Population and Survey Instruments for an APN Led Hypertension Intervention

DNP PROJECT : Project Vision, Mission and Objectives, PICOT Question (Population, Intervention, Comparison, Outcome, and Timeframe), Feasibility, Sample and Setting

Project Vision, Mission, and Objectives

Vision:

A future where minority communities disproportionately affected by hypertension have equitable access to culturally tailored, evidence-based self-management education and support, empowering them to achieve optimal blood pressure control and improved quality of life.

Mission:

To develop and implement a nurse-driven, culturally sensitive hypertension self-management education program that addresses the unique needs and challenges faced by minority populations, promoting health equity and reducing disparities in hypertension management.

Short-term objectives:

· Conduct a comprehensive literature review to identify evidence-based best practices for culturally tailored hypertension self-management education programs.

· Collaborate with community stakeholders and minority health organizations to understand the specific sociocultural determinants, barriers, and facilitators influencing hypertension management in the target populations.

· Design and develop a culturally relevant, linguistically appropriate, and user-friendly hypertension self-management education curriculum, incorporating interactive multimedia resources and community-based learning activities.

· Recruit and train a diverse team of bilingual and culturally competent nurses and community health workers to facilitate the education program.

· Pilot the hypertension self-management education program within selected minority communities, evaluating its feasibility, acceptability, and preliminary efficacy in improving blood pressure control and health-related quality of life.

Long-term Objectives:

· Refine and optimize the hypertension self-management education program based on the findings from the pilot study and stakeholder feedback.

· Establish sustainable partnerships and collaborations with community organizations, healthcare providers, and policymakers to support the large-scale implementation and dissemination of the program across the United States and globally.

· Conduct a multi-site, randomized controlled trial to rigorously evaluate the effectiveness of the culturally tailored hypertension self-management education program in improving blood pressure control, health-related quality of life, and reducing health disparities among minority populations.

· Develop evidence-based guidelines and recommendations for advanced practice nurse-led interventions aimed at improving hypertension management and addressing health disparities in minority populations.

· Contribute to the broader understanding of the sociocultural determinants influencing hypertension and its management, informing future research, policies, and practices in this area.

Congruence with Organizational Mission and Vision:

The proposed project closely aligns with the mission and vision of this initiative by addressing a critical public health issue that disproportionately affects minority communities and promotes health equity through culturally sensitive, nurse-driven interventions. The project’s overarching focus on empowering individuals to take an active role in managing their health and improving overall quality of life resonates with the organization’s commitment to patient-centered care and holistic well-being. In addition, the project’s emphasis on community engagement, collaboration, and evidence-based practice mirrors the organization’s values of partnership, innovation, and excellence.

PICOT Question

In order to achieve the initiative’s above-stated short- and long-term objectives, the following PICOT question will serve as the basis for the proposed DNP project:

Population.

The target population for this project will be adults aged 18 years and older from minority communities (e.g., African American, Hispanic/Latino, Native American, and Asian American) residing in the city of Tulsa, Oklahoma, who have been diagnosed with hypertension. Current statistics indicate that the prevalence of hypertension in this city has increased in recent years (Analysis of hypertension, 2024). The project aims to recruit approximately 300-400 participants from various community centers, places of worship, and healthcare facilities within the city and its surrounding conurbation of about one million people.

Recruitment Process and Informed Consent:

Participants will be recruited through collaborations with community-based organizations, faith-based institutions, and healthcare providers serving minority populations in Chicago. Informational sessions will be conducted to raise awareness about the project, and interested individuals will be screened for eligibility. All potential participants will be provided with detailed information about the study, including its purpose, procedures, risks, and benefits. Informed consent will be obtained from those who meet the eligibility criteria and voluntarily agree to participate.

Primary Characteristics:

The primary characteristics of the target population are as follows:

· Self-identifying as a member of a racial or ethnic minority group (African American, Hispanic/ Latino, Native American, or Asian American)

· Residing in or near the city of Tulsa, Oklahoma

· Diagnosed with hypertension (elevated blood pressure levels)

Inclusion Criteria:

· Age 18 years or older

· Self-reported diagnosis of hypertension

· Ability to understand and communicate in English or Spanish (or other languages, if resources permit)

· Willingness to participate in the hypertension self-management education program and follow-up assessments

Exclusion Criteria:

· Presence of severe cognitive impairment or mental health conditions that may interfere with participation

· Presence of end-stage renal disease or other severe comorbidities that could impact blood pressure management

· Participation in another hypertension management program during the study period

In sum, by clearly defining the above-described target population, recruitment strategies, informed consent process, and eligibility criteria, the project can ensure a representative sample of minority individuals with hypertension in the city of Tulsa, allowing for a comprehensive evaluation of the culturally tailored self-management education program.

Intervention.

The intervention for this proposed DNP-led project is the implementation of a culturally tailored, nurse-driven hypertension self-management education program for minority populations in the city of Tulsa. This evidence-based practice (EBP) change aims to address the disproportionate burden of hypertension and associated health disparities among racial and ethnic minority groups.

The hypertension self-management education program will be designed based on the principles of the Chronic Care Model (CCM) and the Integrative Model of Behavioral Prediction and Lifestyle Intervention (IMPBLI). The CCM emphasizes the importance of self-management support, delivery system redesign, decision support, clinical information systems, and community resources in managing chronic conditions (Kim et al., 2024). The IMPBLI model incorporates sociocultural factors, environmental influences, and health beliefs in promoting lifestyle changes and self-management behaviors (Branscum, 2017). The education program will be delivered through a combination of in-person group sessions and supplementary online modules, facilitated by a team of culturally competent nurses and community health workers. The curriculum will be tailored to address the specific cultural beliefs, dietary practices, and health literacy levels of the target minority populations.

The key components of the intervention will include the following:

· Educational sessions on hypertension, its risk factors, complications, and management strategies, delivered in a culturally sensitive and linguistically appropriate manner.

· Practical demonstrations and hands-on activities related to blood pressure monitoring, medication adherence, dietary modifications (e.g., culturally relevant healthy cooking classes), and physical activity promotion.

· Incorporation of motivational interviewing techniques and goal-setting exercises to enhance self-efficacy and facilitate behavior change (Ekong & Kavookjian, 2016).

· Utilization of interactive multimedia resources, such as educational videos, mobile apps, and online forums, to reinforce learning and promote engagement.

· Involvement of community health workers and peer support groups to foster social support and accountability.

· Coordination with primary care providers and other healthcare professionals to ensure continuity of care and ongoing monitoring of participants' blood pressure levels.

The effectiveness of culturally tailored self-management education programs for hypertension management in minority populations has been supported by various studies

Comparison.

At present and to the author’s best knowledge, there are no standardized, culturally tailored hypertension self-management education programs specifically designed for minority populations within the healthcare system or community settings in the city of Tulsa despite its significant minority population which are suitable for comparison with the proposed intervention. The existing approach to hypertension management primarily focuses on traditional medical management, such as prescribing antihypertensive medications and providing general lifestyle recommendations during routine clinical visits.

Outcome.

To determine the impact of the culturally tailored hypertension self-management education program intervention, two primary outcomes will be measured: blood pressure control and health-related quality of life. Blood pressure measurements will be obtained using standardized protocols and validated automatic blood pressure monitors. Participants’ blood pressure readings will be recorded at baseline, mid-point, and at the end of the intervention period. In addition, the 36-Item Short Form Health Survey (SF-36) will be utilized to assess participants’ health-related quality of life.

The SF-36 is a widely used and well-validated instrument that measures eight domains: physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health (Esubalew et al., 2024). Permission to use the SF-36 will be secured from the survey instrument’s current copyright holder. A copy of the permission letter will be included as an appendix to the final study. The SF-36 is comprised of 36 questions, with varying response formats, including Likert scaled questions and dichotomous (yes/no) responses. This instrument has been extensively tested and demonstrated consistent reliability and validity across diverse populations, including racial and ethnic minorities (Esubalew et al., 2024).

The SF-36 will be administered in paper format at baseline and following the completion of the intervention program. Participants will be provided with the survey during scheduled appointments or group sessions, and trained research assistants will be available to provide support and clarification as needed. The survey typically requires approximately 10-15 minutes to complete (Esubalew et al., 2024). In addition to the primary outcomes, demographic data will be collected from participants, including age, gender, race/ethnicity, educational level, income level, and employment status. This information will aid in understanding the characteristics of the study population and potentially identifying any subgroup differences in the intervention’s effectiveness. In sum, by using the SF-36, a well-established and validated health-related quality of life instrument, in conjunction with standardized blood pressure measurements, this study aims to comprehensively evaluate the impact of the culturally tailored hypertension self-management education program on both clinical outcomes (e.g., blood pressure control) and patient-reported outcomes (e.g., quality of life) among minority populations in Tulsa.

Time Frame.

The implementation phase of the culturally tailored hypertension self-management education program will span a period of 10 weeks. Week 1 will be dedicated to the recruitment and enrollment of participants, obtaining informed consent, and conducting baseline assessments, including blood pressure measurements and the administration of the SF-36 health-related quality of life survey. During Week 2, the education program will commence with an introduction to hypertension, its risk factors, and the importance of self-management strategies. Weeks 3 and 4 will focus on practical skills, such as blood pressure monitoring techniques, medication adherence strategies, culturally tailored dietary education, and healthy cooking demonstrations.

Week 5 will emphasize physical activity promotion and goal-setting for lifestyle modifications. At the midpoint of the program, Week 6 will involve reassessing participants' blood pressure levels and evaluating their progress. In Week 7, motivational interviewing and behavior change techniques will be introduced to support participants in sustaining healthy habits. Week 8 will address stress management strategies and emotional well-being, recognizing the impact of psychosocial factors on hypertension management. Week 9 will involve connecting participants with community resources and facilitating peer support group sessions to foster ongoing engagement and accountability. Finally, in Week 10, the education program will conclude with post-intervention assessments, including blood pressure measurements and the SF-36 survey, as well as a comprehensive program evaluation to inform future iterations and potential scale-up initiatives.

Feasibility

The proposed 10-week timeframe for the implementation phase of the culturally tailored hypertension self-management education program is feasible and achievable. By carefully planning and organizing the various components of the intervention, and through effective collaboration with community partners and stakeholders, it will be possible to complete all the necessary tasks within the allotted time. One key strategy to ensure feasibility will be to leverage existing community resources and infrastructure. Partnering with established community organizations, faith-based institutions, and healthcare facilities serving minority populations in Chicago will facilitate efficient recruitment, scheduling, and logistical arrangements for the educational sessions and related activities. Additionally, the involvement of community health workers and peer support groups will provide valuable assistance in coordinating and facilitating various aspects of the program.

To overcome potential barriers, such as participant attrition or scheduling conflicts, a contingency plan will be in place. This may include offering alternative session times, providing transportation assistance if needed, and maintaining regular communication with participants to address any concerns or challenges they may face. Moreover, by incorporating engaging and interactive elements, such as multimedia resources and hands-on activities, the program aims to foster sustained participant engagement and adherence throughout the implementation phase.

Effective project management and task delegation will also be crucial in ensuring the timely completion of all implementation tasks. A detailed project plan with clearly defined roles, responsibilities, and timelines will be developed, and regular team meetings will be held to monitor progress, address any issues that arise, and make necessary adjustments to the implementation strategy.

Sample and Setting

The setting for the proposed DNP project is the city of Tulsa, Oklahoma, the former “Oil Capital of the World,” with a particular focus on minority communities disproportionately affected by hypertension. Today, Tulsa is no longer the Oil Capital but its legacy is a diverse and vibrant metropolitan area, home to a significant population of racial and ethnic minorities, including African Americans, Hispanic/Latinos, Asian Americans, and Native Americans (Ibarra, 2021). The intervention will target adult individuals aged 18 years and older who self-identify as members of these minority groups and have been diagnosed with hypertension. A typical participant in the hypertension self-management education program would be an individual residing in one of Chicago's minority neighborhoods, potentially facing socioeconomic challenges, limited access to healthcare resources, and cultural barriers that impact their ability to effectively manage their hypertension.