Health Coaches for Hypertension Control

Evidence-level

Effective (About evidence-level criteria)

Description

In 2007, hypertension rates in residents of South Carolina's Oconee County, located in rural Appalachia, surpassed the state and national average. The Health Coaches for Hypertension Control (HCHC) program was formed to promote hypertension self-management using trained community volunteers. These health coaches are a cost-effective and sustainable approach for helping hypertension patients manage their condition.

HCHC serves rural Appalachian Oconee County, which is located in western South Carolina and is now being implemented in Montana. The program was aimed at county residents over the age of 60 diagnosed with hypertension. Local health coach volunteers were recruited and underwent a 30-hour training that covered each topic area included in the small group sessions they would be leading.

Primary partners in the project include:

• DHEC – South Carolina Department of Health and Environmental Control
• Oconee Physician Practices
• Clemson University
• Clemson Cooperative Extension
• Joseph F. Sullivan Center
• Oconee Medical Center

The first phase of this project was funded by a 2009-2012 Office of Rural Health Policy Rural Health Care Services Outreach Grant. A second phase extension was funded by a USDA grant.

Health Coaches for Hypertension Control is currently being implemented in the following states through various groups:

• Clemson University Cooperative Extension in South Carolina
• Chronic Disease Prevention and Health Promotion Bureau in Montana
• McDowell County Commission on Aging in West Virginia
• Coastline Elderly Services Inc. in Massachusetts

Dr. Cheryl Dye, Director of the Clemson University Institute for Engaged Aging, is the Principle Investigator and Master Trainer for this project, with co-investigator Dr. Joel Williams.

Services offered

Participants in the program attended 8 core classes and had the option to attend another 8 supplemental classes focused on nutrition and physical activity. All sessions were designed to meet the needs of participants with low educational attainment and health literacy.

The core classes covered:

• Introductions, personal action plans, and behavior tracking via personal health diary
• Basics of hypertension control
• Nutrition
• Physical activity
• Tobacco use
• Stress management
• Medication management
• Long-term action plans

Program participants also received activity notebooks, blood pressure monitors, pedometers, cookbooks, and relaxation CDs.

Health coaches provided the following services to participants:

• Assistance developing an Individualized Action Plan
• Peer-led educational classes
• Telephone counseling
• Group support
• Use of personal health diary
• Civic engagement benefits for health coaches

Results

In the first phase of program implementation, 146 participants ages 60 and above completed the program and were available for a 16-week follow-up to identify program outcomes. At the beginning of the program, 40.4% of participants (most of whom were under a physician's care) met the Healthy People 2020 definition of controlled hypertension, while 16 weeks after participation, 51.0% of participants met that definition.

In the second phase of the program, the priority population was those 45 years of age and above, with 185 community members completing the 8-week core program and seeing significant results.

Additional results for these participants included:

• Improved systolic blood pressure, weight, and fasting glucose
• Increased knowledge of hypertension issues
• Improved readiness to change behaviors related to physical activity, nutrition, weight management, stress management, and overall healthy lifestyle
• Improvements in self-reported ability to cope with stress and consumption of fruits, vegetables, and low-fat foods
• High participant satisfaction with health coaches and program materials

In 2018, Health Coaches for Hypertension Control was designated an an evidence-based program by the Administration for Community Living/Administration on Aging (ACL). This designation will enable organizations that use HCHC to be reimbursed through Older Americans Act Title III-D funding.

Though a contractual arrangement, HCHC has trained Cooperative Extension agents to deliver the program at Area Agency on Aging provider sites in South Carolina. HCHC has trained health professionals in 5 states to train lay leaders in their communities to implement the program. Many of the partnering agencies have used funds from the ACL or the Centers for Disease Control and Prevention (CDC).

Journal articles written about the HCHC program include:

• Dye, C.J., Williams, J.E., Evatt, J.H. (2016). Activating Patients for Sustained Chronic Disease Self-Management: Thinking Beyond Clinical Outcomes. Journal of Primary Care and Community Health, 7(2), 107-12. Article Abstract
• Dye, C.J., Williams, J.E., & Evatt, J.H. (2015). Improving Hypertension Self-Management with Community Health Coaches. Health Promotion Practice, 16(2), 271-81. Article Abstract
• Dye C.J., Williams, J.E., Kemper K.A., McGuire F. (2012). Impacting Mediators of Change for Physical Activity among Elderly Food Stamp Recipients. Educational Gerontology, 38(11), 788-798.
• Dye C.J., Willoughby F., Battisto D. (2011). Advice from Rural Elders: What it Takes to Age in Place. Educational Gerontology, 37(1), 74-93.

The Health Coaches for Hypertension Control 2017 presentation features more information about the program.

Replication

The HCHC program materials are available and could readily be used by other rural communities. A number of states have reached out to Dr. Dye to inquire about replicating this initiative.

Because the program relies on trained volunteers, program replicators should anticipate that coaches will take breaks for vacations or other personal reasons. To maintain an adequate number of Health Coaches, a program should plan to offer at least 2 coach trainings each year. The HCHC program found that former participants are a good potential source of volunteers.

HCHC incorporated best practices from the following sources:

• CDC's Community Health Worker's Heart Disease and Stroke Prevention Sourcebook
• NIH Your Heart, Your Life
• USDA-funded Expanded Food and Nutrition Education Program

Contact Information

Dr. Cheryl Dye, Principal Investigator
Clemson University
864.656.4442
tcheryl@clemson.edu