Restricted accessResearch articleFirst published online 2024-12
Effectiveness of peer mentoring and self-monitoring to improve blood pressure control in a vulnerable population in Argentina: Pragmatic randomized open-label controlled trial
To evaluate the effectiveness of blood pressure (BP) self-monitoring and peer mentoring to improve the control of hypertension in clinical practice in primary care centers (PCCs) located in low-resource settings in Argentina.
Methods
An individual randomized controlled trial was carried out to test two different approaches based on behavioral interventions in PCCs in Argentina. Hypertensive adults were randomly assigned to one of three arms: BP self-monitoring, peer mentoring, and usual care. The primary outcome was the change in BP values from baseline to the end of follow-up at 3 months. A qualitative approach of participants’ experiences of the peer mentoring arm was also conducted.
Results
A total of 442 participants with hypertension were included in the study. Self-monitoring and peer mentoring interventions did not show a significant difference in BP control compared to usual care. However, this trial showed an improvement regarding antihypertensive medication adherence among those assigned to the peer mentoring intervention compared to the control at the end of follow-up (p = 0.031).
Discussion
Self-monitoring and peer mentoring interventions did not demonstrate to be effective in BP control compared to usual care. Implementing a peer support strategy was demonstrated to be feasible and effective in improving medication adherence in this population.
ForouzanfarMHLiuPRothGA, et al.Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA2017; 317: 165–182.
2.
ZhouBCarrillo-LarcoRMDanaeiG, et al.Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet2021; 398: 957–980.
3.
MillsKTStefanescuAHeJ. The global epidemiology of hypertension. Nat Rev Nephrol2020; 16: 223–237.
4.
RubinsteinALIrazolaVECalandrelliM, et al.Prevalence, awareness, treatment, and control of hypertension in the Southern Cone of Latin America. Am J Hypertens2016; 29: 1343–1352.
BelizanMAlonsoJPNejamisA, et al.Barriers to hypertension and diabetes management in primary health care in Argentina: qualitative research based on a behavioral economics approach. Transl Behav Med2020; 10: 741–750.
7.
FerranteDKonfinoJLinetzkyB, et al.Barriers to prevention of cardiovascular disease in primary care settings in Argentina. Rev Pan Salud Púb2013; 33: 259–266.
8.
DellaVignaS. Psychology and economics: evidence from the field. J Econ Lit2009; 47: 315–372.
9.
KahnemanD. Thinking, fast and slow. 1st ed. New York: Farrar, Struas and Giroux, 2011, First.
10.
LuotoJCarmanKG. Behavioral economics guidelines with applications for health interventions. 2014; Technical Note No. 665.
11.
ZhangXYangSSunK, et al.How to achieve better effect of peer support among adults with type 2 diabetes: a meta-analysis of randomized clinical trials. Patient Educ Couns2016; 99: 186–197.
12.
PetersenLASimpsonKPietzK, et al.Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA2013; 310: 1042–1050.
13.
YooHJParkMSKimTN, et al.A ubiquitous chronic disease care system using cellular phones and the internet.
14.
SenAPSewellTBRileyEB, et al.Financial incentives for home-based health monitoring: a randomized controlled trial. J Gen Intern Med2014; 29: 770–777.
15.
LongJAJahnleECRichardsonDM, et al.Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Ann Intern Med2012; 156: 416–424.
16.
PoggioRPradoCSanteroM, et al.Effectiveness of financial incentives and message framing to improve clinic visits of people with moderate-high cardiovascular risk in a vulnerable population in Argentina: a cluster randomized trial. Prev Med2021; 153: 106738.
17.
VolppKGJohnLKTroxelAB, et al.Financial incentive–based approaches for weight loss: a randomized trial. JAMA2008; 300: 2631–2637.
18.
CappuccioFPKerrySMForbesL, et al.Blood pressure control by home monitoring: meta-analysis of randomised trials. Br Med J2004; 329: 145.
19.
GlynnLGMurphyAWSmithSM, et al.Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review. Br J Gen Pract2010; 60: e476–e488.
20.
Bosch-CapblanchXAbbaKPrictorM, et al.Contracts between patients and healthcare practitioners for improving patients’ adherence to treatment, prevention and health promotion activities. Cochrane Database Syst Rev. 2007.Apr 18;2007; (2):CD004808. doi: https://doi.org/10.1002/14651858.CD004808.pub3.
21.
ThorgeirssonTKawachiI. Behavioral economics: merging psychology and economics for lifestyle interventions. Am J Prev Med2013; 44: 185–189.
22.
HeislerMPietteJD. I help you, and you help me. Diabetes Educ2005; 31: 869–879.
23.
KnoxLHuffJGrahamD, et al.What peer mentoring adds to already good patient care: implementing the Carpeta Roja peer mentoring program in a well-resourced health care system. Ann Family Med2015; 13: S59–S65.
24.
FisherEBBoothroydRICoufalMM, et al.Peer support for self-management of diabetes improved outcomes in international settings. Health Aff2012; 31: 130–139.
25.
McEwenMMPasvogelAGallegosG, et al.Type 2 diabetes self-management social support intervention at the US-Mexico border. Public Health Nurs2010; 27: 310–319.
26.
EisenSVSchultzMRMuellerLN, et al.Outcome of a randomized study of a mental health peer education and support group in the VA. Psychiatr Serv2012; 63(12): 1243–1246. doi: https://doi.org/10.1176/appi.ps.201100348
27.
WinderPAHiltunenEFSetharesKA, et al.Partnerships in mending hearts: nurse and peer intervention for recovering cardiac elders. J Cardiovasc Nurs2004; 19: 184–191.
28.
HaidariAMoeiniMKhosraviA. The impact of peer support program on adherence to the treatment regimen in patients with hypertension: a randomized clinical trial study. Iran J Nurs Midwifery Res2017; 22: 27.
29.
Hamui-SuttonA. Un acercamiento a los métodos mixtos de investigación en educación médica. Invest Educ Méd2013; 2: 211–216.
30.
PickeringTGHallJEAppelLJ, et al.Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. J Clin Hypertension2005; 7: 102–109.
31.
ChaoGT. Mentoring phases and outcomes. J Vocat Behav1997; 51: 15–28.
32.
Phillips-JonesL. The mentor's guide: how to be the kind of mentor you once had–or wish you'd had. USA: Coalition of Counseling Centers, 2000.
33.
SmithJAFlowersPLarkinM. Interpretative phenomenological analysis. Theory, method and research. Qual Res Psychol2009; 6: 346–347.
34.
O’BrienBCHarrisIBBeckmanTJ, et al.Standards for reporting qualitative research: a synthesis of recommendations. Acad Med2014; 89: 1245–1251.
35.
MoriskyDEGreenLWLevineDM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care1986; 24(1): 67–74. doi:https://doi.org/10.1097/00005650-198601000-00007
36.
CamposCJGTuratoER. Content analysis in studies using the clinical-qualitative method: application and perspectives. Rev Lat Am Enfermagem2009; 17: 259–264.
37.
BodenheimerTLorigKHolmanH, et al.Patient self-management of chronic disease in primary care. JAMA2002; 288: 2469–2475.
38.
BaumannLCFrederickNBettyN, et al.A demonstration of peer support for Ugandan adults with type 2 diabetes. Int J Behav Med2015; 22: 374–383.
39.
TangTSFunnellMSincoB, et al.Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes Care2014; 37: 1525–1534.
40.
HwangKOOttenbacherAJGrahamAL, et al.Online narratives and peer support for colorectal cancer screening: a pilot randomized trial. Am J Prev Med2013; 45: 98–107.
41.
LoftersAJainASiuW, et al.Ko-Pamoja: the feasibility of a lay health educator-led breast and cervical screening program for Black women in Ontario, Canada. Cancer Causes Control2017; 28: 1207–1218.
42.
WebelAROkonskyJTrompetaJ, et al.A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. Am J Public Health2010; 100: 247–253.
43.
DennisC-L. Peer support within a health care context: a concept analysis. Int J Nurs Stud2003; 40: 321–332.
44.
TuckerKLSheppardJPStevensR, et al.Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med2017; 14(9): e1002389
45.
MargolisKLAscheSEBergdallAR, et al.Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA2013; 310: 46–56.
46.
BurkeLEStynMASereikaSM, et al.Using mHealth technology to enhance self-monitoring for weight loss: a randomized trial. Am J Prev Med2012; 43: 20–26.
47.
RubinsteinALIrazolaVEPoggioR, et al.Challenges and opportunities for implementation of interventions to prevent and control CVD in low-resource settings: a report from CESCAS in Argentina. Glob Heart2015; 10: 21–29.
48.
HeJIrazolaVMillsKT, et al.Effect of a community health worker–led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA2017; 318: 1016–1025.
49.
HeislerM. Building peer support programs to manage chronic disease: seven models for success. USA: California HealthCare Foundation, 2006.
50.
MiddletonKRAntonSDPerriMG. Long-term adherence to health behavior change. Am J Lifestyle Med2013; 7: 395–404.
51.
FjeldsoeBNeuhausMWinklerE, et al.Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychol2011; 30: 99.
52.
AmmermanASLindquistCHLohrKN, et al.The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med2002; 35: 25–41.
53.
EakinEGLawlerSPVandelanotteC, et al.Telephone interventions for physical activity and dietary behavior change: a systematic review. Am J Prev Med2007; 32: 419–434.
54.
MarteauTMOgilvieDRolandM, et al.Judging nudging: can nudging improve population health?Br Med J2011; 342. doi: https://doi.org/10.1136/bmj.d228
55.
GneezyUMeierSRey-BielP. When and why incentives (don't) work to modify behavior. J Econ Perspect2011; 25: 191–210.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
