Positive affirmation along with patient education appears to help African-American patients with high blood pressure more effectively follow their medication regimen, according to a study published Online First by the Archives of Internal Medicine, one of the JAMA/Archives journals.1
Hypertension disproportionately affects African-Americans compared to whites, and poorly adhering to a medication regimen can explain poor blood pressure control, which can lead to cardiovascular problems and death, the authors write in the study background.
The randomized controlled trial by Gbenga O. Ogedegbe, M.D., of the Center for Healthful Behavior Change at NYU School of Medicine, and colleagues studied 256 hypertensive African-Americans to evaluate whether patient education (PE) plus positive-affect induction and self-affirmation (PA), such as receiving unexpected little gifts and incorporating positive thoughts, was more effective than PE alone in improving medication adherence.
“Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42 percent vs 36 percent respectively),” the authors comment.
However, the authors note that the within-group reduction in systolic blood pressure (2.14 mm Hg vs 2.18 mm Hg) and diastolic blood pressure (-1.59 mm Hg vs -0.78 mm Hg) for the PA group and PE group, respectively, was not significant.
Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract and bimonthly telephone calls to help them overcome barriers to taking their medicine. Patients in the PA group were given an extra chapter in their workbook that addressed the benefits of positive moments in overcoming obstacles to medication adherence.
During their bimonthly telephone calls, the PA group also was asked to identify small things in their lives that gave them positive feelings and told to incorporate those thoughts into their daily routine. They also received unexpected small gifts in the mail before each phone call. The PA group patients were asked to remember their core values and proud moments in their lives whenever they encounter situations that make it hard to take their medicine.
“Our findings suggest that PE enhanced with behavioral constructs drawn from positive psychology and designed to foster PA produced significantly greater medication adherence in hypertensive African- Americans than PE alone. Future studies should assess the cost-effectiveness of integrating such interventions into primary care,” the authors conclude.
In an invited commentary2, Geoffrey C. Williams, M.D., Ph.D., and Christopher P. Niemiec, Ph.D., of the University of Rochester in New York, write: “In this invited commentary, we use self-determination theory (SDT) to guide a brief discussion of theory and research on health-behavior change and the psychological mechanisms through which true maintenance is theorized to occur.”
“From the perspective of SDT, it is critical that interventions target internalization of both autonomous self-regulation and perceived competence in order to promote maintenance of behavior change after the intervention has ended completely,” they note.
“Returning to the trials that are the focus of this invited commentary, we recommend that future research target positive affect and self-affirmation in a context of support for satisfaction of the basic psychological needs for autonomy, competence, and relatedness,” they comment.
1. (Arch Intern Med. Published Online Jan. 23, 2012. doi:10.1001/archinternmed.2011.1307
2. (Arch Intern Med. Published Online Jan. 23, 2012. doi:10.1001/archinternmed.2011.1830.