Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives

Abstract

African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p < 0.0001) indicating significant reductions in resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the SMASH group vs. the standard care (SC) control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003). Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.

Too Important to Ignore: Leveraging Digital Technology to Improve Chronic Illness Management Among Black Men (Preprint)

“…One of mHealth's strengths is its ability to leverage the existing mobile technology infrastructure and the ubiquity of the mobile phone across populations and sub-groups. Previous research has corroborated the high prevalence of smartphone usage among Blacks as well as Hispanics and indicated the value of mHealth in managing chronic illness [11].…”

“…Electronic or digital health encompasses a wide range of technologies that are used for healthcare, health informatics, health education, and health promotion; and Mobile health (mHealth)-the application of wireless technology to promote wellness and information provision between healthcare and individuals-is rapidly gaining attention in both preventive medicine and chronic illness management [11]. One of mHealth's strengths is its ability to leverage the existing mobile technology infrastructure and the ubiquity of the mobile phone across populations and sub-groups.…”

Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction (Preprint)

“…The publication year of the studies ranged from 2012 to 2017 (see Table 1). Most studies (n=11) were conducted in the US [24][25][26][27][28][29][30][31][32] and Canada [33,34], while seven were carried out in European countries, including France [35], Sweden [36][37][38], Spain [39,40] and Italy [41]. The remaining three studies were conducted in China [42,43] and South Korea [44. Nine studies were randomised controlled trials (RCTs) [24,25,27,28,30,[33][34][35]42], ten were nonrandomised studies [26,29,31,32,37,[39][40][41]43,44], and two were qualitative studies [36,38].…”

“…Participants' average age ranged from 42.4 years [27] to 69.5 [42] years. The population groups of the studies included individuals with hypertension [24][25][26][27][28][29][30]32,[36][37][38][39][41][42][43][44], metabolic syndrome risk factors [34], and obstructive sleep apnoea with high cardiovascular risk [35], as well as overweight individuals [31]. Of the 21 included studies, 5 reported to have used behavioural theories, such as selfdetermination theory [24,26,27], motivational interviewing [30] and theory of planned behaviour [43] to underpin and guide the intervention methods and/or the development of the technology.…”

“…The other 11 studies mainly involved clinicians or other HCPs remotely monitoring patient data and health status [24][25][26][27][28][30][31][32][39][40][41], whilst the remaining study involved the researcher remotely monitoring patient data and alerting physicians if needed [34,36]. In these 11 studies involving HCPs, the HCPs provided feedback, including a medication plan or adjustments [24][25][26][27]39,41], regular online coaching consultation [31] instructions [28,30] or communication with patients [40,42]. …”