title: Can stories influence African-American patients' intentions to change hypertension management behaviors? A randomized control trial.
abstract: Information-only interventions for hypertension management have limited effectiveness, particularly among disadvantaged populations. We assessed the impact of viewing African-American patients' stories of successfully controlling hypertension on intention to change hypertension management behaviors and engagement with educational materials.
  
  
  
  In a three-site randomized trial, 618 African-American Veterans with uncontrolled hypertension viewed an information-only DVD about hypertension (control) or a DVD adding videos of African-American Veterans telling stories about successful hypertension management (intervention). After viewing, patients were asked about their engagement with the DVD, and their intentions to change behavior. Mean scores were compared with two-sided t-tests.
  
  
  
  Results favored the Stories intervention, with significantly higher emotional engagement versus control (4.3 vs. 2.2 p<0.0001). Intervention patients reported significantly greater intentions to become more physically active (4.6 vs. 4.4, p=0.018), use salt substitutes (3.9 vs. 3.4, p=0.006), talk openly with their doctor about hypertension (4.6 vs. 4.5, p=0.049), and remember to take hypertension medication (4.8 vs. 4.6, p=0.04).
  
  
  
  Patients were more emotionally engaged and reported intentions to change behavior when watching real patient hypertension management success stories.
  
  
  
  Stories may be more influential than information alone, and represent a scalable approach to modifying behavioral intention.
authors.affiliation: Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States; Department of Health Law Policy and Management, Boston University School of Public Health, United States. Electronic address: Barbara.Bokhour@va.gov.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
authors.affiliation: Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States; Department of Health Law Policy and Management, Boston University School of Public Health, United States. Electronic address: Gemmae.Fix@va.gov.
authors.forename: Gemmae M
authors.initials: GM
authors.lastname: Fix
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, United States; Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago College of Medicine, United States. Electronic address: Howard.Gordon@va.gov.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.affiliation: Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz/Philadelphia VA Medical Center, United States; Division of General Internal Medicine, University of Pennsylvania School of Medicine, United States. Electronic address: jalong@upenn.edu.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
authors.affiliation: Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States. Electronic address: Kathryn.Delaughter@va.gov.
authors.forename: Kathryn
authors.initials: K
authors.lastname: DeLaughter
authors.affiliation: Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States. Electronic address: Michelle.Orner@va.gov.
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Orner
authors.affiliation: Ralph H. Johnson VA Medical Center, United States; Medical University of South Carolina College of Nursing, United States. Electronic address: Charlene.Pope@va.gov.
authors.forename: Charlene
authors.initials: C
authors.lastname: Pope
authors.affiliation: Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, United States; Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, United States. Electronic address: Thomas.Houston@va.gov.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
mesh_terms: D001741:Black or African American / Q000193:education* / Q000523:psychology; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D033182:Intention; D008297:Male; D008875:Middle Aged; D033262:Narration; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D014742:Videodisc Recording
keywords: African-American; Disparities; Education; Health literacy; Hypertension; Narrative communication