Peer-Based Storytelling
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Cooper Green Mercy Hospital
Birmingham, Alabama
Hypertension
Inner city, safety-net provider
African Americans |
PROJECT
Patients receive a series of three DVDs that feature peers from the community talking about their own experiences controlling high blood pressure.
Each DVD has two sections:“Storytelling” and “Learn More.” In the Storytelling section, patients share their experiences on topics such as living with hypertension, changing diet and behaviors, following their medication plans, and communicating with physicians. The “Learn More” section features educational segments on understanding blood pressure, avoiding hidden sodium, and getting enough exercise.
To create the DVDs, project leaders selected 14 patients from a series of six focus groups, recorded interviews with them, and chose clips from those interviews to be included in the DVDs.
Patients watch the first DVD at Cooper Green, where they also receive a DVD player, if needed, and instructions on how to use it. They view the next two DVDs in their own homes.
RATIONALE
Controlling blood pressure is difficult because it requires patients to closely follow their provider’s instructions, including taking their medication as prescribed, changing their diet, exercising and keeping their appointments. Sometimes, social and cultural norms and a patient’s environment can challenge the physician-recommended treatment and lifestyle changes that can lead to blood pressure control.
By presenting evidence-based, physician-endorsed health information using a peer-to-peer model, This project aims to bridge that gap. Peer-to-peer learning can be invaluable among patient populations that have reason to distrust the medical establishment and may prefer to take health-behavior cues from friends and family. Receiving physician-approved information from peers may help patients make healthrelated choices in a more culturally relevant and personally meaningful way that informs and inspires positive healthbehavior changes.
EVALUATION PLAN
Funded by Finding Answers in 2006.
Researchers at The University of Alabama at Birmingham are conducting a randomized controlled trial among African American patients that compares patients receiving a series of three DVDs at baseline, three months, and six months to patients receiving an attention control DVD that covers health topics not related to hypertension.
All patients are physician-diagnosed with hypertension and are being randomly assigned to the intervention or comparison group. Researchers are examining the differences in blood pressure for patients in the intervention versus the comparison group at baseline, three months, and six to nine months. Blood pressure was measured by trained research assistants with a standard protocol.
Principal Investigators
- Thomas K. Houston, MD, MPD
- Jeroan J. Allison, MD, MSc
- Sandral Hullett, MD, MPH
Results
At the start of the trial, mean systolic and diastolic blood pressures were similar in both groups. Among the 230 patients retained throughout the trial, those in the intervention group achieved better blood pressure control than the usual care group. The differences were most significant among patients whose blood pressure was uncontrolled at the start of the trial: At 3 months, those who viewed the intervention DVD had an 11.21 mm Hg greater reduction in systolic blood pressure than the control group and a 6.43 mm Hg greater reduction in diastolic pressure. Overall, there was a 6 mm Hg difference in systolic pressure at 3 months between the storytelling and usual care groups. Blood pressure subsequently increased for both groups, but the relative advantage for the storytelling group remained until the end of follow-up. Reducing systolic blood pressure by two to three mm Hg may save thousands of lives in the United States each year.
Lessons Learned
The trial showed that peer-to-peer storytelling mediated through a DVD can improve blood pressure outcomes for African American patients with hypertension. The reduction in blood pressure for study participants that watched the DVD series was similar to reductions often achieved with medication and better than other behavioral interventions such as dietary advice. It also suggests that additional studies of this approach would be worthwhile; particularly if they focus on determining why storytelling works, have longer follow-up periods to see if the positive effect lasts, and to see if storytelling can work for different populations and conditions. The research study might have been improved if the patients’ blood pressure was measured closer to each DVD viewing, if they had viewed the DVDs more often and if the patients had been followed for longer than 6-9 months.
Publication
Culturally Appropriate Storytelling to Improve Blood Pressure: A Randomized Trial
Annals of Internal Medicine (January 18, 2011) 154:77-84
Video
Using Storytelling to Heal
For More Information
Jeroan J. Allison, MD, MSc
Jeroan.Allison@umassmed.edu
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