Co-Developing a Stress Management Intervention for Black Adults with Hypertension

Despite population-level improvement in cardiovascular disease (CVD) incidence and mortality, CVD still disproportionately burdens Black adults. Recognizing that elevated stress exposure among these groups may contribute to CVD risk, the American Heart Association recently called for the development of interventions for blood pressure (BP) and cardiovascular health (CVH) that reduce stressors and enhance one’s stress response. The latest research on stress indicates Black adults report greater stress exposure and are a logical focus for advancing stress science. Thus, I will work with Black patients receiving care from federally-qualified health centers to iteratively design and pilot test the operable feasibility of a stress management intervention among Black adults with elevated blood pressure. Changes in stress and ambulatory blood pressure will be examined as well. Due to the design process, the resulting intervention will address patient preferences and thus may be an engaging and sustainable strategy in an externally valid setting for the promotion of cardiovascular health in a high-risk subpopulation. This has the potential to complement existing interventions, as cardiovascular health is not solely affected by traditional CVH risk factors (e.g., Life’s Essential 8). The stress management intervention will be informed through both primary data collection (Aims 1-2) as well as existing literature on supraindividual factors that protect against stress and its cardiovascular health consequences. In a user-centered design approach, the intervention will be iteratively developed and prototyped with Black adults with stress. In Aim 3, I propose to feasibility test, in a Stage 1b pilot, the stress management intervention among Black adults with stress and elevated blood pressure. Measures will be at baseline and posttest and assess feasibility; stress and blood pressure will also be measured. A successful pilot would support a large-scale stress-management intervention across safety-net primary care sites with the objectives of cardiovascular disease prevention and reduction of CVH disparities. These aims provide experiential learning in CVH, user-centered design, and primary data collection and behavioral intervention trial methods. By the end of this award period, I will be an independent scientist in behavioral intervention research with a focus on stress and CVH.