We contacted 794 people whom EMTs had identified as at risk for uncontrolled HBP for our interviews. Of the 794 interviews attempted, 282 (35.5%) community residents began the survey, and 270 (34%) finished it; 12 persons began the survey but dropped out during the interview. The denominator for individual questions is based on the number who answered that question, and thus the denominators vary slightly because of the drop-outs, those who declined to answer a particular question, and those who answered a question as "unknown" or "do not remember." Age and sex were available for all participants from the information recorded by EMTs on their incident reports, if not answered on the survey.
Demographic information included age, sex, marital status, health insurance status, race/ethnicity, and educational attainment. Sixty-six percent (n = 186/282) of participants were women. The mean (standard deviation [SD]) age was 64.1 (16.6) (n = 282); 70% (n = 173/245) had more than a high school diploma, and 86% (n = 204/238) were white. These demographics helped us develop a target profile of an older, white, fairly well educated, mostly female study population.
Of the 512 who were not interviewed, 28% (n = 144) refused, 22% (n = 111) had a busy telephone line or answering machine, 18% (n = 92) had incorrect or disconnected telephone numbers, 14% (n = 71) were unable to participate because of a disability, 8% (n = 41) were unable to participate because of a language barrier, approximately 2% (n = 11) were deceased, approximately 1% (n = 7) were hospitalized, and 7% (n = 35) were "other." Selected variables were recorded as part of the medical incident reports and were available to compare the 282 participants who began the survey with the 512 who were not interviewed: age, sex, location of the 9-1-1 EMS visit (home vs away from home), and whether the patients were transported from the scene for further care. The 282 subjects were found to be representative of the 512 for whom an interview was attempted unsuccessfully on all comparisons except age; the 282 were younger (64.1 y; SD, 16.6 y) than the 512 participants who were not interviewed (66.5 y; SD, 18.9 y).
Most (67%, n = 180/269) respondents reported a history of hypertension, were medicated for HBP (67%, n = 180/270), and believed HBP to be a serious health threat (78%, n = 201/259). Nearly all participants (95%, n = 246/259) believed that regular screening was important for personal health. On the basis of this information, we determined our target audience would likely be mostly undercontrolled hypertensive patients, as all these patients were selected for the interview on the basis of extremely high blood pressure values in the medical incident reports. However, a significant proportion, about one-third, might be at risk for being newly diagnosed patients as they had not received a diagnosis by a health care provider but had extremely high blood pressure values during a recent 9-1-1 visit.
Because we wanted to improve access to screening for all patients, particularly those without regular access to care, we asked about patients' familiarity and comfort with local fire stations as a place for follow-up blood pressure screening. Almost every survey participant (95%, n = 249/262) knew of a nearby fire station and reported it would be easy to go there (88%, n = 226/257). Forty-four percent (n = 115/262) reported ever having visited a local fire station. Sixty-five percent (n = 138/211) reported that they believe a fire station would be a good place to learn about health, and most (82%, n =136/165) reported they would feel comfortable having their blood pressure checked at a local fire station. Furthermore, 96% (n = 239/250) of participants viewed EMTs as competent to evaluate and treat medical problems. Sixty-five substantial (n = 166/254) strongly agreed they would trust EMTs to evaluate and treat their medical problems.
Development of intervention strategy and materials
On the basis of survey results and discussions with EMS personnel, we determined that a partnership may be feasible between researchers at an academic institution, the EMS division of the local health department, and 4 fire departments to increase community awareness of uncontrolled HBP. Data showed that the health beliefs as posited in the Health Belief Model were held strongly in our target audience. Furthermore, EMTs were perceived as credible spokespeople, and the majority of participants reported that they would feel comfortable visiting a fire station for a blood pressure check. On the basis of our research, we developed an intervention for reaching people with uncontrolled HBP identified during a 9-1-1 EMS event. On the basis of conversations with EMS providers, the intervention will be conducted via direct mail. We developed a brochure mailer () that notifies the recipient that their EMS crew is concerned about a HBP reading taken at the time of a 9-1-1 EMS visit. On half the brochures that will be mailed to residents the actual blood pressure values of the patient are listed in an attempt to further increase perceived susceptibility to uncontrolled HBP. As HBP was already seen as a serious health threat, we decided not to add more content around severity of HBP. We did, however, include information on the benefits of blood pressure monitoring and treatment. To reduce barriers to screening we included a list of local fire stations where blood pressure can be checked.
Figure. Mailer sent to recipients of emergency medical services who had a recorded systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥100 mm Hg. The mailer is the size of a business envelope and includes a list of participating (more ...)
The mailer is full color, includes a photograph of the recipients’ local EMS team, includes a list of participating fire stations on the reverse side, is entitled “High Blood Pressure Alert,” and includes the message, “We are concerned about the high blood pressure measurement we recorded for you during a recent 9-1-1 visit. Below this message is a blood pressure chart giving values for ranges for systolic and diastolic blood pressure. For systolic blood pressure, the chart lists normal (below 120 ), prehypertension (120-140), hypertension stage 1 (140-160), and hypertension stage 2 (160 and above). For diastolic, the chart lists normal (below 80), prehypertension (80-90), hypertension stage 1 (90-100), and hypertension stage 2 (100 and above). Below the chart there is the following message: “Please come to one of the fire stations listed on the back of this card for a free blood pressure check.”