High blood pressure (hypertension) is the most common diagnosis made by physicians and puts people at risk for heart disease and stroke. Despite effective medications to treat high blood pressure, the current clinic-based approach to its care does not produce optimal results for many people. This could be because there are a number of barriers that prevent people with high blood pressure from complying with treatment recommendations. These barriers can include:
- Lack of awareness of high blood pressure;
- Failure to understand the consequences of long-term uncontrolled hypertension;
- Limited or no access to medical care, including no insurance;
- Difficulty paying for medication;
- Inaccurate beliefs and attitudes about high blood pressure, including beliefs about:
- Treatment side effects,
- Symptoms or lack of symptoms,
- Only taking medication when the patient is stressed or symptomatic;
- Fear of addiction;
- Failure to take medication regularly; and
- Lack of effective physician-patient communication.
The Take Control Program is designed to address the high rate of uncontrolled hypertension and overcome many of these barriers by providing individualized education, referrals, and problem-solving to help persons with high blood pressure follow their doctor’s recommendations.
Take Control uses a stepped care approach, providing participants with only the amount of intervention they need to make changes. The program is delivered by community health workers, lay health advisors who are residents of the community and trained to assist their neighbors. There are 3 steps involved in the Take Control Program:
Step 1. In Step 1 the participant is given basic information about high blood pressure and the consequences of not keeping it under control and, if needed, assistance in finding a physician, enrolling in an insurance program, and enrolling in a pharmacy assistance program to help pay for medications.
Step 2. If after a month the individual’s blood pressure is still high, the participant is moved to Step 2. The Health Advisor (HA) makes weekly home visits to the participant, one per week for 4 weeks. During those visits, the HA, as necessary, reinforces the need to see a doctor and keep appointments and helps with referrals to insurance and pharmacy assistance programs. In addition, during each visit the HA and participant review a video covering topics related to blood pressure control, completes a short worksheet activity, and develops an action plan, identifying specific actions to be taken by the participant during the week. The HA provides the participant with a segmented pillbox and brainstorms with the participant about ways to remember to take medications every day and on time.
Step 3: If at the completion of Step 2 the individual’s blood pressure remains high, the participant is moved to Step 3. During this phase of the program, the HA makes two visits per week for each of 4 weeks. The participant is given a home blood pressure monitor that he or she can use to monitor blood pressure daily. A log book is provided so that the participant can record those daily blood pressure readings and share them with the doctor at the next visit.
The implementation toolkit includes all the materials needed to implement the program, including:
- A detailed description of Steps 2 and 3;
- Information sheets and handouts;
- Blank resource sheets;
- Video scripts;
- Action plans;
- Other useful forms;
- Description of video program interface; and an
- Evaluation plan.
The training manual includes materials to be used to train Take Control Health Advisors to deliver the program. Contents include:
- Introduction to the Take Control program;
- Basics of hypertension;
- Measuring blood pressure;
- Being a health advisor;
- Program visits; and
- Program materials for Steps 2 and 3.
To download the toolkit or the training manual, both of which are presented in PDF format, just complete a short registration form. There is no cost to access these materials.