A Community-Based Participatory Approach to Evaluating and Adapting an Innovative Family-Based Hypertension...

Culturally responsive, family-based interventions to promote hypertension self-management may be a particularly effective approach to improving hypertension outcomes for African Americans who experience persistent hypertension-related disparities in morbidity and mortality. We aimed to further develop and culturally adapt the Walk Together program-a multilevel family-based hypertension self-management intervention implemented in primary care-using a community-based participatory research (CBPR) approach.

African American primary care patients (18-75) with uncontrolled hypertension were recruited from a community-based family medicine clinic; patients invited a family support person (defining "family" broadly) to participate (N = 24). We used a dyadic (i.e., patient plus family) focus group design to solicit feedback which informed responsive, iterative adaptations to the intervention protocol. Intervention credibility and expectation of benefit was assessed via questionnaire. Thematic analysis was used to inductively and deductively identify themes.

Participants in seven focus groups suggested novel additions to the intervention to target environmental barriers to self-management, promote collaboration between the study and healthcare teams, and enhance hypertension education. Participants also recommended adaptations to the hypertension-focused and relationship-focused content. Finally, participants reported ideal interventionist characteristics and strengths of the intervention, which they described as justified, improving access to care, and pragmatic. Survey results indicated participants, on average, found the program logical and convincing and felt meaningful improvements in hypertension could be achieved. Recruitment was ceased when saturation was achieved.

We leveraged a CBPR approach to inform the development and adaptation of the Walk Together program and enhance the intervention's feasibility and acceptability ahead of Stage IB pilot testing.