African-American patients with high blood pressure follow their medication regimen more effectively with a combination of positive affirmations and patient education, concludes a study published Online First in the Archives of Internal Medicine, one of the JAMA/Archives journals.
In comparison to white people, African-Americans are disproportionately affected by hypertension. The authors state in the background information of the article, that a poorly adhered to medication regimen tends to explain poor blood pressure control, which can lead to cardiovascular problems and death.
In a randomized controlled trial Gbenga O. Ogedegbe, M.D., of the Center for Healthful Behavior Change at NYU School of Medicine, and team examined 256 hypertensive African-Americans to assess whether it would be more effective in improving patients medication adherence, by providing patient education (PE), together with positive-affect induction and self-affirmation (PA), like receiving unexpected small gifts and incorporating positive thoughts or by offering PE alone.
The researchers say:
"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)."
However, they say that the differences in reduction of systolic and diastolic blood pressure within both groups was insignificant, with a systolic blood pressure reduction of 2.14 mm Hg in the PA group, compared with 2.18 mm Hg in the PE group, whilst the reduction in diastolic blood pressure was -1.59 mm HG and 0.78 mm Hg respectively.
Patients in both groups were each given a culturally tailored hypertension self-management workbook, as well as a behavioral contract and bimonthly telephone calls, whilst those 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 to assist them in adhering to their medication.
During their bimonthly telephone calls, the PA group was also asked to find small things in their lives that evoke positive feelings, and incorporate these thoughts into their daily routine. They also received unexpected small gifts in the mail, prior to each phone call. Whenever the patients in the PA group encountered situations that made it difficult to take their medicine, they were asked to remind themselves of their core values and remember proud moments in their lives.
The researchers conclude:
Invited Commentary: Benefits to Positive Affect and Self-Affirmation, But Do They Maintain Health-Behavior Change?Both 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."
The conclude saying:
"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."
Written by Petra Rattue