Poorly controlled blood pressure and glucose levels increase the risk of stroke, end-stage renal disease, and premature death. Forty-seven percent of African American women are living with hypertension and are twice as likely to be diagnosed with type 2 diabetes as are White women. Hypertension and type 2 diabetes frequently co-occur. In fact, the prevalence of hypertension is 71% among adults diagnosed with diabetes. Although previous studies have outlined strategies to improve self-management behaviors among African American women, no studies to our knowledge explore the neurobiological mechanisms of self-management interventions. We need to know both if and how self-management interventions for this population work. Uncovering these basic neurobiological mechanisms is an important step in designing more precise and effective interventions to produce behavior change. This pilot study will be one of the first to incorporate psychosocial and cognitive factors (executive function and self-management processes) with neurobiological factors (neuroprocessing, or brain activity in response to analytic/empathetic prompts) associated with health information behavior (seeking, sharing, use) and the performance of self-management diet behaviors.

Our review of the neuroscience literature suggests that interventions can “rewire” our brains to change behavior. Researchers have examined brain activity in response to health messaging and were able to predict ability to abstain from smoking and use of sunscreen. A better understanding of the brain-behavior interaction is needed to deepen our knowledge of how health information rewires the brain and enhances self-management behaviors in patients with chronic illness. Examining the relationships between health information behavior and neuroprocessing will help scientists and practitioners to better understand why messaging leads to behavior change. Integrating knowledge of how our brains differ in processing information is an important step forward to affect behavior change and chronic illness self-management.

Exploring the brain-behavior mechanisms underlying the health information behavior will help to clarify some of the behavior translation pathways that currently are unclear. Additional knowledge of brain-behavior translation will help researchers and practitioners to transform clinical practice. Designing interventions based on neural activity and response will enhance current self-management regimens. Current evidence suggests that health education strategies that incorporate both analytic (knowledge and skills) and empathetic (social and emotional prompts) information have the potential further to increase participation in self-management behaviors (i.e. improved dietary patterns) and to improve health outcomes, such as blood pressure and glucose control and decrease the incidence of negative sequelae (i.e. stroke and myocardial infarction).

In a recent study, we found associations among health information behavior, neuroprocessing (using functional magnetic resonance imaging, or fMRI), and self-management processes in (n=26) African Americans with prehypertension (SBP 120-139 and/or DBP 80-89 mmHg). We have also found that information seeking and sharing explained improved blood pressure self-management in African American women beta=-.17 (p=.05) & beta=.46 (p<.001), respectively). The purpose of this descriptive study is to examine the neurobiological mechanisms associated with health information behavior and self-management in African American women with comorbid hypertension and type 2 diabetes. A convenience sample of 45 community-dwelling African American women who have been clinically diagnosed with hypertension and type 2 diabetes will be recruited.
The specific aims of the pilot project icnlude:

• Specific Aim #1: Characterize the relationships among health information behavior (seeking, sharing, use), neuroprocessing (ability to differentiate between analytic/empathy tasks) and executive function, self-management processes (self-efficacy, self-regulation, patient activation), and outcomes (diet self-management, blood pressure, hemoglobin A1C, hsC-reactive protein, quality of life) in African American women with hypertension and type 2 diabetes.
• Specific Aim #2: Evaluate the shared and independent variance contributions of health information behavior, neuroprocessing and executive function, self-management processes on diet self-management, blood pressure, hemoglobin A1C, hsC-reactive protein, and quality of life outcomes.

In line with the Precision Medicine initiative, identification of brain-behavior phenotypes relating to health information behavior and self-management will assist in designing and testing of targeted and tailored interventions for African American women that potentially are more effective than current self-management interventions. This work will contribute to the reduction of health disparities affecting this population by exploring culturally driven self-management processes.7,19 It will also establish a foundation of additional findings to support our next project, an R01 application to examine the effects of our information sharing intervention in a sample of African American women with hypertension. These goals are in line with the goals of the CSCD pilot program, as well as the goals of the National Institute of Nursing Research.