PROJECT ABSTRACT/SUMMARY Efforts to improve medication non-adherence (MNA) and blood pressure (BP) control in patients with hypertension (HTN) have met with limited success. Innovative approaches are needed that are acceptable, sustainable, efficacious, and easily disseminated. There have been no randomized controlled trials (RCTs) evaluating the application of theory-driven, patient centered, mobile health (mHealth) technology programs among African Americans (AAs) with MNA and uncontrolled HTN. The proposed research will test and refine the Smart phone Medication Adherence Stops Hypertension (SMASH) program. SMASH includes multi-level components: 1) automated reminders from an electronic medication tray;; 2) tailored text message/voice mail motivational feedback and reinforcement guided by self-determination theory and based upon adherence to daily medication and BP monitoring and 3) automated summary reports and direct alerts to providers. A 6- month, 2-arm (SMASH vs. enhanced Standard Care [SC]) efficacy RCT will be conducted in 192 AAs (21-59 years old) with electronic monitor derived MNA and repeated clinic and 24hr BP verified uncontrolled HTN. Evaluations will occur at baseline, months 3 and 6, and post-trial follow-ups at months 12 and 18. Specific aims are to test the hypotheses that, compared to the enhanced SC cohort, the SMASH cohort will demonstrate significantly improved and sustained changes in: 1) Primary Outcome Variables: a) Medication adherence: % with electronic monitor-derived adherence scores >0.90;; b) BP control: % meeting JNC8 guidelines for BP control (resting BP <140/90 mmHg). 2) Secondary Outcome Variables: a) % reaching and sustaining 24-hr ambulatory BP<130/80 mmHg;; b) % of provider adherence to JNC8 guidelines as measured by timing of medication changes and c) patient changes in Self-Determination Theory constructs (e.g., competence and autonomous motivation). 3) Exploratory Outcomes: a) moderators (e.g., gender, age, income) and mediators (e.g., perceived severity of disease, med side effects, depression symptoms, etc.) of medication adherence and BP control;; b) cost effectiveness and c) physical risk factor changes (cholesterol, LDL, HgA1c, blood glucose). After final follow-up evaluations, focus groups with random sample of SMASH subjects (total n=32) and healthcare providers (total n=~12) will assess key user reactions including acceptability, usability, salience and aids/barriers to sustainability. Data from RCT and focus groups will be triangulated to further refine and optimize SMASH and prepare for a multi-site effectiveness RCT. Our long-term objective is to reduce premature mortality among AAs by developing effective and sustainable mHealth chronic disease medical regimen self-management programs including medication adherence, bio-function monitoring (e.g., BP) and timely bidirectional contact with healthcare providers.