Input from Hypertensive African American Residents of the Black Belt. In our past studies, we have embedded members of the targeted patient population into the research team, which has resulted in invaluable advice and modifications of our preliminary plans. We will again include on the research team a research assistant (X. Xxxxx) who grew up in Boligee, AL, a Black Belt town with fewer than 400 residents. Xx. Xxxxx provides ongoing input at research team meetings. In addition to integrating members of our target audience in the research team, we conduct qualitative research to obtain input from a broader range of stakeholders.17,36,37 As part of the planning process for the proposal, we conducted 5 focus groups with 40 Black Belt residents with HTN or diabetes requiring ongoing medication management in 2013 to understand the barriers they face in attempting to control cardiovascular risk factors including HTN. Top barriers included inability to keep doctor appointments, lack of exercise, limited income, lack of will power, and pain as a barrier to physical activity. These findings have led us to target telephone support as a component of the practice facilitation intervention, and motivational interviewing in the peer coaching intervention. During the year-long planning phase of the study, we engaged in ongoing discussions with area residents with HTN in both AL and NC to further inform the design of the study as well as the interventions. These discussions included community member perspectives on the challenges they face accessing medical care and advice, barriers to medication adherence, community-level barriers to healthier diet and physical activity, attitudes toward working with a peer coach potentially from their same community (including potential concerns), attitudes toward home BP monitoring, as well as specific input on study design questions (e.g., preferences for recruitment and informed consenting, preferences for retention activities, input on selection of outcome measures). We recruited patients of area practices and individuals with HTN in the social networks of our current cadre of over 60 trained peer coaches. We conduct in-person groups in community settings, either at the practice or in a community location. A trained moderator led the discussions, in many cases community coordinators based at the partnering community non-profit organizations (Health and Wellness Education Center of Xxxxxxxxxx, AL, and the West Central Alabama Community Health Improvement League).
