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Health Coaches for Hypertension Control

Summary 
  • 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.

Evidence-level

Effective (About evidence-level criteria)

Description

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 and is now being implemented in Montana. 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 first phase of this project was funded by a 2009-2012 Office of Rural Health Policy

Rural Health Care Services Outreach Grant. A second face extension was funded by a USDA grant.

Health Coaches for Hypertension Control is currently being implemented in the following states through various groups:

Dr. Cheryl Dye, Director of the Clemson University Institute for Engaged Aging, is the Principle Investigator and Master Trainer for this project, with co-investigator Dr. Joel Williams.

HCHC is one phase of Clemson University's ongoing Health Coaches for Care Transition. Learn about an earlier Health Coach implementation in another RHIhub model.

Services offered

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
  • Nutrition
  • 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

Results

In the first phase of program implementation, 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.

In the second phase of the program, the priority population was those 45 years of age and above, with 185 community members completing the 8-week core program and seeing significant results.

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

In 2018, Health Coaches for Hypertension Control was designated an an evidence-based program by the Administration for Community Living/Administration on Aging (ACL). This designation will enable organizations that use HCHC to be reimbursed through Older Americans Act Title III-D funding.

Though a contractual arrangement, HCHC has trained Cooperative Extension agents to deliver the program at Area Agency on Aging provider sites in South Carolina. HCHC has trained health professionals in 5 states to train lay leaders in their communities to implement the program. Many of the partnering agencies have used funds from the ACL or the Centers for Disease Control and Prevention (CDC).

Journal articles written about the HCHC program include:

  • 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 Health Coaches for Hypertension Control 2017 presentation features more information about the program.

Replication

The HCHC program materials are available and could readily be used by other rural communities. A number of states have reached out to Dr. Dye to inquire about replicating this initiative.

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:

Contact Information

Dr. Cheryl Dye, Principal Investigator
Clemson University
864.656.4442
tcheryl@clemson.edu

Topics
Cardiovascular disease
Community health workers
Wellness, health promotion, and disease prevention

States served
Massachusetts, Montana, South Carolina, Washington, West Virginia

Date added
June 3, 2014

Date updated or reviewed
December 9, 2019

Suggested citation: Rural Health Information Hub, 2019. Health Coaches for Hypertension Control [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/753 [Accessed 29 October 2020]


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.