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.
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
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
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
Health Care Services Outreach Grant. A second phase
extension was funded by a USDA grant.
Health Coaches for Hypertension Control is currently
being implemented in the following states through various
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.
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
Health coaches provided the following services to
- 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 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
- 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
- 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
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,
- Dye, C.J., Williams, J.E., & Evatt, J.H. (2015).
Improving Hypertension Self-Management with Community
Health Coaches. Health Promotion Practice,
- 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),
- Dye C.J., Willoughby F.,
Battisto D. (2011). Advice from Rural Elders: What it
Takes to Age in Place. Educational Gerontology,
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. 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
Community health workers
Wellness, health promotion, and disease prevention
Massachusetts, Montana, South Carolina, Washington, West Virginia
June 3, 2014
Date updated or reviewed
December 9, 2019
Suggested citation: Rural Health Information Hub,
Health Coaches for Hypertension Control [online]. Rural Health Information Hub. Available at:
[Accessed 7 February 2023]
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.