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Dissertation
A pilot randomized controlled trial comparing the efficacy of problem-solving therapy to enhanced treatment as usual for reducing high blood pressure
Doctor of Philosophy (Ph.D.), Drexel University
01 Apr 2015
DOI:
https://doi.org/10.17918/etd-6346
Abstract
High blood pressure is a highly prevalent and modifiable risk factor for cardiovascular disease that has substantially contributed to disability, morbidity, mortality, health disparities and economic burden in the United States. Although relatively easy to diagnosis and inexpensive to treat, controlling high blood pressure, thereby reducing its sequelae, remains difficult, particularly for Black individuals, due to a host of psychosocial, biological, and environmental factors. There is a need to identify an efficacious stress-reduction intervention for lowering uncontrolled high blood pressure that can be effectively translated into practice. In the current pilot study, the preliminary efficacy and feasibility of Problem-Solving Therapy (PST), compared to telephone-delivered enhanced treatment as usual (ETAU), were evaluated on measures of blood pressure, social problem solving ability, medication adherence, perceived stress, depression, and health-related quality of life (HRQOL) at baseline, posttreatment, and three-month follow up. Recruitment from outpatient medical clinics yielded a sample of 14 participants, predominantly Black and female, with uncontrolled high blood pressure, who were randomly assigned to PST or ETAU. Mean differences between conditions from baseline to posttreatment assessments were examined using a series of intent-to-treat (N = 12) t-tests and repeated measures ANOVAs, none of which were statistically significant. Inspection of effect sizes and clinical significance indicated a trend toward efficacy of PST to improve medication adherence [F(1, 10) = 2.54, p = 0.14, [eta][p]2 = 0.20] and physical HRQOL [F(1,10) = 2.54, p = 0.14, [eta][p]2 = 0.20], as well as slightly more frequent clinically meaningful changes in systolic blood pressure, mental HRQOL, and depression for those who received PST. In terms of feasibility, about 13% of 108 recruited patients were enrolled, the rate of attrition was below 20% for treatment initiators, retention of treatment initiators was 100% for PST (nPST = 6) and 83.3% (nETAU = 5) for ETAU at posttreatment, and about 80% of participants rated the treatments as credible and effective. Three-month follow up assessments were too few to conduct meaningful analyses. Although a trend toward efficacy of PST was indicated, challenges in recruitment limited sample size, and, therefore, the aforementioned preliminary results must be interpreted with caution.
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Details
- Title
- A pilot randomized controlled trial comparing the efficacy of problem-solving therapy to enhanced treatment as usual for reducing high blood pressure
- Creators
- Lauren Miriam Greenberg - DU
- Contributors
- Arthur M. Nezu (Advisor) - Drexel University (1970-)Christine M. Nezu (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Psychological and Brain Sciences (Psychology); College of Arts and Sciences; Drexel University
- Other Identifier
- 6346; 991014632599604721