title: The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial.
abstract: Lower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensive patients have been published. We tested if a multi-level quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy.
  
  
  
  We conducted a non-randomized prospective cohort trial of 525 patients referred with uncontrolled hypertension. Stakeholder informed and health literacy sensitive strategies were implemented at the practice and patient level. Outcomes were assessed at 0, 6, 12, 18 and 24 months.
  
  
  
  At 12 months, the low and higher health literacy groups had statistically significant decreases in mean SBP (6.6 and 5.3mmHg, respectively), but the between group difference was not significant (Δ 1.3mmHg, P=0.067). At 24 months, the low and higher health literacy groups reductions were 8.1 and 4.6mmHg, respectively, again the between group difference was not significant (Δ 3.5mmHg, p=0.25).
  
  
  
  A health literacy sensitive multi-level intervention may equally lower SBP in patients with low and higher health literacy. Practical health literacy appropriate tools and methods can be implemented in primary care settings using a quality improvement approach.
authors: Department of Family Medicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA. Electronic address: Jacqueline_halladay@med.unc.edu.
authors: Jacqueline R
authors: JR
authors: Halladay
authors: Department of Family Medicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA.
authors: Katrina E
authors: KE
authors: Donahue
authors: Department of M edicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA.
authors: Crystal W
authors: CW
authors: Cené
authors: Department of Biostatistics, UNC Chapel Hill, Chapel Hill, USA.
authors: Quefeng
authors: Q
authors: Li
authors: Department of Family medicine, East Carolina University, NC, USA.
authors: Doyle M
authors: DM
authors: Cummings
authors: Department of M edicine, UNC Chapel Hill, USA.
authors: Alan L
authors: AL
authors: Hinderliter
authors: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA.
authors: Cassandra L
authors: CL
authors: Miller
authors: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA.
authors: Beverly A
authors: BA
authors: Garcia
authors: Community Provider, Pink Hill, USA.
authors: Edwin
authors: E
authors: Little
authors: Community Provider, Pink Hill, USA.
authors: Margorie
authors: M
authors: Rachide
authors: Community Care Plan of Eastern North Carolina, USA.
authors: Jim
authors: J
authors: Tillman
authors: Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA.
authors: Alice S
authors: AS
authors: Ammerman
authors: Department of M edicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA.
authors: Darren
authors: D
authors: DeWalt
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D006973:Hypertension; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D012423:Rural Health
keywords: Disparities; Health literacy; Hypertension; Quality improvement; Rural health