A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans
Open accessAbstract
BACKGROUND: Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes. METHODS: This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months. RESULTS: The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P =.049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P = .98) and diastolic BP (-1.59 mm Hg vs -0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant. CONCLUSIONS: A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration clinicaltrials.gov Identifier: NCT00227175.
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Prior studies of positive psychology interventions in other medical cohorts have found improvements in psychological and health behavior outcomes.
“These findings are also consistent with prior studies 14,16,17 of positive psychology interventions in other medical cohorts that have found improvements in psychological and health behavior outcomes.”
From Feasibility and acceptability of a positive psychological intervention for patients with type 2 diabetes (2016) · cites this paper as [16]
The Results report improved medication adherence after a positive-affect intervention in hypertensive African Americans, supporting the health-behavior part of the claim. They do not report an improvement in psychological outcomes; the Results describe affect at baseline, while the Comment discusses possible psychological mechanisms rather than demonstrated changes. The indexed passages provide section labels but no page numbers. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPositive psychology-based programs have led to improvements in health behaviors in studies of patients with hypertension or heart disease.
“Positive psychology-based programs have also led to improvements in health behaviors in studies of patients with hypertension or heart disease, 15-17”
From Feasibility and acceptability of a positive psychological intervention for patients with type 2 diabetes (2016) · cites this paper as [16]
A pair of larger studies implementing a positive psychology-based program found no intervention effect on blood pressure at 1 year.
“Likewise, a pair of larger studies implementing a positive psychology-based program found no intervention effect on blood pressure at 1 year. 211,212”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [212]
Interventions that explicitly target positive emotion show promise for improving health outcomes in a number of chronic illnesses.
“Interventions that explicitly target positive emotion show promise for improving health outcomes in a number of chronic illnesses, including diabetes [16,17], heart disease [18,19], hypertension [20,21], depression [22,23], and HIV [24].”
Randomized controlled trials of positive psychology-related interventions in heart and lung disease patients led to improvements from baseline health behaviors, including medication adherence and physical activity.
“More recently, randomized controlled trials of PP-related interventions in heart and lung disease patients led to improvements from baseline health behaviors (medication adherence and physical activity) [46–48].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [47]
Randomized trials of PP-type interventions in patients with cardiovascular illness found significantly greater improvements in health behaviors (e.g., physical activity and medication adherence) than in control conditions.
“Even more promising are the findings from randomized trials [47, 48] of PP-type interventions in patients with cardiovascular illness that found such interventions to be associated with significantly greater improvements in health behaviors (e.g., physical activity [48] and medication adherence [47]) than in the control conditions.”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [47]
Positive psychology programs improve psychological and health outcomes in people with chronic conditions like heart disease, hypertension, and HIV.
“PP programs have also been found to improve psychological and health outcomes in individuals with chronic medical conditions such as heart disease, hypertension, and HIV [26–31].”
From Well-being interventions for individuals with diabetes: A systematic review (2019) · cites this paper as [29]
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- Authors
- Ogedegbe, G. O.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2012-02-27
- Volume
- 172
- Issue
- 4
- Pages
- 322
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC4669680
- OpenAlex
- W2135465619
- Cited by
- 230
- References
- 43
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 8 · 2023: 8 · 2022: 18 · 2021: 18 · 2020: 18 · 2019: 16 · 2018: 20 · 2017: 22 · 2016: 16 · 2015: 27 · 2014: 22 · 2013: 17 · 2012: 12
- FWCI
- 21.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc25196-0-0-0)
- National Heart, Lung, and Blood Institute (N01 HC025196)
- National Institute on Minority Health and Health Disparities (P60MD003421)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- medication adherence, hypertension, African Americans, self-affirmation, patient education, blood pressure control, culturally tailored interventions, telephone follow-up, behavioral contracts, primary care
- MeSH terms
- Aged, Antihypertensive Agents, Black or African American, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Education as Topic, Primary Health Care, Self Administration, Cognitive Behavioral Therapy, Treatment Outcome, Disease Management, Health Status Disparities, Medication Adherence
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