Clinical trials of health education for hypertensive outpatients: Design and baseline data

A research program was designed to proceed from a set of propositions about health education to a corresponding set of corollaries for evaluation of health education in hypertensive patients. The first step of the program consisted of a series of "diagnostic-baseline" studies to determine the educational needs of patients and health care staff and to analyze other barriers to patient compliance. Apart from a few widespread misconceptions about hypertension among patients and a tendency among staff to overestimate compliance, both patients and providers of health care in The Johns Hopkins clinics are better informed than expected on the basis of similar surveys conducted here nearly 2 yr earlier. Neither side effects nor costs of drugs were cited by patients as major reasons for noncompliance. Educational interventions are being designed on the basis of these findings to identify individual problems with compliance and to influence more deep-seated sources of resistance to change. If our educational diagnosis is correct, the proposed clinical trials of these interventions should yield more long-term compliance and blood pressure control than conventional patient education activities focused on more superficial knowledge, attitudes, and beliefs.