title: A culturally adapted telecommunication system to improve physical activity, diet quality, and medication adherence among hypertensive African-Americans: a randomized controlled trial.
abstract: BACKGROUND
  Hypertension is more prevalent and clinically severe among African-Americans than whites. Several health behaviors influence blood pressure (BP) control, but effective, accessible, culturally sensitive interventions that target multiple behaviors are lacking.
  
  
  OBJECTIVE
  We evaluated a culturally adapted, automated telephone system to help hypertensive, urban African-American adults improve their adherence to their antihypertensive medication regimen and to evidence-based guidelines for dietary behavior and physical activity.
  
  
  METHODS
  We randomized 337 hypertensive primary care patients to an 8-month automated, multi-behavior intervention or to an education-only control. Medication adherence, diet, physical activity, and BP were assessed at baseline and every 4 months for 1 year. Data were analyzed using longitudinal modeling.
  
  
  RESULTS
  The intervention was associated with improvements in a measure of overall diet quality (+3.5 points, p < 0.03) and in energy expenditure (+80 kcal/day, p < 0.03). A decrease in systolic BP between groups was not statistically significant (-2.3 mmHg, p = 0.25).
  
  
  CONCLUSIONS
  Given their convenience, scalability, and ability to deliver tailored messages, automated telecommunications systems can promote self-management of diet and energy balance in urban African-Americans.
authors.affiliation: Medical Information Systems Unit, General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Migneault
authors.forename: Julien J
authors.initials: JJ
authors.lastname: Dedier
authors.forename: Julie A
authors.initials: JA
authors.lastname: Wright
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Marci Kramish
authors.initials: MK
authors.lastname: Campbell
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
authors.forename: Peter
authors.initials: P
authors.lastname: Rudd
authors.forename: Robert H
authors.initials: RH
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001521:Behavior Therapy; D016022:Case-Control Studies; D003469:Culture; D004032:Diet; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D012648:Self Care; D017216:Telemedicine / Q000379:methods*; D013689:Telephone