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

The shift in patterns of disease toward chronic illness necessitates greater patient participation in its management and their own rehabilitation, and they require greater social support over longer periods. 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 healthy 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 variable blood pressure control (62% in control among intervention groups versus 46% in nonintervention groups).