Browsing by Author "Bosworth, HB"
Now showing 1 - 15 of 15
Results Per Page
Sort Options
Item Open Access Baseline medication adherence and blood pressure in a 24-month longitudinal hypertension study.(Journal of clinical nursing, 2011-11) Shaw, R; Bosworth, HBAim and objectives. We sought to identify the feasibility and predictive validity of an easy and quick self-reported measure of medication adherence and to identify characteristics of people with hypertension that may warrant increase attentiveness by nurses to address hypertensive self-management needs. Background. Current control rates of hypertension are approximately 50%. Effective blood pressure control can be achieved in most people with hypertension through antihypertensive medication. However, hypertension control can only be achieved if the patient is adherent with their medication regimen. Patients who are non-adherent may be in need of additional intervention. Design. This secondary analysis evaluated the systolic blood pressure of patients who received usual hypertension management across 24 months at six-month intervals. Methods. A longitudinal study of 159 hypertensive patients in two primary care clinics. Results. In a sample of 159 patients receiving care in a primary care facility, baseline medication non-adherence was associated with a 6·3 mmHg increase in systolic blood pressure (pItem Open Access Change in goal ratings as a mediating variable between self-efficacy and physical activity in older men.(Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2010-06) Hall, KS; Crowley, GM; McConnell, ES; Bosworth, HB; Sloane, R; Ekelund, CC; Morey, MCBACKGROUND: Few studies have examined the associations between exercise self-efficacy, goals, and physical activity over time. PURPOSE: This study examines whether self-selected goals mediate the changes in exercise self-efficacy on physical activity over 12 months. METHODS: Data are derived from 313 older men participating in the Veterans LIFE Study. RESULTS: Changes in exercise self-efficacy were significantly associated with changes in physical activity both directly (betas = 0.25 and 0.24, pItem Open Access Corrigendum to "Weight loss intervention for young adults using mobile technology: Design and rationale of a randomized controlled trial - Cell phone Intervention for You (CITY)" [Contemp Clin Trials 37/2 (2014) 333-341].(Contemporary clinical trials, 2014-11) Batch, BC; Tyson, C; Bagwell, J; Corsino, L; Intille, S; Lin, PH; Lazenka, T; Bennett, G; Bosworth, HB; Voils, C; Grambow, S; Sutton, A; Bordogna, R; Pangborn, M; Schwager, J; Pilewski, K; Caccia, C; Burroughs, J; Svetkey, LPItem Open Access Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus.(Journal of the American Geriatrics Society, 2012-09) Morey, MC; Pieper, CF; Edelman, DE; Yancy Jr, WS; Green, JB; Lum, H; Peterson, MJ; Sloane, R; Cowper, PA; Bosworth, HB; Huffman, KM; Cavanaugh, JT; Hall, KS; Pearson, MP; Taylor, GAOBJECTIVE: To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus. METHODS: Controlled clinical trial. METHODS: Primary care clinics of the Durham Veterans Affairs (VA) Medical Center between September 29, 2008, and March 25, 2010. METHODS: Three hundred two overweight (body mass index 25-45 kg/m(2) ), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/dL, glycosylated hemoglobin (HbA1c)Item Open Access Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease.(Frontiers in health services, 2022-01) Hankins, JS; Potter, MB; Fernandez, ME; Melvin, C; DiMartino, L; Jacobs, SR; Bosworth, HB; King, AA; Simon, J; Glassberg, JA; Kutlar, A; Gordeuk, VR; Shah, N; Baumann, AA; Klesges, LM; Sickle Cell Disease Implementation ConsortiumBackground
Sickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes.Methods
During 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation.Results
Behavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes.Discussion
Our research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.Item Open Access Lessons learned when innovations go awry: a baseline description of a behavioral trial-the Enhancing Fitness in Older Overweight Veterans with Impaired Fasting Glucose study.(Translational behavioral medicine, 2011-11) Hall, KS; Pieper, CF; Edelman, DE; Yancy Jr, WS; Green, JB; Lum, H; Peterson, MJ; Sloane, R; Cowper, PA; Bosworth, HB; Huffman, KM; Cavanaugh, JT; Chapman, JG; Pearson, MP; Howard, TA; Ekelund, CC; McCraw, BL; Burrell, JB; Taylor, GA; Morey, MCIndividuals diagnosed with impaired glucose tolerance (i.e., prediabetes) are at increased risk for developing diabetes. We proposed a clinical trial with a novel adaptive randomization designed to examine the impact of a home-based physical activity (PA) counseling intervention on metabolic risk in prediabetic elders. This manuscript details the lessons learned relative to recruitment, study design, and implementation of a 12-month randomized controlled PA counseling trial. A detailed discussion on how we responded to unforeseen challenges is provided. A total of 302 older patients with prediabetes were randomly assigned to either PA counseling or usual care. A novel adaptive design that reallocated counseling intensity based on self-report of adherence to PA was initiated but revised when rates of non-response were lower than projected. This study presents baseline participant characteristics and discusses unwelcome adaptations to a highly innovative study design to increase PA and enhance glucose metabolism when the best-laid plans went awry.Item Restricted Long-term changes in physical activity following a one-year home-based physical activity counseling program in older adults with multiple morbidities.(J Aging Res, 2010-12-26) Hall, KS; Sloane, R; Pieper, CF; Peterson, MJ; Crowley, GM; Cowper, PA; McConnell, ES; Bosworth, HB; Ekelund, CC; Morey, MCThis study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more comorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed.Item Open Access Patient experiences with a phone-based cardiovascular risk reduction intervention: Are there differences between women and men?(Patient education and counseling, 2021-11) Goldstein, KM; Zullig, LL; Andrews, SM; Sperber, N; Lewinski, AA; Voils, CI; Oddone, EZ; Bosworth, HBObjectives
To explore gender-based differences in experiences with a telehealth-delivered intervention for reduction of cardiovascular risk.Methods
We conducted 23 semi-structured qualitative interviews by telephone with 11 women and 12 men who received a 12-month, pharmacist-delivered, telephone-based medication and behavioral management intervention. We used content analysis to identify themes.Results
We identified three common themes for both men and women: ease and convenience of phone support, preference for proactive outreach, and need for trust building in the context of telehealth. While both genders appreciated the social support from the intervention pharmacist, women voiced appreciation for accountability whereas men generally spoke about encouragement.Conclusions
Rapport building may differ between telehealth and in-person healthcare visits; our work highlights how men and women's experiences can differ with telehealth care and which can inform the development of future, purposeful rapport building activities to strengthen the clinician-patient interaction.Practice implications
Clinicians should seek opportunities to provide frequent and routine support for patients with chronic disease. Telehealth interventions may benefit from gender-specific tailoring of social support.Item Open Access Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program.(Journal of general internal medicine, 2012-08) Jackson, GL; Oddone, EZ; Olsen, MK; Powers, BJ; Grubber, JM; McCant, F; Bosworth, HBBACKGROUND: African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. OBJECTIVE: The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program. PARTICIPANTS: Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial. INTERVENTIONS: Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values. MAIN MEASURES: Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure). KEY RESULTS: Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p = 0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p = 0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p = 0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients. CONCLUSIONS: The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients.Item Open Access Resilience in chronic illness(Resilience in Aging: Concepts, Research, and Outcomes, 2011-12-01) Trivedi, RB; Bosworth, HB; Jackson, GLResilience has been written about and valued since time immemorial. Its value is transmitted down generations through adages, mythology, anecdotes, and even children's books. In essence, resilience can be thought of as a process of successfully adapting to maintain or regain emotional well-being in the face of adversity. It does not mean that distress is not experienced; rather, it is a process through which an individual's thoughts and behaviors overcome distress and optimize positive outcomes. © 2011 Springer Science+Business Media, LLC.Item Open Access Results of the chronic heart failure intervention to improve medication adherence study: A randomized intervention in high-risk patients(American Heart Journal, 2015-04-01) Granger, BB; Ekman, I; Hernandez, AF; Sawyer, T; Bowers, MT; Dewald, TA; Zhao, Y; Levy, J; Bosworth, HBBackground Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF. Methods Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point. Results Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P =.0007). Conclusions A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.Item Open Access Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis.(American journal of hypertension, 2020-03) Sheppard, JP; Tucker, KL; Davison, WJ; Stevens, R; Aekplakorn, W; Bosworth, HB; Bove, A; Earle, K; Godwin, M; Green, BB; Hebert, P; Heneghan, C; Hill, N; Hobbs, FDR; Kantola, I; Kerry, SM; Leiva, A; Magid, DJ; Mant, J; Margolis, KL; McKinstry, B; McLaughlin, MA; McNamara, K; Omboni, S; Ogedegbe, O; Parati, G; Varis, J; Verberk, WJ; Wakefield, BJ; McManus, RJBackground
Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity.Methods
A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis.Results
A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (-3.12 mm Hg, [95% confidence intervals -4.78, -1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease.Conclusions
Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.Item Open Access The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).(Implement Sci, 2010-07-16) Bosworth, HB; Almirall, D; Weiner, BJ; Maciejewski, M; Kaufman, MA; Powers, BJ; Oddone, EZ; Lee, SY; Damush, TM; Smith, V; Olsen, MK; Anderson, D; Roumie, CL; Rakley, S; Del Monte, PS; Bowen, ME; Kravetz, JD; Jackson, GLBACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.Item Open Access The meanings associated with medicines in heart failure patients.(European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2012-05) Granger, BB; McBroom, K; Bosworth, HB; Hernandez, A; Ekman, IBACKGROUND: The purpose of this study was to explore the theoretical linkages between symptom experiences and meaning associated with medication adherence. The specific objectives were to evaluate the key constructs of Meaning-Response theory for understanding medication adherence in patients with chronic heart failure; to assess the influence of symptom persistence on the meaning associated with prescribed medicines; and to explore the extent to which meaningful associations improve medication adherence. Among patients with heart failure, poor medication adherence occurs in over half of the population, resulting in high rates of symptom exacerbation, avoidable hospitalization, and death. Nurses play a key role in facilitating self-management skills, but patients' perceptions of the relationship between symptoms and medicines is not clear. METHODS: Using a prospective mixed methods design, the study assessed patients' (n=10) perception of chronic heart failure symptoms and medication adherence. Patients completed guided interviews related to six concepts of meaning ascribed to medication use and four standardized measures of medication-related beliefs, behaviours, symptoms, and satisfaction. RESULTS: This study suggests that patients' perception of meaning associated with medication taking was categorized as positive, negative, or absent. Symptom persistence influenced a majority of patient beliefs in the efficacy medicines, and patients with more positive meaningful associations with their medicines were more likely to remain adherent during the course of this study. CONCLUSIONS: Development of meaningful associations with medicines may improve long-term adherence with prescribed medication in heart failure.Item Open Access The role of accountability in adherence programs.(Patient education and counseling, 2022-08) Ballengee, LA; Bosworth, HB; Zullig, LL