Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

High rates of hypertension (HTN) among African American men in the United States represent a significant public health issue. Yet even among those diagnosed, many do not achieve blood pressure (BP) control. Because elevated BP is the primary modifiable risk factor for cardiovascular disease, managing it is central to improving overall health outcomes. One contributing factor to this HTN prevalence is stress. African Americans report high levels of stress. This stress leads to heightened allostatic load, a biologic measure of the cumulative burden of chronic stress that is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., overeating, alcohol use) and reduced adherence to antihypertensive medications. Research shows that stress management (SM) interventions improve HTN. Despite this, SM training is not regularly deployed to manage BP, often because health care settings lack the resources to deliver it. One cost-effective, easily scalable solution is mobile phones (i.e., mHealth). Importantly, 98% of African Americans own a mobile phone. Most are smartphones (83%). And text messaging interventions have been shown to improve a variety of HTN management lifestyle changes (e.g., smoking reduction, physical activity enhancement). There is no mobile cognitive behavioral SM intervention (m-CBSMi) on the market today that is designed to reduce BP among African American men by mitigating the impact of stress. The proposed intervention will fill this void. Using proven CBSMi techniques, African American men will learn how to manage stress and reduce BP through text messages and integrated videos. Educational texts will increase knowledge, develop skills, and promote adaptive coping. Supportive texts will increase confidence and motivation. A library of interactive videos will allow a user to choose tailored training and content based on his personal needs and experiences (e.g., utilizing a choose-your-own-adventure style). All videos will be accessible through links embedded within text messages, making it effortless to view them. In Phase I, a prototype m-CBSMI was developed. This development was informed by formative research with 20 African American men across the lifespan. The results of Phase I strongly support the feasibility and potential effectiveness of the intervention, far exceeding the benchmarks established in the Phase I proposal. During Phase II, the m-CBSMi for African American men will be fully developed. Then, in partnership with Family and Medical Counseling Service, the effectiveness of the m-CBSMi to reduce BP among hypertensive African American men will be examined. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess subjective stress, use of antihypertensive medications, coping, well-being, and knowledge.