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Young adults (18 to 39 years old) with hypertension have the lowest rates of blood pressure control (defined as blood pressure less than 140/90 mmHg) compared to other adult age groups. Approximately 1 in 15 young adults have high blood pressure, increasing their risk of future heart attack, stroke, congestive heart failure, and/or chronic kidney disease. Many young adults reported having few resources to address their needs for health education on managing cardiovascular risk.
The goal of our study was to develop and disseminate a website with evidence-based, clinical information and health behavior resources tailored to young adults with hypertension.
In collaboration with young adults, health systems, and community stakeholders, the My Hypertension Education and Reaching Target (MyHEART) website was created. A toolkit was also developed for clinicians and healthcare systems to disseminate the website within their organizations. The dissemination plan was guided by the Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ).
Google Analytics data were acquired for January 1, 2017 to June 29, 2017. The MyHEART website received 1090 visits with 2130 page views; 18.99% (207/1090) were returning visitors. The majority (55.96%, 610/1090) approached the website through organic searches, 34.95% (381/1090) accessed the MyHEART website directly, and 5.96% (65/1090) approached through referrals from other sites. There was a spike in site visits around times of increased efforts to disseminate the website.
The successfully implemented MyHEART website and toolkit reflect collaborative input from community and healthcare stakeholders to provide evidence-based, portable hypertension education to a hard-to-reach population. The MyHEART website and toolkit can support healthcare providers’ education and counseling with young adults and organizations’ hypertension population health goals.
Uncontrolled hypertension among young adults (18 to 39 year-olds) [
To further understand barriers to young adults achieving hypertension control, we engaged racially and ethnically diverse young adults in 6 focus groups and conducted one-on-one interviews with primary care providers [
Prior studies demonstrated that when patients with hypertension receive health education targeted to their needs, their self-management of hypertension improves (eg, behavior changes, home blood pressure monitoring) [
The aims of MyHEART are to (1) decrease barriers to young adult hypertension care delivery; and (2) improve hypertension control in this hard to reach population. It is known that website education alone is insufficient for long-term health behavior change; however, it can be effective as an additional component to ongoing hypertension control initiatives [
Prior studies [
Our stakeholders consisted of 38 young adult patients with a mean age of 26.7 (SD 9.6) years old and were 34% (13/38) male, 45% (17/38) Black, and 42% (16/38) with 1 or more years of college [
We built the website in partnership with the University of Wisconsin Health Innovation Program (HIP) using the Drupal 7 Content Management Framework (TurnKey Linux). Based on stakeholder input, the MyHEART website has the following 3 main categories (
The website’s architectural structure was cyclically evaluated by the lay advisory group (CARDS), information technology specialists, and clinical content experts (ie, physicians, nurses) using established categories: internal reliability, external security, content usefulness, navigation usability, and system interface attractiveness [
A toolkit was developed for the MyHEART website to assist clinicians and healthcare systems with incorporating the website in clinical practice and community outreach. The toolkit provides customizable materials and Web and social media communication drafts to share the website with members of their organization (
The Dissemination Planning Tool of the Agency for Healthcare Research and Quality (AHRQ) [
Additional dissemination avenues included clinician notifications, academic and healthcare marketing teams, university/campus health centers, research communities, and public community announcement boards (eg, grocery stores, coffee shops, etc). Regional dissemination efforts include the Wisconsin Collaborative for Healthcare Quality (WCHQ). This is a voluntary consortium of 37 Wisconsin healthcare organizations (physician groups, hospitals, health plans) that has led the nation in measuring and improving healthcare quality for multiple chronic conditions [
Google Analytics data were acquired for January 1, 2017 to June 29, 2017. In this time, the MyHEART website received a total of 1090 visits, with an average of 1.95 pages/session (range 1 to 7 pages/session for 95% of users). The number of site visits were in line with our expectations during this implementation period. Among the site visitors, 81.01% (883/1090) were new visitors (
Among new users, the bounce rate was 77%, while the bounce rate among returning users was 49%. Most users spent a short time on the site (0 to 10 seconds), but the time among the remaining users was approximately evenly distributed between 11 and 1800 seconds. The page with the largest number of views among new users was “What do the blood pressure numbers mean?” (eg, understanding blood pressure values). Interestingly, among new users who accessed that page, the majority (89.8%, 495/551 of page views) accessed the page by conducting an organic search; new users spent an average of 2 minutes and 32 seconds on this page. Across all viewers, the most viewed content was the “What do the blood pressure numbers mean?” (55.41%, 604/1090 views), followed by the MyHEART website home page (47.06%, 513/1090 views). The spike in website visits noted during February and May 2017 (
Percentage of new versus returning visitors to the MyHEART website from January 1, 2017 to June 29, 2017 (N=1090).
Number of visitors per day to the MyHEART website from January 1, 2017 to June 29, 2017.
The MyHEART website and corresponding toolkit were successfully developed with diverse young adult, community, and academic stakeholders. The website can provide young adults with evidence-based hypertension information to support their self-management goals. The corresponding toolkit can support clinicians’ efforts to share knowledge about hypertension with young adults and offer counseling about behavior change. The authors successfully engaged clinical staff and their patients across healthcare systems and are actively working to engage young adults in the community (with limited healthcare access). The MyHEART website’s accessibility on mobile platforms helps target the young adult population. However, the authors are learning how to increase the duration of engagement of young adults on the website. For example, an interactive functionality is in development with the goal of increasing the length of time young adults use the website and acquire hypertension information.
We recognize that the website and toolkit were created in English, limiting access to young adults and clinicians who are not fluent in English. However, our team plans to make these materials available in Spanish. The website also currently lacks interactivity, but we plan to add this in the near future. Finally, we did not conduct a comparative analysis with other technology or programs. We are continuing to expand our dissemination activities and will develop multidimensional interventions in the future.
In collaboration with young adults, health systems, and community stakeholders, the MyHEART young adult website is a portable resource to provide evidence-based information to a hard-to-reach population. The MyHEART website and toolkit provide resources for patients, clinicians, and healthcare organizations to improve hypertension control in young adults
Selected screenshots of the MyHEART website.
Sample of detailed notes from CARDS Lay Advisory Group meeting on MyHEART's architectural structure.
Examples of promotional materials for healthcare providers in the MyHEART toolkit.
American Heart Association
Agency for Healthcare Research and Quality
Community Advisors on Research Design and Strategies
Centers for Disease Control
Health Innovation Program
Institutional Review Board
My Hypertension Education and Reaching Target
National Institutes of Health
Wisconsin Collaborative for Healthcare Quality
Wisconsin Network for Research Support
The project was supported by the Clinical and Translational Science Award (CTSA) program, previously through the National Center for Research Resources (NCRR) [grant number 1UL1RR025011], and now by the National Center for Advancing Translational Sciences (NCATS) [grant number UL1TR000427]. Heather M. Johnson is supported by the National Heart, Lung, and Blood Institute of the NIH [grant number K23HL112907]. Additional support was provided by the UW School of Medicine and Public Health from The Wisconsin Partnership Program.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. None of the sponsors had a role in study design, in the collection, analysis or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
HJ and JL conceptualized and designed the study. HJ, JL, CB, RW, LZ, RH, KS, and DL were responsible for the acquisition of data, analysis and interpretation of data, drafting the manuscript, revising the manuscript critically for important intellectual content, and final approval of the version to be submitted. The authors greatly appreciate the time and continued dedication of the CARDS lay advisory group who provided the foundation for the MyHEART website. We are also grateful for the staff and students at the University of Wisconsin HIP who provided assistance with proofreading the website.
None declared.