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Objective: To promote adherence to the Dietary Approaches to Stop Hypertension Diet (DASH) using a novel mobile app. Methods: The theory-grounded WHEELS for DASH app is designed to build enduring cognitive representations for long-term dietary behavioral changes. Users participated in twice-daily cognitive behavioral intervention activities,requiring a total of 8 minutes or less, over 56 days: these included goal setting, reading tailored DASH messages, and tracking eating patterns. Volunteers were recruited from an outpatient research registry, (N=72, age 19 to 73-mean=43, 78% female, 18% African American, 33% HTN diagnosis); 66 testers completed end of study surveys. A validated tool , App Quality Evaluation (AQEL), was used for intra-class correlation (ICC) reliability estimates and 95% confidence intervals based on a mean-rating ( k =66), absolute-agreement, and 2-way random-effects model. One item, “How useful was the App in improving my daily healthy eating” measured end-user satisfaction. ANOVA analyses with Bonferroni correction were used to evaluate app-collected DASH eating behaviors over time. Results: Reliability estimates were excellent, (ICC[2,66]=.85; 95% CI .66 to .97, p , p=< .001 and p= Conclusion: The WHEELS for DASH mobile application has potential to change dietary behaviors and support adherence to the DASH Eating Plan. The next step is to test this App for impact on blood pressure in patients with hypertension.

Since the first International Society on Hypertension in Blacks consensus statement on the “Management of High Blood Pressure in African American” in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure–lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently 15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is ≥115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy.

For this study, the Manage Associated Perceptions (MAP) of Dietary Behavior Study, researchers developed, evaluated, and tested messages tailored to improve compliance with the Dietary Approaches to Stop Hypertension (DASH) diet by gradually instilling healthy Cognitive Representations of the DASH Diet (CRDDs). The sample consisted of women from diverse backgrounds (N = 53), randomly assigned to two experimental groups (n = 13 and n = 14) and to two control groups (n = 12 and n = 14). The experimental groups performed a version of the intervention for 30 days. Data about dietary compliance and CRDDs were collected at 30, 60, and 90 days. Compared to control group members, experimental group members demonstrated greater improvements in CRDD scores and were significantly more compliant with the diet. Another significant finding was that older women were more compliant.

Leventhal and Diefenbach's (1991) self-regulatory theory is discussed in explaining the dynamic nature of “how” and “what” people think about hypertension and how this information is different according to severity of hypertension. Using a sample of hypertensive adults who had controlled and uncontrolled blood pressure (BP) status, the factor structure of the Cognitive Representations of Hypertension (CRHTN) scales, an instrument based on self-regulatory theory of Leventhal & Diefenbach, is examined through exploratory, confirmatory, and multigroup factor analyses. Results indicate that a 5-factor model is representative of theoretical constructs of disease label or symptoms, consequences, and controllability. The model accurately fits observed data for outpatients with controlled and uncontrolled BP status. Results provide support for an understanding of individuals’ cognitive structuring of disease-specific attitudes, beliefs, and self-management skills.

Data are limited for effective therapeutic lifestyle modifications or therapeutic lifestyle changes (TLC) interventions targeting minorities for promoting healthy eating behaviors and improving high blood pressure. Unhealthy eating habits or adverse lifestyle behaviors are directly related to high blood pressure. The purpose of this chapter is to address a critical gap in hypertension research on how to provide knowledge to sustain effective non-pharmacological treatment or TLC to and modify unhealthy eating and unhealthy eating. Specifically the beneficial effects of Dietary Approaches to Stop Hypertension (DASH) diet are highlighted, with a description of the theory-driven conceptual framework anchored by cognitive social and self-regulation model theories. These approaches identify how cognitive representations or culturally relevant perceptions (beliefs, attitudes, and intensions for behavior) affect the knowledge to set goals and guide decisions for motivation and self-confidence to accomplish long-term lifestyle behavioral changes.

The effective mentoring of a diverse student population requires that faculty examine their own stereotypical thinking, know the social environment of their students, and strive to engage students of color as fully as possible in the educational process.

The purpose of this study was to use the Self-Regulation Model on African immigrant women, to determine the association of migration and residence in the United States with cognitive representations and dietary behavior, and also to explore migration stress and blood pressure (BP) in them. Participants included a convenience sample of 91 Nigerian immigrant women (NIW) and 38 African American women (AAW). Data collection instruments were the Acculturative Stress Scale and the Women’s and Men’s Hypertension Experiences and Emerging Lifestyle Survey of 2008-2009. Descriptive t test and ANOVA statistics were used to analyze study variables comparing groups and NIW duration of residency in the United States. Knowledge of Hypertension and Cognitive Representation of Hypertension were significantly increased in the NIW by years of residency. Migration stress had no significant relationship with BP level. A longitudinal study initiated on immigrants’ arrival in the United States is recommended to understand the trajectory of chronic illnesses such as hypertension.

African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.

Background The purposes of this study were to establish the reproducibility and reliability of clinic and home blood pressure readings and to determine whether correlations differed according to age and ethnicity. Methods Blood pressure readings taken in a clinical setting and at home from 161 hypertensive women who were either younger or older (including 91 White American and 61 African-American) were compared with 24-h ambulatory blood pressure monitoring (ABPM) readings (considered the gold standard of blood pressure measurement). Results Bland-Altman statistical method showed good levels of agreement between clinic blood pressures measured 30 days apart, and blood pressures measured at home in the morning over a 30-day program, when compared with mean 24-h ABPM readings. On examining individual Bland-Altman plots for younger and older women, White American and African-American women's blood pressures were well correlated for home measures and 24-h ABPM readings. The correlation between daytime systolic home blood pressure readings and systolic 24-h ABPM readings was much stronger for White American women (r=0.75) than for African-American women (r=0.57). There were also correlation differences in mean systolic blood pressure between home blood pressure readings and 24-h ABPM readings according to age (r=0.66 for younger and r=0.72 for older). Conclusion These results support current research findings that home blood pressure measurements are reliable when compared with 24-h ABPM readings both in African-American and White women.

Purpose To determine whether the type of health care provider (i.e., physician versus physician-nurse team) affected the quality of hypertension care given to two groups of randomly selected adult women. Data Sources Three indicators measured the quality of hypertension care: blood pressure control level, knowledge of hypertension, and discussion about blood pressure medications with the health care provider(s). Blood pressure readings were taken with a 24-hr ambulatory blood pressure monitor, and demographic data from survey results taken at orientation and researchercollected data on posttreatment knowledge of hypertension and cognitive representations of hypertension were gathered. Chi-square and t tests were used to analyze the data. Conclusions The group whose care was managed by a physiciannurse team demonstrated lower means for 24-hr systolic blood pressure and diastolic blood pressure (systolic: M = 132, SD = 14.9; diastolic: M = 75, SD = 11.3) than the group whose care was managed only by one or more physicians (systolic: M = 136, SD = 13.4; diastolic: M = 79, SD = 11.24). Also, the group whose care was managed by a physician-nurse team revealed significantly higher scores for discussion of blood pressure medication than the group whose care was managed only by one or more physicians. There were no group differences for knowledge of hypertension. Implications for Practice Nurses qualified to assist with meeting the needs of hypertension clients in primary care settings can positively affect clients’ knowledge about blood pressure medication and—perhaps as a result of this knowledge—how well the clients control their blood pressure.

The purpose of this study was to investigate the interaction of age and cognitive representations of hypertension in predicting blood pressure. A model of illness self-regulation was used as the theoretical framework for the study. Secondary analysis of data collected from 224 hypertensive adult outpatients was conducted to assess five constructs of illness. ANOVA results indicated that older adults reported fewer hypertension-related symptoms than younger-and middle-aged adults, and that younger adults reported fewer health behaviors to control hypertension than did middle-aged and older adults. Results of hierarchical multiple regression models indicated that after adjusting for effects of demographic factors, no single cognitive representation construct was a significant predictor of blood pressure. The interactions of age and three cognitive representation constructs were, however, significant predictors of blood pressure. For younger adults, increases in the perceived Consequences, Control, and Timeline for hypertension were predictive of decreases in hypertension, although for older adults increased perceptions of control were associated with increased blood pressure.

T HIS ARTICLE provides information about a variety of electronic measuring devices that should help increase the efficiency and usefulness of clinical nursing research. The devices reviewed include two-way beepers, medication dispensers, and monitors for sleep, activity, and heart rate and have been used in clinical studies for conditions such as hypertension, tuberculosis (TB), dementia, narcolepsy, exercise during pregnancy, and family planning. Although easy to use and representative of the state of the art in clinical research, electronic devices tend to be costly, and technical problems can require either specialized expertise or communication with the manufacturer or distributor. The advantages and disadvantages of using these devices in clinical research are presented. The purpose of this article is to add to existing information (e.g., Fahrenberg & Myrtek, 1996; Frank-Stromborg & Olsen, 1997) about data gathering techniques that directly measure behaviors of importance to nurses in research and clinical practice. The six devices reviewed were chosen to cover the most relevant classifications proposed by Jacox, Pillar, and Redman (1990): drugs, devices, and behaviors that are in the domains of prevention/ promotion, assessment/diagnosis, and interventions/ therapeutics. All met the following criteria: (1) behaviors measured are within nursing's domain; (2) behaviors measured span several areas of specialization and scope of practice; (3) behaviors measured are important to client/patient outcomes; (4) use of the device can promote an integration of behavioral and biomedical information; and (5) instructions for use are easy to follow.