AUTHOR=Chen Ping , Shen Ying , He Chao , Sun Xinying 

TITLE=Effectiveness of a Transtheoretical Model-Based Intervention to Improve Blood Pressure Control of Hypertensive Patients in China: A Clustered Randomized Controlled Trial

JOURNAL=Frontiers in Public Health

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.760421

DOI=10.3389/fpubh.2021.760421

ISSN=2296-2565

ABSTRACT=<sec><title>Background</title><p>Hypertension can result in great cardiovascular risk, while medication adherence and blood pressure control of patients were suboptimal. Therefore, we conducted a 12-month clustered randomized controlled trial to evaluate the effectiveness of transtheoretical model (TTM)-based health intervention mode on blood pressure of Chinese newly-diagnosed hypertensive patients.</p></sec><sec><title>Methods</title><p>This trial was conducted in six primary healthcare centers, Shunyi District, Beijing, China from September 2016 to September 2017. A total of 400 patients were included and randomized, 194 patients in the control group and 206 patients in the intervention group. Patients in the intervention group received TTM-based health intervention and those in the control group received usual care. Multilevel modeling was used to adjust for clustering effect and repeated measurements.</p></sec><sec><title>Results</title><p>Systolic blood pressure of patient was reduced by 4.534 mm Hg at 3-month follow-up [95% CI (−3.054, −1.403), <italic>p</italic> = 0.005], 3.982 mm Hg at 6-month follow-up [95% CI (−7.387, −0.577), <italic>p</italic> = 0.022], and 5.803 mm Hg at 12-month follow-up [95% (−9.716, −1.891), <italic>p</italic> = 0.004]. Diastolic blood pressure of patient was reduced by 3.383 mm Hg at 3-month follow-up [95% CI (−5.724, −1.042), <italic>p</italic> = 0.005], 0.330 mm Hg at 6-month follow-up [95% CI (−2.870, 2.210), <italic>p</italic> = 0.799], and 3.129 mm Hg at 12-month follow-up [95% CI (−6.048, −0.21), <italic>p</italic> = 0.036]. Medication adherence of patients was improved at all the three time points. For stages of change for taking medication, patients in the intervention group were 8.401-fold more likely to be in a higher stage at 3-month follow-up [95% CI (4.186, 16.862), <italic>p</italic> &lt; 0.001]. The odds ratio of being in a higher stage was 8.454 at 6-month follow-up [95% CI (3.943, 18.123), <italic>p</italic> &lt; 0.001] and 19.263 at 12-month follow-up [95% CI (7.979, 46.505), <italic>p</italic> &lt; 0.001].</p></sec><sec><title>Conclusion</title><p>Transtheoretical model-based health intervention might be a promising strategy to improve medication adherence of newly-diagnosed hypertensive patients in community.</p></sec>