{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:39:08Z","timestamp":1786462748473,"version":"build-2736575974"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Hypertension treatment advances have resulted in improvements in blood pressure control and self-management. Yet, disparities persist for Black veterans.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the impact of a narrative-informed texting intervention with educational content and bidirectional text messaging on blood pressure and hypertension self-management.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This nonblinded, 2-arm randomized clinical trial recruited participants from March 2021 to July 2022 at 2 Veterans Affairs (VA) medical centers (1 in Chicago, Illinois, and 1 in Philadelphia, Pennsylvania); follow-up was completed in May 2023. Participants were Black veterans with at least 1 medication for hypertension, with oversampling of female veterans. Participants were randomly assigned to the intervention arm or control arm. Data analysis was based on the intention-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Those assigned to the intervention group received the Continuing the Conversation intervention, which involved watching 5 videos (5-7 minutes each) of Black veterans sharing stories of their challenges and successes with managing hypertension. Participants selected a favorite storyteller and were enrolled in a 6-month texting protocol wherein they received 3 types of text messages: narrative (quotations from storytellers), educational, and bidirectional. The comparison or control arm received 6 months of bidirectional text messages (BTMs) only.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Change in systolic and diastolic blood pressure from baseline to 6-month follow-up was the primary outcome. Secondary outcomes included change in self-reported hypertension management activities (medication adherence, diet, physical activity). All outcomes were prespecified. Difference-in-differences (DID) regression models assessed whether the intervention arm had a 6-month improvement larger than that in the control arm. Engagement (6-month response rates to BTMs) and motivation of participants were also evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 600 Black veterans enrolled (469 males [78.7%]; mean [SD] age, 64.0 [9.1] years), 516 veterans (86.0%; 262 in intervention arm, 254 in control arm) completed the 6-month follow-up. There was no significant difference between arms in mean change of systolic (DID, \u22120.8 mm Hg; 95% CI, \u20133.9 to 2.3 mm Hg;\n P<\/jats:italic>\n \u2009=\u2009.62) or diastolic (DID, 0.4 mm Hg; 95% CI, \u22121.6 to 2.4 mm Hg;\n P<\/jats:italic>\n \u2009=\u2009.70) blood pressure or in secondary outcomes. Mean systolic (\u22122.1 mm Hg; 95% CI, \u20133.7 to \u22120.6 mm Hg;\n P<\/jats:italic>\n \u2009=\u2009.006) and diastolic (\u22121.8 mm Hg; 95% CI, \u20132.8 to \u22120.8 mm Hg;\n P<\/jats:italic>\n \u2009=\u2009.001) blood pressure measurements decreased significantly for the entire cohort. In the intervention arm, 221 of 239 participants (92.5%) agreed with the statement: \u201cI could identify with the Veteran in the video.\u201d Across both arms, the response rate to BTMs was 57.5% (11 427 of 19 875 possible opportunities to respond), and 60.7% (10 564 of 17 407 possible opportunities to respond) among those completing follow-up. Of 516 veterans, 410 (79.5%) described text messages as helpful motivators for improving health.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of video stories followed by narrative, educational, and BTMs to support hypertension self-management, this intervention did not improve blood pressure compared with receiving BTMs alone. Text messages supported engagement and enhanced motivation for Black veterans.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03970590<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.41342","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T16:00:41Z","timestamp":1762358441000},"page":"e2541342","source":"Crossref","is-referenced-by-count":5,"title":["Text Messaging and Video Stories to Support Hypertension Self-Management in Black Veterans"],"prefix":"10.1001","volume":"8","author":[{"given":"Sarah L.","family":"Cutrona","sequence":"first","affiliation":[{"name":"Center for Health Optimization and Implementation Research, Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts"},{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"McDannold","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn L.","family":"DeLaughter","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemmae M.","family":"Fix","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts"},{"name":"Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Shimada","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts"},{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester"},{"name":"Boston University School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara G.","family":"Bokhour","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts"},{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard S.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois"},{"name":"Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois College of Medicine, Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene","family":"Pope","sequence":"additional","affiliation":[{"name":"Ralph J. 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