180, Lawrence W. Green and David M. Levine, co-principal investigators, and Sigrid Deeds, project coordinator, and NHLBI HV 1-72986. The authors wish to acknowledge the help of Carol Johns, Patterson Russell, Joan Wolle, Judy Chwalow, Christine Lewis, Lorraine Midanick, Sam Shapiro, Lee Bone, and Marion Field Fass. Portions of this paper were presented at the 1979 National Conference on High Blood Pressure Control, Washington, D.C., April 4–6, 1979.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morisky, D.E., Bowler, M.H. & Finlay, J.S. An educational and behavioral approach toward increasing patient activation in hypertension management. J Community Health 7, 171–182 (1982). https://doi.org/10.1007/BF01325513

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01325513

Keywords

Navigation