Health Coaches for Hypertension Control
- Need: A cost-effective approach to help rural patients with hypertension learn to manage their condition.
- Intervention: Community volunteers trained as health coaches provided an 8-session hypertension management training program to hypertension patients older than 60, with an optional supplemental 8 sessions focused on nutrition and physical activity.
- Results: Just 16 weeks after the program, participants had improved systolic blood pressure, weight, and fasting glucose, greater knowledge of hypertension, and improved self-reported behaviors.
Effective (About evidence-level criteria)
In 2007, hypertension rates in residents of South
Carolina's Oconee County, located in rural Appalachia,
surpassed the state and national average. The Health
Coaches for Hypertension Control (HCHC) program was
formed to promote hypertension self-management using
trained community volunteers. These health coaches are a
cost-effective and sustainable approach for helping
hypertension patients manage their condition.
HCHC serves rural Appalachian Oconee County, which is located in western South Carolina. The program was aimed at county residents over the age of 60 diagnosed with hypertension. Local health coach volunteers were recruited and underwent a 30-hour training that covered each topic area included in the small group sessions they would be leading.
Primary partners in the project include:
- DHEC – South Carolina Department of Health and Environmental Control
- Oconee Physician Practices
- Clemson University
- Clemson Cooperative Extension
- Joseph F. Sullivan Center
- Oconee Medical Center
The project was funded by a 2009-2012 Office of Rural Health Policy Rural Health Care Services Outreach Grant and extended by a USDA grant. The program is now being implemented by Clemson University Cooperative Extension. Dr. Cheryl Dye is the Principle Investigator on this project, with co-investigator Dr. Joel Williams.
HCHC is one phase of Clemson University's ongoing Health Coach project. Learn about an earlier Health Coach implementation, Community Health Coaches for Successful Care Transitions.
Participants in the program attended 8 core classes and had the option to attend another 8 supplemental classes focused on nutrition and physical activity. All sessions were designed to meet the needs of participants with low educational attainment and health literacy.
The core classes covered:
- Introductions, personal action plans, and behavior tracking via personal health diary
- Basics of hypertension control
- Physical activity
- Tobacco use
- Stress management
- Medication management
- Long-term action plans
Program participants also received activity notebooks, blood pressure monitors, pedometers, cookbooks, and relaxation CDs.
Health coaches provided the following services to participants:
- Assistance developing an Individualized Action Plan
- Peer-led educational classes
- Telephone counseling
- Group support
- Use of personal health diary
- Civic engagement benefits for health coaches
In all, 146 participants ages 60 and above completed the program and were available for a 16-week follow-up to identify program outcomes. At the beginning of the program, 40.4% of participants (most of whom were under a physician's care) met the Healthy People 2020 definition of controlled hypertension, while 16 weeks after participation, 51.0% of participants met that definition.
Additional results for these participants included:
- Improved systolic blood pressure, weight, and fasting glucose
- Increased knowledge of hypertension issues
- Improved readiness to change behaviors related to physical activity, nutrition, weight management, stress management, and overall healthy lifestyle
- Improvements in self-reported ability to cope with stress and consumption of fruits, vegetables, and low-fat foods
- High participant satisfaction with health coaches and program materials
After the program expanded, 185 community members ages 45 years and above completed 8-week core program.
Dye, C.J., Williams, J.E., Evatt, J.H. (2016). Activating Patients for Sustained Chronic Disease Self-Management: Thinking Beyond Clinical Outcomes. Journal of Primary Care and Community Health, 7(2), 107-12. Article Abstract
Dye, C.J., Williams, J.E., & Evatt, J.H. (2015). Improving Hypertension Self-Management with Community Health Coaches. Health Promotion Practice, 16(2), 271-81. Article Abstract
Dye C.J., Williams, J.E., Kemper K.A., McGuire F. (2012). Impacting Mediators of Change for Physical Activity among Elderly Food Stamp Recipients. Educational Gerontology, 38(11), 788-798.
Dye C.J., Willoughby F., Battisto D. (2011). Advice from Rural Elders: What it Takes to Age in Place. Educational Gerontology, 37(1), 74-93.
The HCHC program is featured in RHIhub's Community Health Worker Toolkit Program Clearinghouse.The Health Coaches for Hypertension Control 2017 presentation features more information about the program.
The HCHC program materials are available and could readily be used by other rural communities.
Because the program relies on trained volunteers, program replicators should anticipate that coaches will take breaks for vacations or other personal reasons. To maintain an adequate number of Health Coaches, a program should plan to offer at least 2 coach trainings each year. The HCHC program found that former participants are a good potential source of volunteers.
HCHC incorporated best practices from the following sources:
Community health workers
Wellness, health promotion, and disease prevention
June 3, 2014
September 6, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.