Combining Wireless Technology and Behavioral Economics to Engage Patients (WiBEEP) with cardiometabolic disease: a pilot study

Abstract

BackgroundThe long-term management of cardiometabolic diseases, such as type 2 diabetes and hypertension, is complex and can be facilitated by supporting patient-directed behavioral changes. The concurrent application of wireless technology and personalized text messages (PTMs) based on behavioral economics in managing cardiometabolic diseases, although promising, has not been studied. The aim of this pilot study was to evaluate the feasibility and acceptability of the concurrent application of wireless home blood pressure (BP) monitoring (as an example of “automated hovering”) and PTMs (as an example of “nudging”) targeting pharmacotherapy and lifestyle habits in patients with cardiometabolic disease (type 2 diabetes and/or hypertension).MethodsThe Wireless Technology and Behavioral Economics to Engage Patients (WiBEEP) with cardiometabolic disease study was a single-arm, open-label, 7-week-long pilot study in 12 patients (mean age 58.5 years) with access to a mobile phone. The study took place at Tufts Medical Center (Boston, MA) between March and September 2017. All patients received PTMs; nine patients received wireless home BP monitoring. At baseline, patients completed questionnaires to learn about their health goals and to assess medication adherence; at the end of week 7, all patients completed questionnaires to evaluate the feasibility and acceptability of the intervention and assess medication adherence. Hemoglobin A1c was ascertained from data collected during routine clinical care in 7 patients with available data.ResultsThe majority of patients reported the text messages to be easy to understand (88%) and appropriate in frequency (71%) and language (88%). All patients reported BP monitoring to be useful. Mean arterial pressure was lower at the end-of-study compared to baseline (− 3.4 mmHg [95% CI, − 5 to − 1.8]. Mean change in hemoglobin A1c was − 0.31% [95% CI, − 0.56 to − 0.06].ConclusionsAmong patients with cardiometabolic disease, the combination of wireless BP monitoring and lifestyle-focused text messaging was feasible and acceptable. Larger studies will determine the long-term effectiveness of such an approach.

Influence of Connected Health Interventions for Adherence to Cardiovascular Disease Prevention: A Scoping Review

“…Another study 19 evaluated the feasibility and acceptability of the simultaneous application of wireless home blood pressure monitoring (as an example of "nudging") and approaches targeting pharmacological treatment and lifestyle habits in patients with cardiometabolic disease (type 2 diabetes and/or hypertension). The patients with cardiometabolic disease studied reported that lifestyle-targeting text messaging approaches were feasible and acceptable, and that the text messages were easy to understand (88%) and were sent at an Connected Health Interventions to Cardiovascular Disease Prevention Agher et al 549 appropriate frequency (71%), in appropriate language (88%).…”

“…The patients with cardiometabolic disease studied reported that lifestyle-targeting text messaging approaches were feasible and acceptable, and that the text messages were easy to understand (88%) and were sent at an Connected Health Interventions to Cardiovascular Disease Prevention Agher et al 549 appropriate frequency (71%), in appropriate language (88%). Most of the studies used "smartphone health applications (connect)" [8][9][10][11][12]15,16,19,20,22,[24][25][26][27] . "Focus group" (do) and "Education" (read) were used together in two articles.…”

“…Based on the two sets of proposed annotations, we defined categories with their own sets of possible values, to determine the final characteristics for the annotation process. We extracted 10 characteristics from six articles 9,11,18,19,25,26 and identified variables with a colored mark if they applied to the article in question ►Supplementary Table S4 (available in the online version) for the study characteristics. We focus here on the description of health interventions in cardiovascular risk prevention.…”

<p>Moving the Dial on Heart Failure Patient Adherence Rates</p>

“…This pilot study tested the effects of a combined intervention on 12 patients with type 2 diabetes and/or hypertension. 75 Patients were provided with wireless home blood pressure (BP) monitors and motivational text messages and advice for seven weeks. Mean blood pressure, medication adherence, and satisfaction with the program all increased at the end of the study.…”

Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011–2021

“…Alternatively, mobile health technologies (mHealth) are health-related applications on mobile phones or other “smart devices” (e.g., apps, specialty websites, or smartwatches) and can include appointment and medication reminders through text messages. 7 Health care professionals may choose to implement a combination of telehealth strategies to manage CVD and its risk factors and supplement services through text messaging (e.g., medication reminders or lifestyle coaching), 8 synchronous teleconferencing or videoconferencing with pharmacists and other health care professionals, 9–16 and interactive voice response (IVR) systems. 17…”