BackgroundHypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach.ObjectiveOur goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support.MethodsWe conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined.ResultsA total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change –12.6, SD 24.0 vs mean change –11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change –4.9, SD 13.1 mm Hg vs mean change –3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (β=–0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting.ConclusionsUse of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and ...

BackgroundThere are an estimated 25.8 million American children and adults, equivalent to 8.3% of the US population, living with diabetes. Diabetes is particularly burdensome on minority populations. The use of mobile technologies for reaching broad populations is a promising approach, given its wide footprint and ability to deliver inexpensive personalized messages, to increase awareness of type 2 diabetes and promote behavior changes targeting risk factors associated with type 2 diabetes. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing mobile health information service, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. Txt4health is a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives.ObjectiveThe purpose of this investigation was to use the RE-AIM framework to document txt4health reach and adoption by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati.MethodsWe conducted a retrospective records analysis of individual-level txt4health system data from participants in Southeast Michigan and Greater Cincinnati to determine participant usage of txt4health and engagement with the program.ResultsResults from the retrospective records analysis revealed that 5570 participants initiated the 2-step enrollment process via 1 of 3 enrollment strategies: text message, website, or directly with Beacon staff who signed participants up via the website. In total, 33.00% (1838/5570) of participants completed the 2-step enrollment process and were fully enrolled in the program. All participants (100.00%, 1620/1620) who enrolled via text message completed the entire 2-step enrollment process versus 5.52% (218/3950) of participants who enrolled via website or a Beacon staff member. Of those who fully enrolled, 71.00% (1305/1838) completed the diabetes risk assessment and 74.27% (1365/1838) set an initial weight loss goal. Overall, 39.06% (718/1838) of participants completed all 14 weeks of the program and 56.26% (1034/1838) dropped out before completing all 14 weeks, with the bulk of dropouts occurring in the first 4 weeks. Length of participation varied greatly, ranging from 0-48.7 weeks (median 8.6, mean 15.8, SD 15.8). Wide variability of participant engagement in regards to weekly weight and physical activity was documented.ConclusionsAlthough broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all.

BackgroundAlthough there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities.ObjectiveThe purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati.MethodsWe conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health.ResultsTxt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159).ConclusionsResults from this study suggest that participants in txt4health, a large-scale, public health–focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change.

There are an estimated 25.8 million American children and adults, roughly 8.3% of the U.S. population, living with diabetes. Diabetes is particularly burdensome on minority populations where health disparities persist. Mobile technologies are an attractive method for reaching broad populations given the high penetration of cell phones across diverse groups, and may be a useful strategy for raising awareness of type 2 diabetes. To raise awareness of the risks associated with type 2 diabetes, pilots of txt4health, an automated 14-week text message program, were launched by the Southeast Michigan and Greater Cincinnati Beacon Communities. This investigation sought to evaluate the txt4health program pilot in Southeast Michigan and Greater Cincinnati through documenting participant usage of txt4health, as well as user perceptions of the program.In this two part evaluation, we conducted a retrospective records analysis of individual-level txt4health system usage data from participants in Southeast Michigan and Greater Cincinnati to determine usage of the program. We also conducted a multimodal user survey with 161 txt4health users recruited through the program to understand participant perceptions of program satisfaction, participant use, and self-reported perceptions of behavior change. Preliminary results from the retrospective records analysis reveal that across both pilots, 5,570 participants initiated enrollment in txt4health, of which 33% completed the two-step enrollment process. Once enrolled, the majority of participants set a weight loss goal (74%), and tracked their weight (89%) and physical activity (65%) at least once during the program; however 56% dropped out before the end of the program, with 70% of dropouts occurring before the end of the fourth week. Among program completers, rates of weekly weight tracking were low with 22% of participants logging weekly weights at least five times, yet rates of weekly physical activity tracker were greater with 49% logging weekly physical activity at least five times. Despite high attrition across the pilots, surveyed txt4health users report high levels of program satisfaction, with 67% reporting satisfaction scores of eight or higher on a ten point scale (10 0most satisfied; M 08.2, SD 01.6). The majority of participants report that txt4health helped them make lifestyle and behavior changes related to diet and physical activity. While broadly focused public health text message interventions may have a great reach, individual engagement among participants widely varies, suggesting that this type of approach may not be appropriate for all, but is a feasible and acceptable delivery modality for a large subset of people.

African Americans are disproportionately more susceptible to Hypertension (HTN) than non-Hispanic Whites, which is a leading cause of cardiovascular disease. Poor adherence to prescribed medication regimens is a major contributor to HTN, as only about half of patients are adherent. Moreover, while the majority of HTN treatment is delivered in primary care settings, a sizable proportion of care is provided in the emergency department (ED), particularly within low income communities. Short Message Service (SMS) text messaging may offer a simple, non-labor intensive strategy for improving medication adherence among African Americans in both primary care and ED settings, as text message use within this population is widely integrated into everyday life, even among the lowest income levels. The goal of this evaluation is to determine intervention efficacy, as well as to establish the feasibility and acceptability of using an automated SMS intervention to improve medication adherence in African Americans with uncontrolled HTN in these settings.We recently launched two randomized controlled trials (RCTs) of uncontrolled hypertensive African Americans in Detroit, MI; one with participants from primary care clinics, and one with participants from an ED. The primary outcome measure is change in medication adherence from baseline to one-month follow-up. Secondary outcome measures include changes in blood pressure and medication self-efficacy, participant satisfaction and acceptability, and feasibility of use in our target population. We have currently enrolled 9 participants in the primary care RCT and 7 participants in the ED RCT (target n=70 in each RCT) and preliminary evaluation results are forthcoming. Although the evaluation is ongoing, several lessons regarding the conduct of mHealth research within limited resource settings have been learned including overcoming recruitment and enrollment barriers, challenges associated with utilizing SMS-based interventions with low-income targeted mobile phone carriers, and strategies for retaining participants from baseline to one-month follow-up.