The TargetEd MAnageMent Intervention for Reducing Stroke Risk in Black Men: A 6-Month Prospective Randomized Controlled Trial

Abstract

This 6-month randomized controlled trial compared TEAM, a group intervention to reduce stroke risk versus a 6-month wait-list control in Black men with stroke or transient ischemic attack. The primary outcome was the change from baseline to 6 months in systolic blood pressure (SBP). There were 160 randomized, N = 78 to TEAM, N = 82 to Waitlist, mean age 61.2 (SD 9.5). Attrition was 53.1% and similar across arms. Biomarker values were extracted from health records for individuals with missed visits. Baseline SBP was 135.3 (SD 17.9). Among the entire sample, SBP was numerically but not statistically significantly reduced with no significant difference between TEAM versus Waitlist. Post-hoc analyses suggested those with elevated baseline blood pressure (BP) had significant BP reduction in the group as a whole and in TEAM. Future research might target Black men with poorly controlled BP and address barriers to engaging in risk reduction programs.

Keywords

stroke secondary stroke African American men Black men health disparities

Get full access to this article

View all access options for this article.

References

Appleby

Gill

S. T.

Hayes

L. K.

Walker

T. L.

Walsh

Kumar

(2019). Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review. PLOS ONE, 14(11), Article e0225150. https://doi.org/10.1371/journal.pone.0225150

Cao

Jain

Author

(2023). Secondary stroke risk reduction in black adults: A systematic review. Journal of Racial and Ethnic Health Disparities, 10(1), 306–318. https://doi.org/10.1007/s40615-021-01221-2

Centers for Disease Control and Prevention. (2014). Self-measured blood pressure monitoring: Action steps for clinicians. U.S. Department of Health and Human Services. https://www.cdc.gov/bloodpressure/docs/oper_guide_clinicians.pdf .

Centers for Disease Control and Prevention. (2022). Prevent stroke: What you can do. https://www.cdc.gov/stroke/prevention.html.

Conway

J. M.

Ingwersen

L. A.

Moshfegh

A. J.

(2004). Accuracy of dietary recall using the USDA five-step multiple-pass method in men: An observational validation study. Journal of the American Dietetic Association, 104(4), 595–603. https://doi.org/10.1016/j.jada.2004.01.007

Ellis

(2014). An examination of stroke-related knowledge in male stroke survivors living in the South Carolina stroke belt. American Journal of Men's Health, 8(6), 532–537. https://doi.org/10.1177/1557988314531038

Fagerström

K. O.

(1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors, 3(3-4), 235–241. https://doi.org/10.1016/0306-4603(78)90024-2

Flansbjer

U. B.

Lexell

Brogårdh

(2012). Long-term benefits of progressive resistance training in chronic stroke: A 4-year follow-up. Journal of Rehabilitation Medicine, 44(3), 218–221. https://doi.org/10.2340/16501977-0936

Gardener

Sacco

R. L.

Rundek

Battistella

Cheung

Y. K.

Elkind

M. S. V.

(2020). Race and ethnic disparities in stroke incidence in the northern manhattan study. Stroke, 51(4), 1064–1069. https://doi.org/10.1161/STROKEAHA.119.028806

10.

GBD 2019 Stroke Collaborators. (2021). Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the global burden of disease study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0

11.

Guzik

A. K.

Martin-Schild

Tadi

Chapman

S. N.

Kasab

A. l.

Martini

Meyer

S. R.

Demaerschalk

B. C.

Wozniak

B. M.

Southerland

A. M,

(2021). Telestroke across the Continuum of care: Lessons from the COVID-19 pandemic. Journal of Stroke and Cerebrovascular Diseases, 30(7), 105802. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105802

12.

Harrington

Taylor

Hollinghurst

Reed

Kay

Wood

V. A.

(2010). A community-based exercise and education scheme for stroke survivors: A randomized controlled trial and economic evaluation. Clinical Rehabilitation, 24(1), 3–15. https://doi.org/10.1177/0269215509347437

13.

Harris

P. A.

Scott

K. W.

Lebo

Hassan

Lightner

Pulley

(2012). Researchmatch: A national registry to recruit volunteers for clinical research. Academic Medicine, 87(1), 66–73. https://doi.org/10.1097/ACM.0b013e31823ab7d2

14.

Harris

P. A.

Taylor

Minor

B. L.

Elliott

Fernandez

O'Neal

McLeod

Delacqua

Kirby

Duda

S. N.

, & REDCap Consortium. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208

15.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010

16.

Harris

Nelson

L. A.

Muller

Buchwald

(2015). Stroke in American Indians and Alaska natives: A systematic review. American Journal of Public Health, 105(8), e16–e26. https://doi.org/10.2105/AJPH.2015.302698

17.

Harrison

D. G.

Touyz

R. M.

(2025). Hypertension editors’ view of the 2025 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 82(10), e193–e195. https://doi.org/10.1161/HYPERTENSIONAHA.125.25467

18.

Hays

R. D.

Sherbourne

C. D.

Mazel

R. M.

(1995). User’s manual for Medical Outcomes Study (MOS) core measures of health-related quality of life. RAND Corporation.

19.

Howard

Moy

C. S.

Howard

V. J.

McClure

L. A.

Kleindorfer

D. O.

Kissela

B. M.

Judd

S. E.

Unverzagt

F. W.

Soliman

E. Z.

Safford

M. M.

(2016). Where to focus efforts to reduce the black-white disparity in stroke mortality: Incidence versus case fatality? Stroke, 47(7), 1893–1898. https://doi.org/10.1161/STROKEAHA.115.012631

20.

Ikeme

Kottenmeier

Uzochukwu

Brinjikji

(2022). Evidence-based disparities in stroke care metrics and outcomes in the United States: A systematic review. Stroke, 53(2), 670–679. https://doi.org/10.1161/STROKEAHA.121.036263

21.

Jose

P. O.

Frank

A. T. H.

Kapphahn

K. I.

Goldstein

B. A.

Eggleston

Hastings

K. G.

Cullen

M. R.

Palaniappan

L. P.

(2014). Cardiovascular disease mortality in Asian Americans. Journal of the American College of Cardiology, 64(23), 2486–2494. https://doi.org/10.1016/j.jacc.2014.08.048

22.

Kasner

S. E.

(2006). Clinical interpretation and use of stroke scales. The Lancet Neurology, 5(7), 603–612. https://doi.org/10.1016/S1474-4422(06)70495-1

23.

Kleindorfer

D. O.

Towfighi

Chaturvedi

Cockroft

K. M.

Gutierrez

Lombardi-Hill

Kamel

Kernan

W. N.

Kittner

S. J.

Leira

E. C.

Lennon

Meschia

J. F.

Nguyen

T. N.

Pollak

P. M.

Santangeli

Sharrief

A. Z.

Smith Jr

S. C.

Turan

T. N.

Williams

L. S.

(2021). 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American stroke association. Stroke, 52(7), e364–e467. https://doi.org/10.1161/STR.0000000000000375

24.

S. H. S.

Chang

A. M.

Chau

J. P. C.

(2018). Stroke self-management support improves survivors’ self-efficacy and outcome expectation of self-management behaviors. Stroke, 49(3), 758–760. https://doi.org/10.1161/STROKEAHA.117.019437

25.

Magwood

G. S.

Ellis

Nichols

Burns

S. P.

Jenkins

Woodbury

Adams

(2019). Barriers and facilitators of stroke recovery: Perspectives from African Americans with stroke, caregivers and healthcare professionals. Journal of Stroke and Cerebrovascular Diseases, 28(9), 2506–2516. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.012

26.

Mahoney

F. I.

Barthel

D. W.

(1965). Functional evaluation: The barthel Index. Maryland State Medical Journal, 14, 61–65.

27.

McLean

Band

Saunderson

Hanlon

Murray

Little

McManus

R. J.

Yardley

Mair

F. S.

, DIPSS co-investigators. (2016). Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis. Journal of Hypertension, 34(4), 600–612. https://doi.org/10.1097/HJH.0000000000000859

28.

MedlinePlus. (2020, October 2). Cholesterol levels: What you need to know. National Library of Medicine. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html .

29.

Murphy

S. L.

Kochanek

K. D.

Arias

Tejada-Vera

(2022). Deaths: Final data for 2019 (National Vital Statistics Reports, Vol. 69, No. 13). Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69-13-508.pdf.

30.

Nadeau, S. E., Wu, S. S., Dobkin, B. H., Azen, S. P., Rose, D. K., Tilson, J. K., Cen, S.Y., Duncan, P. W., & LEAPS Investigative Team. (2013). Effects of task-specific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation. Neurorehabilitation and Neural Repair, 27(4), 370–380. https://doi.org/10.1177/1545968313481284

31.

National Institute on Drug Abuse. (2017). Resource guide: Screening for drug use in general medical settings. https://www.drugabuse.gov/publications/resource-guide.

32.

Nott

Wiseman

Seymour

Pike

Cuming

Wall

(2021). Stroke self-management and the role of self-efficacy. Disability and Rehabilitation, 43(10), 1410–1419. https://doi.org/10.1080/09638288.2019.1666431

33.

Office of Minority Health. (2024). Profile: Black/African American. U.S. Department of Health and Human Services. https://minorityhealth.hhs.gov/blackafrican-american-health

34.

Omron Healthcare. (2018). 3 series upper arm blood pressure monitor (BP7100) instruction manual [Instruction manual]. https://omronhealthcare.com/storage/pdfs/im_bp7100_en_3787112-0c.pdf.

35.

Ouellette

M. M.

LeBrasseur

N. K.

Bean

J. F.

Phillips

Stein

Frontera

W. R.

Fielding

R. A.

(2004). High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke, 35(6), 1404–1409. https://doi.org/10.1161/01.STR.0000127785.73065.34

36.

Pew Research Center. (2024, April 15). Facts about the U.S. Black population. https://www.pewresearch.org/race-and-ethnicity/fact-sheet/facts-about-the-us-black-population/.

37.

Rothwell

P. M.

Giles

M. F.

Flossmann

Lovelock

C. E.

Redgrave

J. N.

Warlow

C. P.

Mehta

(2005). A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. The Lancet, 366(9479), 29–36. https://doi.org/10.1016/S0140-6736(05)66702-5

38.

Rubenstein

J. H.

Morgenstern

Kellenberg

Kalish

Donovan

Inadomi

McConnell

Stojanovska

Schoenfeld

(2011). Validation of a new physical activity questionnaire for a sedentary population. Digestive Diseases and Sciences, 56(9), 2678–2687. https://doi.org/10.1007/s10620-011-1641-y

39.

Sajatovic

Tatsuoka

Welter

Colon-Zimmermann

Blixen

Perzynski

A. T.

Amato

Cage

Sams

Moore

S. M.

Pundik

Sundararajan

Modlin

Sila

(2018). A targeted self-management approach for reducing stroke risk factors in African American men who have had a stroke or transient ischemic attack. American Journal of Health Promotion, 32(2), 282–293. https://doi.org/10.1177/0890117117695218

40.

Schwarzer

Jerusalem

(1995). Generalized self-efficacy scale. In Johnston

Wright

Weinman

(Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). NFER-Nelson.

41.

Scott

Pope

(2002). Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization. The American Journal of Psychiatry, 159(11), 1927–1929. https://doi.org/10.1176/appi.ajp.159.11.1927

42.

Still

C. H.

Burant

Moore

Einstadter

Killion

Modlin

Sundararajan

Thornton

J. D.

Wright Jr

J. T.

Sajatovic

(2021). The targeted management (TEAM) intervention for reducing stroke risk in African American men: Rationale and study design of a prospective randomized controlled trial. Journal of Multidisciplinary Healthcare, 14, 513–522. https://doi.org/10.2147/JMDH.S288753

43.

Strowd

R. E.

Strauss

Graham

Dodenhoff

Schreiber

Thomson

Ambrosini

Thurman

A. M.

Olszewski

Smith

L. D.

Cartwright

M. S.

Guzik

Wells

R. E.

Munger Clary

Malone

Ezzeddine

Duncan

P. W.

Tegeler

C. H.

(2021). Rapid implementation of outpatient teleneurology in rural appalachia: Barriers and disparities. Neurology: Clinical Practice, 11(3), 232–241. https://doi.org/10.1212/CPJ.0000000000000906

44.

Sullivan

Dunton

N. J.

(2004). Development and validation of the stroke knowledge test. Topics in Stroke Rehabilitation, 11(3), 19–28. https://doi.org/10.1310/RED5-V47T-8MJN-JY9H

45.

Towfighi

Boden-Albala

Cruz-Flores

El Husseini

Odonkor

C. A.

Ovbiagele

Sacco

R. L.

Skolarus

L. E.

Thrift

A. G.

, & American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Hypertension, Council on the Kidney in Cardiovascular Disease, and Council on Peripheral Vascular Disease. (2023). Strategies to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control: A scientific statement from the American Heart Association. Stroke, 54(7), e371–e388. https://doi.org/10.1161/STR.0000000000000437

46.

Towfighi

Cheng

E. M.

Ayala-Rivera

Barry

McCreath

Ganz

D. A.

Lee

M. L.

Sanossian

Mehta

Dutta

(2021). Effect of a coordinated community and chronic care model team intervention vs usual care on systolic blood pressure in patients with stroke or transient ischemic attack: The SUCCEED randomized clinical trial. JAMA Network Open, 4(2), Article e2036227. https://doi.org/10.1001/jamanetworkopen.2020.36227

47.

Towfighi

Cheng

E. M.

Ayala-Rivera

McCreath

Sanossian

Dutta

Mehta

Bryg

Rao

Song

(2017). Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by uniting community and chronic care model teams early to End disparities (SUCCEED). BMC Neurology, 17(1), Article 24. https://doi.org/10.1186/s12883-017-0792-7

48.

Vauth

Kleim

Wirtz

Corrigan

P. W.

(2007). Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Research, 150(1), 71–80. https://doi.org/10.1016/j.psychres.2006.07.005

49.

Zhu

Said

M. S. B. M.

Geok

T. B.

(2025). A review of health management for stroke survivors during the rehabilitation period. International Journal of Biotechnology and Biomedicine, 1(3), 45–54. https://doi.org/10.31674/ijbb.2024.v01i03.005