Can stories influence African-American patients' intentions to change hypertension management behaviors? A randomized control trial

Patient Educ Couns. 2016 Sep;99(9):1482-8. doi: 10.1016/j.pec.2016.06.024. Epub 2016 Jun 21.


Objectives: Information-only interventions for hypertension management have limited effectiveness, particularly among disadvantaged populations. We assessed the impact of viewing African-American patients' stories of successfully controlling hypertension on intention to change hypertension management behaviors and engagement with educational materials.

Methods: In a three-site randomized trial, 618 African-American Veterans with uncontrolled hypertension viewed an information-only DVD about hypertension (control) or a DVD adding videos of African-American Veterans telling stories about successful hypertension management (intervention). After viewing, patients were asked about their engagement with the DVD, and their intentions to change behavior. Mean scores were compared with two-sided t-tests.

Results: Results favored the Stories intervention, with significantly higher emotional engagement versus control (4.3 vs. 2.2 p<0.0001). Intervention patients reported significantly greater intentions to become more physically active (4.6 vs. 4.4, p=0.018), use salt substitutes (3.9 vs. 3.4, p=0.006), talk openly with their doctor about hypertension (4.6 vs. 4.5, p=0.049), and remember to take hypertension medication (4.8 vs. 4.6, p=0.04).

Conclusion: Patients were more emotionally engaged and reported intentions to change behavior when watching real patient hypertension management success stories.

Practice implications: Stories may be more influential than information alone, and represent a scalable approach to modifying behavioral intention.

Keywords: African-American; Disparities; Education; Health literacy; Hypertension; Narrative communication.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • African Americans / education*
  • African Americans / psychology
  • Behavior Therapy / methods*
  • Female
  • Follow-Up Studies
  • Health Education / methods*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hypertension / ethnology*
  • Hypertension / psychology
  • Hypertension / therapy*
  • Intention*
  • Male
  • Middle Aged
  • Narration*
  • Outcome Assessment, Health Care
  • Patient Education as Topic / methods*
  • United States
  • United States Department of Veterans Affairs
  • Veterans / psychology
  • Veterans / statistics & numerical data
  • Videodisc Recording