Innovative strategies that dispel the myths about urban young black men with high blood pressure

Background. Young urban black men continue to suffer among the highest rates of undiagnosed, untreated, and uncontrolled high blood pressure. These rates are commonly attributed to the perceptions that young black men: do not care about their health; are hard to reach; will not participate in health care and research studies; will not consent to be randomized; and are hard to follow and retain in care and in studies. Methods. In two randomized clinical trials of high blood pressure control in young urban black men (N = 204 and N = 309, respectively), strategies to maximize identification, recruitment, randomization, and follow up were developed and tested. Staff hired from the community were responsible for recruitment strategies and follow up activities. A Nurse Practitioner-Community Health Worker-Physician team provided clinical care. The strategies used to improve high blood pressure care and control in young urban black men were: 1) hire a creative, nonjudgmental, committed team and cross train each member for multiple roles; 2) reach out into the community to find the men and encourage them to participate; 3) build a relationship based upon trust, consideration, and recognition of the men's priorities; 4) help the men see what they can do for themselves and their health; 5) involve the men in all decisions about high blood pressure care and control; 6) elicit the help of family, friends, and community agencies to maintain contact. Results. In Trial I, 1391 potentially eligible men were identified. Of these, 803 responded to an invitation to be screened and made an appointment; 528 kept the appointment; 207 met eligibility criteria; and 204 were randomized. The follow up rate after one year of study was 86%. In Trial II, 821 potentially eligible men were identified. Of these, 606 men responded and made an appointment to be screened; 566 met criteria at screening visit 1; 309 met enrollment criteria at screening visit 2 and were randomized. The follow up rate after 18 months of study was 90%. Conclusions. An approach utilizing a committed, trained team can dispel the myths about 'hard-to-reach' young black men and can identify, recruit, track, and follow up this little studied, high risk population. (C) 2000 by Cardiovascular Reviews and Reports, Inc.