TY - JOUR AU - Decambron, Mélanie AU - Tchikladze Merand, Christine PY - 2025/4/22 TI - Telemedicine Booths for Screening Cardiovascular Risk Factors: Prospective Multicenter Study JO - JMIR Hum Factors SP - e57032 VL - 12 KW - cardiovascular disease risk factors KW - cardiovascular disease KW - CVD KW - cardiology KW - cardiac KW - cardiologists KW - health check KW - hypertension KW - HTN KW - hypertensive KW - high blood pressure KW - blood pressure KW - obesity KW - screening KW - health screening KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - COVID-19 KW - SARS-CoV-2 KW - Coronavirus KW - respiratory KW - infectious KW - pulmonary KW - pandemic N2 - Background: Cardiovascular risk factors such as hypertension often remain undetected and untreated. This was particularly problematic during the COVID-19 pandemic when there were fewer in-person medical consultations. Objective: This study aimed to determine whether health screening using a telemedicine booth would have an impact on people?s medical care during the COVID-19 pandemic. Methods: Health screening was run using a telemedicine booth (the consult station) that was placed in three different vaccination centers in northern France between July 2021 and September 2021. Participants followed a series of instructions to obtain various measures, including their blood pressure, BMI, and heart rate. If any measures were found to be outside of the normal range, participants were advised to consult a doctor. After 3 months, the participants with abnormal readings were contacted by telephone and were asked a series of standardized questions. The primary outcome was the percentage of respondents who reported that they had consulted a doctor since the health check. Results: Approximately 6000 people attended the 3 vaccination centers over the study period. Of these, around 2500 used the consult station. A total of 1333 participants (53.3%) were found to have abnormal readings, which mostly concerned their blood pressure, heart rate, or BMI. There were 638 participants who responded to the follow-up call, and 234 of these (37%) reported that they had consulted a doctor since the health check. However, 158 of the 638 respondents (24.8%) reported that they would have consulted a doctor even without the screening. Conclusions: We succeeded in screening large numbers of people for cardiovascular risk factors during the COVID-19 pandemic by using a telemedicine booth. Although relatively few follow-up call respondents reported that they went on to consult a physician, the screening would nevertheless have raised people?s awareness of their cardiovascular risk factors. UR - https://humanfactors.jmir.org/2025/1/e57032 UR - http://dx.doi.org/10.2196/57032 ID - info:doi/10.2196/57032 ER - TY - JOUR AU - Wang, Yi AU - Tyagi, Shilpa AU - Ng, Liang David Wei AU - Teo, Ying Valerie Hui AU - Kok, David AU - Foo, Dennis AU - Koh, Choon-Huat Gerald PY - 2025/4/15 TI - Primary Technology-Enhanced Care for Hypertension Scaling Program: Trial-Based Economic Evaluation Examining Effectiveness and Cost-Effectiveness Using Real-World Data in Singapore JO - J Med Internet Res SP - e59275 VL - 27 KW - telehealth monitoring KW - hypertension KW - cost-effectiveness analysis KW - real-world data KW - Singapore KW - telehealth KW - cost-effectiveness KW - blood pressure monitoring KW - health care KW - teleconsultation KW - chatbot KW - regression analysis KW - medical cost N2 - Background: Telehealth interventions are effective in hypertension management. However, the cost-effectiveness of using them for managing patients with hypertension remains inconclusive. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting. Objective: The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) scaling program, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The program comprises remote blood pressure (BP) monitoring at home, health care team support through teleconsultations, and in-app support with a digital chatbot. This study aimed to evaluate the program?s effectiveness and cost-effectiveness. Methods: For patients under the PTEC-HT scaling program, BP readings over 6 months and 12 months, age, and gender were collected within the program. Health care use, health care cost, and patient ethnicity were extracted from the National Healthcare Group Polyclinics. For patients in the usual care group, demographic information, clinical data, health care use, and health care costs were extracted from the national claims records. Comparing the PTEC-HT scaling program with usual care, a trial-based economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effectiveness over time horizons of 6 months and 12 months. The health care system?s perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and the usual care group. Results: For the 6-month analysis, 427 patients were included in the PTEC-HT group, and 64,679 patients were included in the usual care group. For the 12-month analysis, 338 patients were included in the PTEC-HT group, and 7324 patients were included in the usual care group. Using exact matching plus regression, in the 6-month analysis, the probability of having controlled BP was 13.5% (95% CI 6.3%-20.7%) higher for the PTEC-HT group compared to the usual care group. In the 12-month analysis, the probability of having controlled BP was 16% (95% CI 10.7%-21.3%) higher for the PTEC-HT group. Without considering the cost of the BP machine and program maintenance cost, the direct medical cost was S $57.7 (95% CI 54.4-61.0; a currency exchange rate of S $1=US $0.74 was applicable;) lower per patient for the PTEC-HT group in the 6-month analysis and S $170.9 (95% CI 151.9-189.9) lower per patient for the PTEC-HT group in the 12-month analysis. With the cost of the BP machine and program maintenance considered, compared to usual care, the PTEC-HT program reached breakeven at around the sixth month and saved S $52.6 (95% CI 33.6-71.6) per patient at the 12th month. Conclusions: Implemented in a real-world setting in Singapore, our study showed that the PTEC-HT scaling program is more effective in controlling BP status with lower cost compared to the usual care over 12 months. UR - https://www.jmir.org/2025/1/e59275 UR - http://dx.doi.org/10.2196/59275 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59275 ER - TY - JOUR AU - Matulis 3rd, Charles John AU - Greenwood, Jason AU - Eberle, Michele AU - Anderson, Benjamin AU - Blair, David AU - Chaudhry, Rajeev PY - 2025/4/11 TI - Implementation of an Integrated, Clinical Decision Support Tool at the Point of Antihypertensive Medication Refill Request to Improve Hypertension Management: Controlled Pre-Post Study JO - JMIR Med Inform SP - e70752 VL - 13 KW - clinical decision support systems KW - population health KW - hypertension KW - electronic health records N2 - Background: Improving processes regarding the management of electronic health record (EHR) requests for chronic antihypertensive medication renewals may represent an opportunity to enhance blood pressure (BP) management at the individual and population level. Objective: This study aimed to evaluate the effectiveness of the eRx HTN Chart Check, an integrated clinical decision support tool available at the point of antihypertensive medication refill request, in facilitating enhanced provider management of chronic hypertension. Methods: The study was conducted at two Mayo Clinic sites?Northwest Wisconsin Family Medicine and Rochester Community Internal Medicine practices?with control groups in comparable Mayo Clinic practices. The intervention integrated structured clinical data, including recent BP readings, laboratory results, and visit dates, into the electronic prescription renewal interface to facilitate prescriber decision-making regarding hypertension management. A difference-in-differences (DID) design compared pre- and postintervention hypertension control rates between the intervention and control groups. Data were collected from the Epic EHR system and analyzed using linear regression models. Results: The baseline BP control rates were slightly higher in intervention clinics. Postimplementation, no significant improvement in population-level hypertension control was observed (DID estimate: 0.07%, 95% CI ?4.0% to 4.1%; P=.97). Of the 19,968 refill requests processed, 46% met all monitoring criteria. However, clinician approval rates remained high (90%), indicating minimal impact on prescribing behavior. Conclusions: Despite successful implementation, the tool did not significantly improve hypertension control, possibly due to competing quality initiatives and high in-basket volumes. Future iterations should focus on enhanced integration with other decision support tools and strategies to improve clinician engagement and patient outcomes. Further research is needed to optimize chronic disease management through EHR-integrated decision support systems. UR - https://medinform.jmir.org/2025/1/e70752 UR - http://dx.doi.org/10.2196/70752 ID - info:doi/10.2196/70752 ER - TY - JOUR AU - Dorsch, P. Michael AU - Flynn, J. Allen AU - Greer, M. Kaitlyn AU - Ganai, Sabah AU - Barnes, D. Geoffrey AU - Zikmund-Fisher, Brian PY - 2025/4/11 TI - A Web-Based Tool to Perform a Values Clarification for Stroke Prevention in Patients With Atrial Fibrillation: Design and Preliminary Testing Study JO - JMIR Cardio SP - e67956 VL - 9 KW - digital health KW - atrial fibrillation KW - stroke prevention KW - shared decision-making KW - values clarification N2 - Background: Atrial fibrillation (AF) is associated with an increased risk of stroke. Oral anticoagulation (OAC) is used for stroke prevention in AF, but it also increases bleeding risk. Clinical guidelines do not definitively recommend for or against OAC for patients with borderline stroke risk. Decision-making may benefit from values clarification exercises to communicate risk trade-offs. Objective: This study aimed to evaluate if a visual with a values clarification alters the understanding of the trade-offs of anticoagulation in AF. Methods: Participants aged 45?64 years were recruited across the United States via an online survey. While answering the survey, they were asked to imagine they were newly diagnosed with AF with a CHA2DS2-VASc (congestive heart failure; hypertension; age ?75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) score of 1 for men and 2 for women. Eligibility criteria included no diagnosis of AF and no prior OAC use. Participants were randomized to one of three conditions: (1) standard text-based information only (n=255), (2) visual aids showing stroke-risk probabilities (n=218), or (3) visual aids plus a values clarification exercise (visual+VC; n=200). Participants were subrandomized within the 2 visual-based groups to view either a gauge display or an icon array representing stroke risk. All participants read a hypothetical scenario of being newly diagnosed with AF and hypertension. The primary outcome was decision confidence as measured by the SURE (Sure of Myself; Understand Information; Risk-Benefit Ratio; Encouragement) test. Secondary measures included participants? perceived stroke risk reduction, worry about stroke or bleeding, and likelihood to choose OAC. Results: A total of 673 participants completed the survey. The overall SURE test was 61.2% (156/255) for the standard, 66.5% (145/218) for the visual, and 67% (134/200) for the visual+VC group (visual vs standard P=.23; visual+VC vs standard P=.20). Participants were less likely to choose OAC in the visual groups (standard: mean 58.3, SD 30; visual: mean 51.4, SD 32; visual+VC: 51.9, SD 28; P=.03). Participants felt the reduction in stroke risk from an OAC was less in the visual groups (standard: mean 63.8, SD 22; visual: mean 54.2, SD 28; visual+VC: mean 58.6, SD 25; P<.001). Visualization methods (gauge vs icon array) showed no significant differences in overall SURE test results. Participants were less likely to choose OAC and perceived a smaller stroke risk reduction with gauge than icon array (OAC choice: gauge 48.8, icon array 55.4; P=.03; stroke risk reduction: gauge 52.1, icon array 60.4; P=.001). Conclusions: Visual aids can modestly affect decision confidence and perceptions regarding the benefits of OAC but do not significantly alter decision certainty in a scenario where the guidelines do not recommend for or against OAC. Future work should determine the role of a gauge versus icon array visual for decision-making in stroke prevention in AF. UR - https://cardio.jmir.org/2025/1/e67956 UR - http://dx.doi.org/10.2196/67956 ID - info:doi/10.2196/67956 ER - TY - JOUR AU - Clements, Frances AU - Vedam, Hima AU - Chung, Yewon AU - Smoleniec, John AU - Sullivan, Colin AU - Shanmugalingam, Renuka AU - Hennessy, Annemarie AU - Makris, Angela PY - 2025/4/11 TI - Effect of Continuous Positive Airway Pressure or Positional Therapy Compared to Control for Treatment of Obstructive Sleep Apnea on the Development of Gestational Diabetes Mellitus in Pregnancy: Protocol for Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e51434 VL - 14 KW - obstructive sleep apnoea KW - OSA KW - sleep disordered breathing KW - pregnancy KW - CPAP KW - positional therapy KW - gestational diabetes KW - GDM KW - preeclampsia KW - fetomaternal KW - maternal KW - pregnant KW - fetus KW - fetal KW - breathing KW - apnoea KW - sleep KW - respiratory KW - eclampsia KW - pregnant women KW - pregnancy complications KW - hypertension N2 - Background: Obstructive sleep apnea (OSA) is a common sleep disorder, and in pregnancy, it is associated with an increased risk of complications, including gestational diabetes mellitus and preeclampsia. Supine sleep may worsen OSA, and in pregnancy, it is associated with an increased risk of stillbirth due to effects on fetomaternal blood flow. Continuous positive airway pressure (CPAP) therapy is considered the gold-standard treatment for moderate to severe OSA, although compliance is frequently poor; positional therapy (PT) is generally less effective than CPAP in nonpregnant patients but may be better tolerated and more accessible during pregnancy. There is limited data on whether widespread, early screening for sleep disorders in pregnant women with symptoms of sleep-disordered breathing or at high risk of metabolic complications and subsequent early intervention with CPAP or PT attenuates fetomaternal risks. Objective: This study aims to determine the feasibility of conducting a randomized controlled trial to assess improved fetomaternal outcomes in a high-risk pregnant population with OSA, using CPAP or PT, initiated by the 16th week of gestation. Methods: This study is a randomized, controlled, open-label feasibility study in which pregnant women with an apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) ?5 are treated with CPAP (auto-titrating and fixed pressure) or positional therapy from early gestation (by 16 weeks) until delivery. The primary outcome is the feasibility of the study protocol and the development of gestational diabetes mellitus by the 28-week gestation period. Secondary outcomes include the development of hypertensive disorders of pregnancy (HDP), maternal weight gain, uterine artery blood flow, glycemic control during pregnancy (in participants who develop gestational diabetes), changes in maternal circulating biomarkers, and neonatal birthweight complications. Polysomnography at 28- to 32-week gestation period, postpartum polysomnography, therapy compliance, and patient acceptability are also assessed. Results: The trial commenced on September 30, 2019. The trial is ongoing as of August 6, 2024. Conclusions: The trial intends to contribute to the growing evidence base to support the need for the identification and treatment of OSA occurring during pregnancy and to assess the feasibility of the study protocol. This will be the first trial to compare the early initiation of CPAP (auto-titrating and fixed pressure) and positional therapy in pregnant women from early gestation, providing alternative therapies for the treatment of OSA in this important population. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001530112; https://tinyurl.com/yctdzs4u International Registered Report Identifier (IRRID): DERR1-10.2196/51434 UR - https://www.researchprotocols.org/2025/1/e51434 UR - http://dx.doi.org/10.2196/51434 UR - http://www.ncbi.nlm.nih.gov/pubmed/40215099 ID - info:doi/10.2196/51434 ER - TY - JOUR AU - Clapham, Eleanor AU - Picone, Dean AU - Carmichael, Samuel AU - Bonner, Carissa AU - Chapman, Niamh PY - 2025/4/3 TI - Appropriateness of Web-Based Resources for Home Blood Pressure Measurement and Their Alignment With Guideline Recommendations, Readability, and End User Involvement: Environmental Scan of Web-Based Resources JO - JMIR Infodemiology SP - e55248 VL - 5 KW - readability KW - online resources KW - blood pressure guidelines KW - end user KW - home blood pressure measurement KW - patient education KW - educational resource KW - self-education KW - hypertension N2 - Background: High blood pressure (?140/90 mm Hg) is the most prominent mortality risk factor worldwide. Home blood pressure measurement (HBPM) is recommended for blood pressure (BP) management. HBPM is most effective to improve BP management when delivered with patient education. It is unknown whether web-based resources are appropriate for patient education for HBPM. Patient education should provide accurate, evidence-based information, communicate at an eighth grade reading level, and involve end users in development to meet the needs of adults of all health literacy levels. Using these criteria, this study aimed to determine the appropriateness of web-based HBPM resources. Objective: This study aimed to determine whether web-based resources are appropriate for HBPM education based on three research questions: (1) Do web-based resources provide evidence-based information that aligns with guideline recommendations? (2) Do they communicate at an appropriate reading level? (3) Do they involve end users in their development? Methods: An environmental scan of web-based resources for HBPM was conducted on Google (October 2022) using search terms developed with consumers (n=6). Resources were included if they were identified on the first page of the search findings, not paywalled, and in English. Resource appropriateness was appraised based on three criteria: (1) alignment of resource content to 23 recommendations for HBPM from 6 international guidelines, (2) being at an appropriate grade reading level as determined by a health literacy assessment software, and (3) having evidence of end user involvement in resource development. Results: None of the identified resources (n=24) aligned with all 23 of the guideline recommendations. All resources aligned with the recommendation to measure BP when seated, while few aligned with the recommendation to use a validated BP device (n=9, 38%). All resources exceeded the recommended eighth grade reading level (mean 11.8, range 8.8-17.0) and none reported evidence of patient end user involvement in development. Conclusions: None of the web-based resources met the criteria for appropriate education to support adults to measure BP at home. Resources should be developed with end users using health literacy tools and multimodal communication methods to ensure they are appropriate to meet the needs of patients. UR - https://infodemiology.jmir.org/2025/1/e55248 UR - http://dx.doi.org/10.2196/55248 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55248 ER - TY - JOUR AU - May, Susann AU - Seifert, Frances AU - Bruch, Dunja AU - Heinze, Martin AU - Spethmann, Sebastian AU - Muehlensiepen, Felix PY - 2025/3/28 TI - Insights Into How mHealth Applications Could Be Introduced Into Standard Hypertension Care in Germany: Qualitative Study With German Cardiologists and General Practitioners JO - JMIR Mhealth Uhealth SP - e56666 VL - 13 KW - hypertension KW - mHealth apps KW - physicians KW - qualitative study KW - digitalization KW - app KW - application KW - Germany KW - blood pressure KW - cardiologists KW - thematic analysis KW - general practitioner KW - mobile phone N2 - Background: Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians? willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care. Objective: The aim of this study was to explore the relationship between physicians? information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines. Methods: We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps. Results: The analysis revealed significant variability in physicians? information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption. Conclusions: The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 UR - https://mhealth.jmir.org/2025/1/e56666 UR - http://dx.doi.org/10.2196/56666 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56666 ER - TY - JOUR AU - Wang, Naibo AU - Wang, Chen AU - Zhang, Puhong AU - Li, Yinghua AU - He, J. Feng AU - Li, Li AU - Li, Yuan AU - Luo, Rong AU - Wan, Dezhi AU - Xu, Lewei AU - Deng, Lifang AU - Wu, Lei PY - 2025/3/27 TI - Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up JO - J Med Internet Res SP - e60092 VL - 27 KW - school-based health education KW - EduSaltS KW - mobile health KW - salt reduction KW - cluster randomized trial N2 - Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)? and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention?s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren?s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were ?0.24 g/day (95% CI ?0.82 to 0.33), ?0.68 mm Hg (95% CI ?2.32 to 0.95), and ?1.37 mm Hg (95% CI ?2.79 to 0.06), respectively. For adults, the intervention group?s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were ?1.06 g/day (95% CI ?1.81 to ?0.30), ?2.26 mm Hg (95% CI ?4.26 to ?0.26), and ?2.33 mm Hg (95% CI ?3.84 to ?0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 UR - https://www.jmir.org/2025/1/e60092 UR - http://dx.doi.org/10.2196/60092 UR - http://www.ncbi.nlm.nih.gov/pubmed/40017342 ID - info:doi/10.2196/60092 ER - TY - JOUR AU - Wright, D. Kathy AU - Richards Adams, K. Ingrid AU - Helsabeck, P. Nathan AU - Rose, M. Karen AU - Moss, O. Karen AU - Nemati, Donya AU - Palmer, Navia AU - Kim, Bohyun AU - Pokhrel Bhattarai, Sunita AU - Nguyen, Christopher AU - Addison, Daniel AU - Klatt, D. Maryanna PY - 2025/3/27 TI - Stress and Hypertension Among African American Female Family Caregivers of Persons Living With Alzheimer Disease and Related Dementias: Protocol for a Pilot Internet-Based Randomized Controlled Trial JO - JMIR Res Protoc SP - e66975 VL - 14 KW - African American women KW - high blood pressure KW - stress reactivity and resilience KW - caregiving KW - hypertension KW - stress KW - Alzheimer disease KW - dementia KW - lifestyle and healthy self-care behaviors N2 - Background: Caregivers of persons with Alzheimer disease and related dementias (ADRD) neglect their health, including by ignoring stress levels. African American women are vulnerable and susceptible to hypertension. Chronic caregiving stress and hypertension place them at high risk for cardiovascular disease. Addressing stress reactivity or resilience is vital in lessening their caregiving stress, enhancing their quality of life (QOL), and fostering healthy blood pressure (BP) self-care behaviors. Objective: This pilot study aims to investigate the feasibility and acceptability of implementing the Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH) intervention in this population and to evaluate its effect on ADRD caregivers? stress and QOL. Additionally, it explores the mediation of stress reactivity or resilience between interventions and self-care behaviors. Methods: A small randomized controlled trial pilot study will recruit 28 African American or Black female caregivers aged 40 years diagnosed with hypertension and on an antihypertensive medication. Participants will be randomly assigned to either the MIM DASH or the Alzheimer?s Association caregiver training group (attention control). Trained facilitators will deliver both interventions over 8 weeks through 1-hour, group, internet-based sessions, via video or telephone. After completion, both groups will receive coaching calls over 9 months, beginning with 8 weekly calls followed by 4 monthly calls to encourage use of the educational materials. Primary outcome measures include feasibility (recruitment and retention) and acceptability (attendance). Secondary measures assess caregiver stress (Perceived Stress Scale), QOL, and self-care behaviors (Food Frequency Questionnaire and self-reported physical activity). Data collection occurs at baseline, 3 months, and 9 months. Quantitative data will be analyzed using descriptive statistics, CIs, and mediation models. Results: This study was approved by the institutional review board in April 2022 and funded in May 2022. The first data were collected in January 2023, and the last data were collected in September 2024. The completion of all aims? data analysis is anticipated in spring 2025. The participants? mean age was 62.4 (SD 7.98) years, with a mean baseline systolic BP of 128 (SD 19) mm Hg and diastolic BP of 79 (SD 10) mm Hg. Participants reported that MIM DASH was acceptable (at a mean score of 59.08, SD 7.38, compared to 60.83, SD 5.56 for caregiver training). Regarding feasibility, as reflected in attendance, MIM DASH participants had a mean attendance of 6.3 (SD 2.3) sessions, and the caregiver training group had 4.9 (SD 2.9) sessions. Conclusions: This study?s findings demonstrate the feasibility of conducting an internet-based intervention (MIM DASH) for African American women with hypertension who also care for families living with ADRD. These results will inform the design of a larger randomized controlled trial to evaluate the intervention?s efficacy and scalability further. Trial Registration: ClinicalTrials.gov NCT05721482; https://clinicaltrials.gov/study/NCT05721482 International Registered Report Identifier (IRRID): DERR1-10.2196/66975 UR - https://www.researchprotocols.org/2025/1/e66975 UR - http://dx.doi.org/10.2196/66975 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66975 ER - TY - JOUR AU - Wu, J. Jennifer AU - Graham, Ross AU - Çelebi, Julie AU - Fraser, Kevin AU - Gin, T. Geneen AU - Dang, Laurel AU - Hatamy, Esmatullah AU - Walker, Amanda AU - Barbato, Courtney AU - Lunde, Ottar AU - Coles, Lisa AU - Agnihotri, Parag AU - Morn, Cassandra AU - Tai-Seale, Ming PY - 2025/3/24 TI - Factors Influencing Primary Care Physicians? Intent to Refer Patients With Hypertension to a Digital Remote Blood Pressure Monitoring Program: Mixed Methods Study JO - J Med Internet Res SP - e64933 VL - 27 KW - digital health KW - primary care KW - electronic health records KW - referral KW - hypertension KW - remote monitoring KW - remote blood pressure KW - digital technology KW - mobile phone KW - mixed method KW - quantitative analysis KW - linear regression KW - clinical information N2 - Background: Primary care physicians? (PCP) referral rates to digital health programs are highly variable. This study explores whether knowledge of the digital remote blood pressure monitoring (RBPM) program and information on referral patterns influence PCPs? intention to refer patients. Objective: This study aims to examine the relationship between PCPs? knowledge of the digital RBPM program and information on their own prior referral rates versus their own with their peers? referral rates and their likelihood to refer patients to the digital RBPM program. Methods: This is a mixed methods study integrating quantitative analysis of electronic health record data regarding the frequency of PCPs? referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs? knowledge of the program and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient. They were randomized to either receive their own referral rate or their own plus their peers? referral rate. They were assessed on their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined participant characteristics and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31% (n=70) responded to the survey. From electronic health record data, the mean referral rate of patients per PCP was 11.80% (SD 13.30%). The mean self-reported knowledge of the digital health program was 6.47 (SD 1.81). The mean likelihood of referring an eligible patient (on a scale of 0 to 10, with 0 being not at all, and 10 being definitely) based on a vignette was 8.54 (SD 2.12). The own referral data group?s mean likelihood to refer was 8.91 (SD 1.28), whereas the own plus peer prior referral data group was 8.35 (SD 2.19). Regression analyses suggested the intention to refer the vignette patient was significantly associated with their knowledge (coefficient 0.46, 95% CI 0.20-0.73; P<.001), whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95% CI 0.46-0.78; P<.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95% CI ?0.43 to 0.89; P=.48). Conclusions: Physicians? intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, which was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program. UR - https://www.jmir.org/2025/1/e64933 UR - http://dx.doi.org/10.2196/64933 UR - http://www.ncbi.nlm.nih.gov/pubmed/40126550 ID - info:doi/10.2196/64933 ER - TY - JOUR AU - Cheng, Yinlin AU - Gu, Kuiying AU - Ji, Weidong AU - Hu, Zhensheng AU - Yang, Yining AU - Zhou, Yi PY - 2025/3/12 TI - Two-Year Hypertension Incidence Risk Prediction in Populations in the Desert Regions of Northwest China: Prospective Cohort Study JO - J Med Internet Res SP - e68442 VL - 27 KW - hypertension KW - desert KW - machine learning KW - deep learning KW - prevention KW - clinical applicability N2 - Background: Hypertension is a major global health issue and a significant modifiable risk factor for cardiovascular diseases, contributing to a substantial socioeconomic burden due to its high prevalence. In China, particularly among populations living near desert regions, hypertension is even more prevalent due to unique environmental and lifestyle conditions, exacerbating the disease burden in these areas, underscoring the urgent need for effective early detection and intervention strategies. Objective: This study aims to develop, calibrate, and prospectively validate a 2-year hypertension risk prediction model by using large-scale health examination data collected from populations residing in 4 regions surrounding the Taklamakan Desert of northwest China. Methods: We retrospectively analyzed the health examination data of 1,038,170 adults (2019-2021) and prospectively validated our findings in a separate cohort of 961,519 adults (2021-2023). Data included demographics, lifestyle factors, physical examinations, and laboratory measurements. Feature selection was performed using light gradient-boosting machine?based recursive feature elimination with cross-validation and Least Absolute Shrinkage and Selection Operator, yielding 24 key predictors. Multiple machine learning (logistic regression, random forest, extreme gradient boosting, light gradient-boosting machine) and deep learning (Feature Tokenizer + Transformer, SAINT) models were trained with Bayesian hyperparameter optimization. Results: Over a 2-year follow-up, 15.20% (157,766/1,038,170) of the participants in the retrospective cohort and 10.50% (101,077/961,519) in the prospective cohort developed hypertension. Among the models developed, the CatBoost model demonstrated the best performance, achieving area under the curve (AUC) values of 0.888 (95% CI 0.886-0.889) in the retrospective cohort and 0.803 (95% CI 0.801-0.804) in the prospective cohort. Calibration via isotonic regression improved the model?s probability estimates, with Brier scores of 0.090 (95% CI 0.089-0.091) and 0.102 (95% CI 0.101-0.103) in the internal validation and prospective cohorts, respectively. Participants were ranked by the positive predictive value calculated using the calibrated model and stratified into 4 risk categories (low, medium, high, and very high), with the very high group exhibiting a 41.08% (5741/13,975) hypertension incidence over 2 years. Age, BMI, and socioeconomic factors were identified as significant predictors of hypertension. Conclusions: Our machine learning model effectively predicted the 2-year risk of hypertension, making it particularly suitable for preventive health care management in high-risk populations residing in the desert regions of China. Our model exhibited excellent predictive performance and has potential for clinical application. A web-based application was developed based on our predictive model, which further enhanced the accessibility for clinical and public health use, aiding in reducing the burden of hypertension through timely prevention strategies. UR - https://www.jmir.org/2025/1/e68442 UR - http://dx.doi.org/10.2196/68442 UR - http://www.ncbi.nlm.nih.gov/pubmed/40072485 ID - info:doi/10.2196/68442 ER - TY - JOUR AU - May, Susann AU - Muehlensiepen, Felix AU - Wengemuth, Eileen AU - Seifert, Frances AU - Heinze, Martin AU - Bruch, Dunja AU - Spethmann, Sebastian PY - 2025/3/10 TI - Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals JO - JMIR Hum Factors SP - e52544 VL - 12 KW - hypertension KW - mHealth apps KW - digital health KW - physicians KW - nurses KW - HCP KW - qualitative interviews KW - health care professional KW - cardiologists KW - mHealth KW - Germany KW - general practitioners KW - blood pressure monitoring KW - qualitative study KW - qualitative content analysis N2 - Background: Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment. Objective: This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified. Methods: Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis. Results: The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges. Conclusions: In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 UR - https://humanfactors.jmir.org/2025/1/e52544 UR - http://dx.doi.org/10.2196/52544 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52544 ER - TY - JOUR AU - Clifford, Namuun AU - Tunis, Rachel AU - Ariyo, Adetimilehin AU - Yu, Haoxiang AU - Rhee, Hyekyun AU - Radhakrishnan, Kavita PY - 2025/2/10 TI - Trends and Gaps in Digital Precision Hypertension Management: Scoping Review JO - J Med Internet Res SP - e59841 VL - 27 KW - precision health KW - hypertension KW - digital health KW - prediction models KW - personalization KW - phenotyping KW - machine learning KW - algorithms KW - mobile apps KW - mobile health N2 - Background: Hypertension (HTN) is the leading cause of cardiovascular disease morbidity and mortality worldwide. Despite effective treatments, most people with HTN do not have their blood pressure under control. Precision health strategies emphasizing predictive, preventive, and personalized care through digital tools offer notable opportunities to optimize the management of HTN. Objective: This scoping review aimed to fill a research gap in understanding the current state of precision health research using digital tools for the management of HTN in adults. Methods: This study used a scoping review framework to systematically search for articles in 5 databases published between 2013 and 2023. The included articles were thematically analyzed based on their precision health focus: personalized interventions, prediction models, and phenotyping. Data were extracted and summarized for study and sample characteristics, precision health focus, digital health technology, disciplines involved, and characteristics of personalized interventions. Results: After screening 883 articles, 46 were included; most studies had a precision health focus on personalized digital interventions (34/46, 74%), followed by prediction models (8/46, 17%) and phenotyping (4/46, 9%). Most studies (38/46, 82%) were conducted in or used data from North America or Europe, and 63% (29/46) of the studies came exclusively from the medical and health sciences, with 33% (15/46) of studies involving 2 or more disciplines. The most commonly used digital technologies were mobile phones (33/46, 72%), blood pressure monitors (18/46, 39%), and machine learning algorithms (11/46, 24%). In total, 45% (21/46) of the studies either did not report race or ethnicity data (14/46, 30%) or partially reported this information (7/46, 15%). For personalized intervention studies, nearly half (14/30, 47%) used 2 or less types of data for personalization, with only 7% (2/30) of the studies using social determinants of health data and no studies using physical environment or digital literacy data. Personalization characteristics of studies varied, with 43% (13/30) of studies using fully automated personalization approaches, 33% (10/30) using human-driven personalization, and 23% (7/30) using a hybrid approach. Conclusions: This scoping review provides a comprehensive mapping of the literature on the current trends and gaps in digital precision health research for the management of HTN in adults. Personalized digital interventions were the primary focus of most studies; however, the review highlighted the need for more precise definitions of personalization and the integration of more diverse data sources to improve the tailoring of interventions and promotion of health equity. In addition, there were significant gaps in the reporting of race and ethnicity data of participants, underuse of wearable devices for passive data collection, and the need for greater interdisciplinary collaboration to advance precision health research in digital HTN management. Trial Registration: OSF Registries osf.io/yuzf8; https://osf.io/yuzf8 UR - https://www.jmir.org/2025/1/e59841 UR - http://dx.doi.org/10.2196/59841 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59841 ER - TY - JOUR AU - He, Jinyu AU - Li, Yanjun AU - Zeng, Huatang AU - Sun, Haoran AU - Wu, Liqun AU - Zhu, Zhenzhen AU - Zhang, Ning AU - Liang, Wannian PY - 2025/2/10 TI - Health Equity of Hypertension Management Between Local Residents and Internal Migrants in Shenzhen, China: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e65548 VL - 11 KW - health equity KW - hypertension management KW - immigrant population KW - hypertension KW - China KW - global health KW - public health KW - health disparities KW - medical record KW - community health care KW - native population KW - immigrant KW - socioeconomic KW - disease burden KW - well-being KW - chronic disease KW - community health center N2 - Background: With hypertension emerging as a global public health concern, taking measures to alleviate its burden is urgently needed. The hypertension management program (HMP) in China is a standardized policy to help people with hypertension to improve their health levels and reduce health inequalities. However, studies focusing on details regarding participation in this program remain scarce. Objective: This study aims to investigate the participation rates in HMPs in China and examine the health disparities in hypertension management between local residents and internal migrants in Shenzhen. Methods: This study used the medical record of Shenzhen, Guangdong, China. We included adults with new-onset diagnosis of hypertension after 2017 and focused on patients who have a record in the community health center. We described the basic characteristics of people diagnosed with hypertension, including age, gender, marital status, occupation, education level, and health insurance type. Enrolled rate, follow-up rate, and adherence rate were used to measure the engagement with this program at the city, district, and community levels. Results: Of the 1,160,214 hypertensive patients, 29.70% (344,526/1,160,214) were local residents, while 70.3% (815,688/1,160,214) were internal migrants. In addition, 55.36% (642,250/1,160,214) were enrolled in the HMP. Of those, 57.52% (369,439/642,25) were followed up. In addition, 62.59% (231,217/369,439) of followed up individuals were adherents. Internal migrants demonstrated a significantly higher participation in the HMP, especially for the enrolled rate (local residents: 156,085/344,526, 45.30% vs internal migrants: 486,165/815,688, 59.60%) and adherence rate (local residents: 44,044/84,635, 52.04% vs internal migrants: 187,173/284,804, 65.72%). Apart from that, local, single, and younger individuals had lower rates compared to their counterparts. There also existed within-district and within-community variation among enrolled, follow-up, and adherence rates. Conclusions: Based on our research, individuals with different demographic and socioeconomic characteristics and in different regions had different enrolled, follow-up, and adherence rates. Internal migrants in Shenzhen showed a significantly higher participation in the HMP. Given these findings, there exists the potential to enhance the outreach and engagement of local, single, and younger populations through targeted promotional strategies. UR - https://publichealth.jmir.org/2025/1/e65548 UR - http://dx.doi.org/10.2196/65548 ID - info:doi/10.2196/65548 ER - TY - JOUR AU - Wei, Feiran AU - Ge, You AU - Li, Han AU - Liu, Yuan PY - 2025/2/6 TI - Impact of the National Essential Public Health Service Package on Blood Pressure Control in Chinese People With Hypertension: Retrospective Population-Based Longitudinal Study JO - JMIR Public Health Surveill SP - e65783 VL - 11 KW - hypertension KW - primary care KW - public health KW - blood pressure control KW - cardiovascular disease N2 - Background: The National Essential Public Health Service Package (NEPHSP) was launched in 2009 to tackle poor blood pressure control in Chinese people with hypertension; however, it?s effect is still unclear. Objective: In a retrospective population-based longitudinal study, we aimed to evaluate effect of the NEPHSP on blood pressure control. Methods: A total of 516,777 patients registered in the NEPHSP were included. The blood pressure control data were assessed based on the Residence Health Record System dataset. We longitudinally evaluated the effects of the NEPHSP on blood pressure control by analyzing changes in blood pressure at quarterly follow-ups. Both the degree and trend of the blood pressure changes were analyzed. We conducted stratified analysis to explore effects of the NEPHSP on blood pressure control among subgroups of participants with specific characteristics. Results: The mean baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 147.12 (SD 19.88) mm Hg and 85.11 (SD 11.79) mm Hg, respectively. The control rates of baseline SBP and DBP were 39.79% (205,630/516,777) and 69.21% (357,685/516,777). Compared to baseline, the mean SBP decreased in each quarter by 5.06 mm Hg (95% CI ?5.11 to ?5.00; P<.001), 6.69 mm Hg (95% CI; ?6.74 to ?6.63; P<.001), 10.30 mm Hg (95% CI ?10.34 to ?10.23; P<.001), and 6.63 mm Hg (95% CI ?6.68 to ?6.57; P<.001). The SBP control rates increased in each quarter to 53.12% (274,493/516,777; ? coefficient=0.60, 95% CI 0.59-0.61; P<.001), 56.61% (292,537/516,777; ? coefficient=0.76, 95% CI 0.75-0.77; P<.001), 63.4% (327,648/516,777; ? coefficient=1.08, 95% CI 1.07-1.09; P<.001), and 55.09% (284,711/516,777; ? coefficient=0.69, 95% CI 0.68-0.70; P<.001). Compared to baseline, the mean DBP decreased in each quarter by 1.75 mm Hg (95% CI ?1.79 to ?1.72; P<.001), 2.64 mm Hg (95% CI ?2.68 to ?2.61; P<.001), 4.20 mm Hg (95% CI ?4.23 to ?4.16; P<.001), and 2.64 mm Hg (95% CI ?2.68 to ?2.61; P<.001). DBP control rates increased in each quarter to 78.11% (403,641/516,777; ? coefficient=0.52, 95% CI 0.51-0.53; P<.001), 80.32% (415,062/516,777; ? coefficient=0.67, 95% CI 0.66-0.68; P<.001), 83.17% (429,829/516,777; ? coefficient=0.89, 95% CI 0.88-0.90; P<.001), and 79.47% (410,662/516,777; ? coefficient=0.61, 95% CI 0.60-0.62; P<.001). The older age group had a larger decrease in their mean SBP (? coefficient=0.87, 95% CI 0.85-0.90; P<.001) and a larger increase in SBP control rates (? coefficient=0.054, 95% CI 0.051-0.058; P<.001). The participants with cardiovascular disease (CVD) had a smaller decrease in their mean SBP (? coefficient=?0.38, 95% CI ?0.41 to ?0.35; P<.001) and smaller increase in SBP control rates (? coefficient=?0.041, 95% CI ?0.045 to ?0.037; P<.001) compared to the blood pressure of participants without CVD. Conclusions: The NEPHSP was effective in improving blood pressure control of Chinese people with hypertension. Blood pressure control of older individuals and those with CVD need to be intensified. UR - https://publichealth.jmir.org/2025/1/e65783 UR - http://dx.doi.org/10.2196/65783 ID - info:doi/10.2196/65783 ER - TY - JOUR AU - Joshi, Ashish AU - Surapaneni, Mohan Krishna AU - Grover, Ashoo AU - Kaur, Harpreet AU - Saggu, Rani Sofia AU - Oliveira, Doilyn PY - 2025/2/6 TI - Swasthya Pahal (Health for All) Using a Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored Informatics Framework in Rural and Urban Areas of Chennai, Tamil Nadu: Protocol for a Quantitative Study JO - JMIR Res Protoc SP - e39950 VL - 14 KW - interventions KW - Swasthya Pahal KW - acceptance KW - health behavior KW - NCDs risks KW - self-management KW - healthcare KW - noncommunicable disease N2 - Background: Noncommunicable diseases (NCDs) require a longer period of care, for which health care systems must acquire technologically advanced solutions to enhance patient care. Swasthya Pahal (health for all) is an innovative, interactive, multilingual, stand-alone, internet-enabled computer-based program that aims to improve the self-management of NCDs. Objective: This study aims to enhance the self-management of chronic NCDs (diabetes, hypertension, high cholesterol, and obesity) by determining the usefulness, acceptance, and effectiveness of the Swasthya Pahal program in hospital and community settings in both rural and urban areas of Chennai, Tamil Nadu. This objective can be met by generating risk factor profiles of individuals enrolled and enhancing their self-management of NCDs using a portable health information kiosk that uses the Sustainable, Multisector, Accessible, Affordable, Reimbursable, and Tailored (SMAART) model. Methods: A quantitative study will be conducted on a convenient sample of 2800 individuals from selected hospital and community settings in rural (n=1400) and urban areas (n=1400) in Chennai, Tamil Nadu. Data will be collected on sociodemographics, health behaviors, and clinical status, as well as knowledge, attitudes, and practices. Objective assessments such as weight, blood pressure, and random blood sugar levels will be measured. In addition, the usefulness, acceptance, and effectiveness of the Swasthya Pahal program will be determined. Results: Results will be summarized using descriptive analysis. Appropriate bivariate and multivariate regression analysis will be performed to determine the predictors of the outcome variables of usefulness, acceptance, and effectiveness of Swasthya Pahal in wider settings. All analyses will be performed using SAS (version 9.1; SAS Institute), and the results will be reported as 95% CI values and P<.05. Conclusions: The study proposes to enhance the self-management of NCDs in both rural and urban community settings through the implementation of the Swasthya Pahal program based on the SMAART informatics framework. The study aims to understand the implementation, acceptability, and usability of Swasthya Pahal among a diverse sample of people in urban and rural settings. International Registered Report Identifier (IRRID): PRR1-10.2196/39950 UR - https://www.researchprotocols.org/2025/1/e39950 UR - http://dx.doi.org/10.2196/39950 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/39950 ER - TY - JOUR AU - Gong, Ke AU - Chen, Yifan AU - Song, Xinyue AU - Fu, Zhizhong AU - Ding, Xiaorong PY - 2025/1/23 TI - Causal Inference for Hypertension Prediction With Wearable Electrocardiogram and Photoplethysmogram Signals: Feasibility Study JO - JMIR Cardio SP - e60238 VL - 9 KW - hypertension KW - causal inference KW - wearable physiological signals KW - electrocardiogram KW - photoplethysmogram N2 - Background: Hypertension is a leading cause of cardiovascular disease and premature death worldwide, and it puts a heavy burden on the health care system. Therefore, it is very important to detect and evaluate hypertension and related cardiovascular events to enable early prevention, detection, and management. Hypertension can be detected in a timely manner with cardiac signals, such as through an electrocardiogram (ECG) and photoplethysmogram (PPG), which can be observed via wearable sensors. Most previous studies predicted hypertension from ECG and PPG signals with extracted features that are correlated with hypertension. However, correlation is sometimes unreliable and may be affected by confounding factors. Objective: The aim of this study was to investigate the feasibility of predicting the risk of hypertension by exploring features that are causally related to hypertension via causal inference methods. Additionally, we paid special attention to and verified the reliability and effectiveness of causality compared to correlation. Methods: We used a large public dataset from the Aurora Project, which was conducted by Microsoft Research. The dataset included diverse individuals who were balanced in terms of gender, age, and the condition of hypertension, with their ECG and PPG signals simultaneously acquired with wrist-worn wearable devices. We first extracted 205 features from the ECG and PPG signals, calculated 6 statistical metrics for these 205 features, and selected some valuable features out of the 205 features under each statistical metric. Then, 6 causal graphs of the selected features for each kind of statistical metric and hypertension were constructed with the equivalent greedy search algorithm. We further fused the 6 causal graphs into 1 causal graph and identified features that were causally related to hypertension from the causal graph. Finally, we used these features to detect hypertension via machine learning algorithms. Results: We validated the proposed method on 405 subjects. We identified 24 causal features that were associated with hypertension. The causal features could detect hypertension with an accuracy of 89%, precision of 92%, and recall of 82%, which outperformed detection with correlation features (accuracy of 85%, precision of 88%, and recall of 77%). Conclusions: The results indicated that the causal inference?based approach can potentially clarify the mechanism of hypertension detection with noninvasive signals and effectively detect hypertension. It also revealed that causality can be more reliable and effective than correlation for hypertension detection and other application scenarios. UR - https://cardio.jmir.org/2025/1/e60238 UR - http://dx.doi.org/10.2196/60238 ID - info:doi/10.2196/60238 ER - TY - JOUR AU - Kirkham, M. Aidan AU - Fergusson, A. Dean AU - Presseau, Justin AU - McIsaac, I. Daniel AU - Shorr, Risa AU - Roberts, J. Derek PY - 2025/1/16 TI - Strategies to Improve Health Care Provider Prescription of and Patient Adherence to Guideline-Recommended Cardiovascular Medications for Atherosclerotic Occlusive Disease: Protocol for Two Systematic Reviews and Meta-Analyses of Randomized Controlled Trials JO - JMIR Res Protoc SP - e60326 VL - 14 KW - coronary artery disease KW - cerebrovascular disease KW - peripheral artery disease KW - polyvascular disease KW - underprescription KW - nonadherence KW - implementation strategy KW - adherence-supporting strategy KW - statins KW - antiplatelets KW - antihypertensives KW - guideline-recommended medications KW - implementation KW - atherosclerosis KW - patient adherence KW - RCT KW - randomized controlled trials KW - PRISMA N2 - Background: In patients with atherosclerotic occlusive diseases, systematic reviews and meta-analyses of randomized controlled trials (RCTs) report that antiplatelets, statins, and antihypertensives reduce the risk of major adverse cardiac events, need for revascularization procedures, mortality, and health care resource use. However, evidence suggests that these patients are not prescribed these medications adequately or do not adhere to them once prescribed. Objective: We aim to systematically review and meta-analyze RCTs examining the effectiveness of implementation or adherence-supporting strategies for improving health care provider prescription of, or patient adherence to, guideline-recommended cardiovascular medications in patients with atherosclerotic occlusive disease. Methods: We designed and reported the protocol according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols) statement. We will search MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL from their inception. RCTs examining implementation or adherence-supporting strategies for improving prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with cerebrovascular disease, coronary artery disease, peripheral artery disease, or polyvascular disease (>1 of these diseases) will be included. Two investigators will independently review identified titles/abstracts and full-text studies, extract data, assess the risk of bias (using the Cochrane tool), and classify implementation or adherence-supporting strategies using the refined Cochrane Effective Practice and Organization of Care (EPOC) taxonomy (for strategies aimed at improving prescription) and Behavior Change Wheel (BCW; for adherence-supporting strategies). We will narratively synthesize data describing which implementation or adherence-supporting strategies have been evaluated across RCTs, and their reported effectiveness at improving prescription of, or adherence to, guideline-recommended cardiovascular medications (primary outcomes) and patient-important outcomes and health care resource use (secondary outcomes) within refined EPOC taxonomy levels and BCW interventions and policies. Where limited clinical heterogeneity exists between RCTs, estimates describing the effectiveness of implementation or adherence-supporting strategies within different refined EPOC taxonomy levels and BCW interventions and policies will be pooled using random-effects models. Stratified meta-analyses and meta-regressions will assess if strategy effectiveness varies by recruited patient populations, prescriber types, clinical practice settings, and study design characteristics. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will be used to communicate evidence certainty. Results: The search was completed on June 6, 2023. Database searches and the PubMed ?related articles? feature identified 4319 unique citations for title/abstract screening. We are currently screening titles/abstracts. Conclusions: These studies will identify which implementation and adherence-supporting strategies are being used (and in which combinations) across RCTs for improving the prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with atherosclerotic occlusive diseases. They will also determine the effectiveness of currently trialed implementation and adherence-supporting strategies, and whether effectiveness varies by patient, prescriber, or clinical practice setting traits. Trial Registration: PROSPERO CRD42023461317; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461317; PROSPERO CRD42023461299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461299 UR - https://www.researchprotocols.org/2025/1/e60326 UR - http://dx.doi.org/10.2196/60326 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60326 ER - TY - JOUR AU - Sakairi, Mizuki AU - Miyagami, Taiju AU - Tabata, Hiroki AU - Yanagisawa, Naotake AU - Saita, Mizue AU - Suzuki, Mai AU - Fujibayashi, Kazutoshi AU - Fukuda, Hiroshi AU - Naito, Toshio PY - 2025/1/9 TI - Efficacy of Unsupervised YouTube Dance Exercise for Patients With Hypertension: Randomized Controlled Trial JO - JMIR Cardio SP - e65981 VL - 9 KW - dance KW - video KW - exercise therapy KW - hypertension KW - blood pressure therapy KW - YouTube KW - mHealth N2 - Background: High blood pressure (BP) is linked to unhealthy lifestyles, and its treatment includes medications and exercise therapy. Many previous studies have evaluated the effects of exercise on BP improvement; however, exercise requires securing a location, time, and staff, which can be challenging in clinical settings. The antihypertensive effects of dance exercise for patients with hypertension have already been verified, and it has been found that adherence and dropout rates are better compared to other forms of exercise. If the burden of providing dance instruction is reduced, dance exercise will become a highly useful intervention for hypertension treatment. Objective: This study aims to investigate the effects of regular exercise therapy using dance videos on the BP of patients with hypertension, with the goal of providing a reference for prescribing exercise therapy that is highly feasible in clinical settings. Methods: This nonblind, double-arm, randomized controlled trial was conducted at Juntendo University, Tokyo, from April to December 2023. A total of 40 patients with hypertension were randomly assigned to either an intervention group (dance) or a control group (self-selected exercise), with each group comprising 20 participants. The intervention group performed daily dance exercises using street dance videos (10 min per video) uploaded to YouTube. The control group was instructed to choose any exercise other than dance and perform it for 10 minutes each day. The activity levels of the participants were monitored using a triaxial accelerometer. BP and body composition were measured on the day of participation and after 2 months. During the intervention period, we did not provide exercise instruction or supervise participants? activities. Results: A total of 34 patients were included in the study (16 in the intervention group and 18 in the control group). The exclusion criteria were the absence of BP data, medication changes, or withdrawal from the study. The mean age was 56 (SD 9.8) years, and 18 (53%) of the patients were female. The mean BMI was 28.0 (SD 6.3) m/kg2, and systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 139.5 (SD 17.1) mm Hg and 85.8 (SD 9.1) mm Hg, respectively. The basic characteristics did not differ between the two groups. In the multivariate analysis, SBP and DBP improved significantly in the intervention group compared to the control group (mean SBP ?12.8, SD 6.1 mm Hg; P=.047; mean DBP ?9.7, SD 3.3 mm Hg; P=.006). Conclusions: This study evaluated the effects of dance exercise on patients with hypertension, as previously verified, under the additional condition of using dance videos without direct staff instruction or supervision. The results showed that dance videos were more effective in lowering BP than conventional exercise prescriptions. Trial Registration: University Hospital Medical Information Network UMIN 000051251; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058446 UR - https://cardio.jmir.org/2025/1/e65981 UR - http://dx.doi.org/10.2196/65981 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65981 ER - TY - JOUR AU - Borrowman, D. Jaclyn AU - Carr, J. Lucas AU - Pierce, L. Gary AU - Story, T. William AU - Gibbs, Barone Bethany AU - Whitaker, M. Kara PY - 2025/1/8 TI - Postpartum Remote Health Coaching Intervention for Individuals With a Hypertensive Disorder of Pregnancy: Proof-of-Concept Study JO - JMIR Form Res SP - e65611 VL - 9 KW - cardiovascular disease KW - postpartum KW - hypertensive disorders of pregnancy KW - intervention KW - physical activity intervention KW - proof-of-concept KW - cardiovascular health KW - CVD risk KW - cardiovascular disease risk KW - feasibility KW - acceptability KW - health coaching KW - women's health KW - postnatal N2 - Background: Cardiovascular disease (CVD) is the leading cause of death among women in America. Hypertensive disorders of pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16% of all pregnancies affected. With CVD 2?4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Objective: With postpartum physical activity (PA) interventions after HDP as an underexplored preventative strategy, we aimed in this study to assess (1) the feasibility and acceptability of a remotely delivered PA intervention for individuals with HDP 3?6 months postpartum and (2) changes in average steps per day, skills related to PA behavior, and postpartum blood pressure (BP). Methods: A remotely delivered 14-week health coaching intervention was designed based on prior formative work. The health coaching intervention called the Hypertensive Disorders of Pregnancy Postpartum Exercise (HyPE) intervention was tested for feasibility and acceptability with a single-arm proof-of-concept study design. A total of 19 women who were 3?6 months postpartum HDP; currently inactive; 18 years of age or older; resided in Iowa; and without diabetes, kidney disease, and CVD were enrolled. Feasibility was assessed by the number of sessions attended and acceptability by self-reported satisfaction with the program. Changes in steps achieved per day were measured with an activPAL4 micro, PA behavior skills via validated surveys online, and BP was assessed remotely with a research-grade Omron Series 5 (Omron Corporation) BP monitor. Results: Participants at enrollment were on average 30.3 years of age, 4.1 months postpartum, self-identified as non-Hispanic White (14/17, 82%), in a committed relationship (16/17, 94%), and had a bachelor?s degree (9/17, 53%). A total of 140 of 152 possible health coaching sessions were attended by those who started the intervention (n=19, 92%). Intervention completers (n=17) indicated they were satisfied with the program (n=17, 100%) and would recommend it to others (n=17, 100%). No significant changes in activPAL measured steps were observed from pre- to posttesting (mean 138.40, SD 129.40 steps/day; P=.75). Significant improvements were observed in PA behavior skills including planning (mean 5.35, SD 4.97 vs mean 15.06, SD 3.09; P<.001) and monitoring of PA levels (mean 7.29, SD 3.44 vs mean 13.00, SD 2.45; P<.001). No significant decreases were observed for systolic (mean ?1.28, SD 3.59 mm Hg; Hedges g=?0.26; P=.16) and diastolic BP (mean ?1.80, SD 5.03 mm Hg; Hedges g=?0.44; P=.12). Conclusions: While PA behaviors did not change, the intervention was found to be feasible and acceptable among this sample of at-risk women. After additional refinement, the intervention should be retested among a larger, more diverse, and less physically active sample. Trial Registration: ClinicalTrials.gov NCT06019715; https://clinicaltrials.gov/study/NCT06019715 UR - https://formative.jmir.org/2025/1/e65611 UR - http://dx.doi.org/10.2196/65611 ID - info:doi/10.2196/65611 ER - TY - JOUR AU - Lolak, Sermkiat AU - Attia, John AU - McKay, J. Gareth AU - Thakkinstian, Ammarin PY - 2025/1/8 TI - Application of Dragonnet and Conformal Inference for Estimating Individualized Treatment Effects for Personalized Stroke Prevention: Retrospective Cohort Study JO - JMIR Cardio SP - e50627 VL - 9 KW - stroke KW - causal effect KW - ITE KW - individual treatment effect KW - Dragonnet KW - conformal inference KW - mortality KW - hospital records KW - hypertension KW - risk factor KW - diabetes KW - dyslipidemia KW - atrial fibrillation KW - machine learning KW - treatment N2 - Background: Stroke is a major cause of death and disability worldwide. Identifying individuals who would benefit most from preventative interventions, such as antiplatelet therapy, is critical for personalized stroke prevention. However, traditional methods for estimating treatment effects often focus on the average effect across a population and do not account for individual variations in risk and treatment response. Objective: This study aimed to estimate the individualized treatment effects (ITEs) for stroke prevention using a novel combination of Dragonnet, a causal neural network, and conformal inference. The study also aimed to determine and validate the causal effects of known stroke risk factors?hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), and atrial fibrillation (AF)?using both a conventional causal model and machine learning models. Methods: A retrospective cohort study was conducted using data from 275,247 high-risk patients treated at Ramathibodi Hospital, Thailand, between 2010 and 2020. Patients aged >18 years with HT, DM, DLP, or AF were eligible. The main outcome was ischemic or hemorrhagic stroke, identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Causal effects of the risk factors were estimated using a range of methods, including: (1) propensity score?based methods, such as stratified propensity scores, inverse probability weighting, and doubly robust estimation; (2) structural causal models; (3) double machine learning; and (4) Dragonnet, a causal neural network, which was used together with weighted split-conformal quantile regression to estimate ITEs. Results: AF, HT, and DM were identified as significant stroke risk factors. Average causal risk effect estimates for these risk factors ranged from 0.075 to 0.097 for AF, 0.017 to 0.025 for HT, and 0.006 to 0.010 for DM, depending on the method used. Dragonnet yielded causal risk ratios of 4.56 for AF, 2.44 for HT, and 1.41 for DM, which is comparable to other causal models and the standard epidemiological case-control study. Mean ITE analysis indicated that several patients with DM or DM with HT, who were not receiving antiplatelet treatment at the time of data collection, showed reductions in total risk of ?0.015 and ?0.016, respectively. Conclusions: This study provides a comprehensive evaluation of stroke risk factors and demonstrates the feasibility of using Dragonnet and conformal inference to estimate ITEs of antiplatelet therapy for stroke prevention. The mean ITE analysis suggested that those with DM or DM with HT, who were not receiving antiplatelet treatment at the time of data collection, could potentially benefit from this therapy. The findings highlight the potential of these advanced techniques to inform personalized treatment strategies for stroke, enabling clinicians to identify individuals who are most likely to benefit from specific interventions. UR - https://cardio.jmir.org/2025/1/e50627 UR - http://dx.doi.org/10.2196/50627 ID - info:doi/10.2196/50627 ER - TY - JOUR AU - Qin, Chenlong AU - Peng, Li AU - Liu, Yun AU - Zhang, Xiaoliang AU - Miao, Shumei AU - Wei, Zhiyuan AU - Feng, Wei AU - Zhang, Hongjian AU - Wan, Cheng AU - Yu, Yun AU - Lu, Shan AU - Huang, Ruochen AU - Zhang, Xin PY - 2024/12/30 TI - Development and Validation of a Nomogram-Based Model to Predict Primary Hypertension Within the Next Year in Children and Adolescents: Retrospective Cohort Study JO - J Med Internet Res SP - e58686 VL - 26 KW - independent risk factors KW - prediction model KW - primary hypertension KW - clinical applicability KW - development KW - validation KW - pediatrics KW - electronic health records N2 - Background: Primary hypertension (PH) poses significant risks to children and adolescents. Few prediction models for the risk of PH in children and adolescents currently exist, posing a challenge for doctors in making informed clinical decisions. Objective: This study aimed to investigate the incidence and risk factors of PH in Chinese children and adolescents. It also aimed to establish and validate a nomogram-based model for predicting the next year?s PH risk. Methods: A training cohort (n=3938, between January 1, 2008, and December 31, 2020) and a validation cohort (n=1269, between January 1, 2021, and July 1, 2023) were established for model training and validation. An independent cohort of 576 individuals was established for external validation of the model. The result of the least absolute shrinkage and selection operator regression technique was used to select the optimal predictive features, and multivariate logistic regression to construct the nomogram. The performance of the nomogram underwent assessment and validation through the area under the receiver operating characteristic curve, concordance index, calibration curves, decision curve analysis, clinical impact curves, and sensitivity analysis. Results: The PH risk factors that we have ultimately identified include gender (odds ratio [OR] 3.34, 95% CI 2.88 to 3.86; P<.001), age (OR 1.11, 95% CI 1.08 to 1.14; P<.001), family history of hypertension (OR 42.74, 95% CI 23.07 to 79.19; P<.001), fasting blood glucose (OR 6.07, 95% CI 4.74 to 7.78; P<.001), low-density lipoprotein cholesterol (OR 2.03, 95% CI 1.60 to 2.57; P<.001), and uric acid (OR 1.01, 95% CI 1.01 to 1.01; P<.001), while factor breastfeeding (OR 0.04, 95% CI 0.03 to 0.05; P<.001) has been identified as a protective factor. Subsequently, a nomogram has been constructed incorporating these factors. Areas under the receiver operating characteristic curves of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.790 in the external validation cohort. Concordance indexes of the nomogram were 0.892 in the training cohort, 0.808 in the validation cohort, and 0.790 in the external validation cohort. The nomogram has been proven to have good clinical benefits and stability in calibration curves, decision curve analysis, clinical impact curves, and sensitivity analysis. Finally, we observed noteworthy differences in uric acid levels and family history of hypertension among various subgroups, demonstrating a high correlation with PH. Moreover, the web-based calculator of the nomogram was built online. Conclusions: We have developed and validated a stable and reliable nomogram that can accurately predict PH risk within the next year among children and adolescents in primary care and offer effective and cost-efficient support for clinical decisions for the risk prediction of PH. UR - https://www.jmir.org/2024/1/e58686 UR - http://dx.doi.org/10.2196/58686 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58686 ER - TY - JOUR AU - Eze, E. Chinwe AU - Dorsch, P. Michael AU - Coe, B. Antoinette AU - Lester, A. Corey AU - Buis, R. Lorraine AU - Farris, B. Karen PY - 2024/12/23 TI - Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study JO - JMIR Form Res SP - e56954 VL - 8 KW - remote blood pressure monitoring KW - telemonitoring KW - hypertension KW - blood pressure KW - technology KW - health behaviors KW - quantitative KW - cross-sectional study KW - United States KW - lack of awareness KW - health information KW - health provider KW - electronic communication channels KW - adult KW - aging KW - mobile phone N2 - Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ?18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6%). About one-third of participants were aware of RBPM (165/507, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3%) and their lack of awareness of RBPM (190/447, 42.5%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7%), and 61.7% (37/60) engage in daily BP measurement, compared with 62.6% (280/447) and 25.1% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7%) than those in the non-RBPM group (70/447, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35?150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95% CI 1.39?21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95% CI 1.62?47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers? recommendations, and tailoring RBPM services to patients? preferred electronic communication channels. UR - https://formative.jmir.org/2024/1/e56954 UR - http://dx.doi.org/10.2196/56954 ID - info:doi/10.2196/56954 ER - TY - JOUR AU - Foti, Kathryn AU - Hubbard, Demetria AU - Smith, A. Kimberly AU - Hearld, Larry AU - Richman, Joshua AU - Horton, Trudi AU - Parker, Sharon AU - Roughton, Dodey AU - Craft, Macie AU - Clarkson, A. Stephen AU - Jackson, A. Elizabeth AU - Cherrington, L. Andrea PY - 2024/12/20 TI - Improving Blood Pressure Control and Tobacco Use Cessation Intervention In Primary Care: Protocol for the Alabama Cardiovascular Cooperative Heart Health Improvement Project JO - JMIR Res Protoc SP - e63685 VL - 13 KW - hypertension KW - primary care KW - quality improvement KW - tobacco use KW - smoking cessation KW - healthcare quality KW - quality of care KW - risk modification KW - cardiovascular disease prevention N2 - Background: Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state and a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD outcomes and risk factors by race or ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes academic and community stakeholders, was formed to support primary care practices to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use screening. Objective: The study aimed to support primary care practices to increase BP control among adults with hypertension and increase rates of tobacco use screening and cessation intervention. Methods: We are using a type 1 hybrid design to test the effects of the HHIP on BP control among adults with hypertension and tobacco use screening and cessation intervention, while collecting information on implementation. Primary care practices were recruited through existing practice networks and additional electronic and in-person outreach. To ensure participation from a broad range of clinics, we required at least 50% of practices to be Federally Qualified Health Centers or look-alikes and to include representation from practices in rural areas. At baseline, we collected information about practice characteristics and preintervention rates of BP control and tobacco use screening and cessation intervention. The QI intervention includes quarterly activities conducted over a 12-month period. The HHIP uses a multipronged approach to QI, including practice facilitation and technical assistance, on-site and e-learning, and improvement through data transparency. We will conduct a pre-post analysis to estimate the effects of the HHIP and whether there is an enduring change in outcomes after the 12 months of HHIP activities beyond what would be expected due to secular trends. Results: Practice recruitment took place between April 2021 and October 2022. After contacting 417 primary care practices, 51 were enrolled, including 28 Federally Qualified Health Centers or look-alikes; 47 practices implemented the HHIP. Among 45 practices that completed the baseline survey, 11 (24%) were solo practices, while 28 (62%) had 1-5 clinicians, and 6 (13%) had 6 or more clinicians. The median number of patient visits per year was 5819 (IQR 3707.3-8630.5). Practices had been in operation for a mean of 19.2 (SD 13.0) years. At baseline, the mean BP control rate was 49.6% and the rate of tobacco use screening and cessation intervention was 67.4%. Conclusions: If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and, subsequently, cardiovascular health and health equity in the state of Alabama. International Registered Report Identifier (IRRID): DERR1-10.2196/63685 UR - https://www.researchprotocols.org/2024/1/e63685 UR - http://dx.doi.org/10.2196/63685 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63685 ER - TY - JOUR AU - Richardson, Leanne AU - Noori, Nihal AU - Fantham, Jack AU - Timlin, Gregor AU - Siddle, James AU - Godec, Thomas AU - Taylor, Mike AU - Baum, Charles PY - 2024/12/3 TI - Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e53430 VL - 12 KW - digital diary KW - hypertension KW - blood pressure KW - remote monitoring KW - smartphone app KW - mobile phone KW - app KW - monitoring KW - COVID-19 KW - SARS-CoV-2 KW - digital intervention KW - management KW - observational study KW - deployment KW - feasibility KW - use KW - safety KW - medication KW - symptoms KW - community KW - systolic KW - diastolic KW - utilization N2 - Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Results: Of the 389 participants who enrolled in and completed the study, 380 (98%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1%) of the 239 participants entered full BP routines into the digital app 80% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as ?excellent? for domains of perspicuity, efficiency, and dependability and ?above average? for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension. UR - https://mhealth.jmir.org/2024/1/e53430 UR - http://dx.doi.org/10.2196/53430 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53430 ER - TY - JOUR AU - Nong, Thu Trang Thi AU - Nguyen, Hoang Giang AU - Lepe, Alexander AU - Tran, Bich Thuy AU - Nguyen, Phuong Lan Thi AU - Koot, R. Jaap A. PY - 2024/12/2 TI - Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study JO - J Med Internet Res SP - e54127 VL - 26 KW - NCD screening KW - DHIS2 tracker KW - District Health Information Software, version 2 tracker KW - digital application KW - ISHC health volunteers KW - non-communicable diseases KW - prevention KW - Vietnam KW - mobile phone N2 - Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non?age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet?s display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. UR - https://www.jmir.org/2024/1/e54127 UR - http://dx.doi.org/10.2196/54127 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54127 ER - TY - JOUR AU - Matsumura, Koichiro AU - Nakagomi, Atsushi AU - Yagi, Eijiro AU - Yamada, Nobuhiro AU - Funauchi, Yohei AU - Kakehi, Kazuyoshi AU - Yoshida, Ayano AU - Kawamura, Takayuki AU - Ueno, Masafumi AU - Nakazawa, Gaku AU - Tabuchi, Takahiro PY - 2024/11/26 TI - Impact of an mHealth App (Kencom) on Patients With Untreated Hypertension Initiating Antihypertensive Medications: Real-World Cohort Study JO - JMIR Cardio SP - e52266 VL - 8 KW - untreated hypertension KW - mobile health app KW - antihypertensive medication KW - cardiovascular disease KW - mHealth N2 - Background: To prevent the further development of cardiovascular diseases, it is a growing global priority to detect untreated hypertension in patients and ensure adequate blood pressure control via drug therapy. However, few effective tools that facilitate the initiation of antihypertensive medications among such patients have been identified. Objective: We aimed to determine whether a mobile health (mHealth) app facilitates the initiation of antihypertensive medications among patients with untreated hypertension. Methods: We analyzed a large longitudinal integrated database mainly comprised of data from middle-aged, employed people and their families. The database contained data from health checkups, health insurance claims, and the mHealth app kencom. kencom is used to manage daily life logs (eg, weight, number of steps) and to provide health information tailored to customers. Patients with untreated hypertension were identified using the baseline health checkup data, and follow-up health checkups were conducted to identify the rate of initiation of antihypertensive medications between mHealth app users and nonusers. Antihypertensive medication status was confirmed via a questionnaire administered during the medical checkup as well as a review of the health insurance claims database. We conducted a modified Poisson regression analysis, weighted by inverse probability of treatment weighting, to examine the effect of mHealth app usage on the initiation of antihypertensive medications. Additionally, data from four lifestyle questionnaires from the baseline and follow-up health checkups were collected to evaluate lifestyle modifications that could be attributed to the mHealth app. Results: Data were collected from 50,803 eligible patients (mean age 49, SD 9 years; men n=39,412, 77.6%; women n=11,391, 22.4%) with a median follow-up period of 3.0 (IQR 2.3?3.1) years. The rate of initiation of antihypertensive medications was significantly higher in the mHealth app user group than in the nonuser group: 23.4% (3482/14,879) versus 18.5% (6646/35,924; P<.001), respectively. The risk ratio of mHealth app usage for initiated antihypertensive medications was 1.28 (95% CI 1.23?1.33). Among those who did not intend to improve their lifestyle habits such as exercise and diet at baseline, the rate of lifestyle improvement at follow-up was compared between mHealth app users and nonusers, using data from the questionnaires; mHealth app users demonstrated a significantly higher rate of lifestyle changes than nonusers. Conclusions: For patients with untreated hypertension, the use of the mHealth app kencom, which was not dedicated to hypertension treatment, was associated with a higher initiation of antihypertensive medications. UR - https://cardio.jmir.org/2024/1/e52266 UR - http://dx.doi.org/10.2196/52266 ID - info:doi/10.2196/52266 ER - TY - JOUR AU - Cavero-Redondo, Iván AU - Martinez-Rodrigo, Arturo AU - Saz-Lara, Alicia AU - Moreno-Herraiz, Nerea AU - Casado-Vicente, Veronica AU - Gomez-Sanchez, Leticia AU - Garcia-Ortiz, Luis AU - Gomez-Marcos, A. Manuel AU - PY - 2024/11/25 TI - Antihypertensive Drug Recommendations for Reducing Arterial Stiffness in Patients With Hypertension: Machine Learning?Based Multicohort (RIGIPREV) Study JO - J Med Internet Res SP - e54357 VL - 26 KW - antihypertensive KW - drugs KW - models KW - patients KW - pulse wave velocity KW - recommendations KW - hypertension KW - machine learning KW - drug recommendations KW - arterial stiffness KW - RIGIPREV N2 - Background: High systolic blood pressure is one of the leading global risk factors for mortality, contributing significantly to cardiovascular diseases. Despite advances in treatment, a large proportion of patients with hypertension do not achieve optimal blood pressure control. Arterial stiffness (AS), measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and overall mortality. Various antihypertensive drugs exhibit differential effects on PWV, but the extent to which these effects vary depending on individual patient characteristics is not well understood. Given the complexity of selecting the most appropriate antihypertensive medication for reducing PWV, machine learning (ML) techniques offer an opportunity to improve personalized treatment recommendations. Objective: This study aims to develop an ML model that provides personalized recommendations for antihypertensive medications aimed at reducing PWV. The model considers individual patient characteristics, such as demographic factors, clinical data, and cardiovascular measurements, to identify the most suitable antihypertensive agent for improving AS. Methods: This study, known as the RIGIPREV study, used data from the EVA, LOD-DIABETES, and EVIDENT studies involving individuals with hypertension with baseline and follow-up measurements. Antihypertensive drugs were grouped into classes such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), ?-blockers, diuretics, and combinations of diuretics with ACEIs or ARBs. The primary outcomes were carotid-femoral and brachial-ankle PWV, while the secondary outcomes included various cardiovascular, anthropometric, and biochemical parameters. A multioutput regressor using 6 random forest models was used to predict the impact of each antihypertensive class on PWV reduction. Model performance was evaluated using the coefficient of determination (R2) and mean squared error. Results: The random forest models exhibited strong predictive capabilities, with internal validation yielding R2 values between 0.61 and 0.74, while external validation showed a range of 0.26 to 0.46. The mean squared values ranged from 0.08 to 0.22 for internal validation and from 0.29 to 0.45 for external validation. Variable importance analysis revealed that glycated hemoglobin and weight were the most critical predictors for ACEIs, while carotid-femoral PWV and total cholesterol were key variables for ARBs. The decision tree model achieved an accuracy of 84.02% in identifying the most suitable antihypertensive drug based on individual patient characteristics. Furthermore, the system?s recommendations for ARBs matched 55.3% of patients? original prescriptions. Conclusions: This study demonstrates the utility of ML techniques in providing personalized treatment recommendations for antihypertensive therapy. By accounting for individual patient characteristics, the model improves the selection of drugs that control blood pressure and reduce AS. These findings could significantly aid clinicians in optimizing hypertension management and reducing cardiovascular risk. However, further studies with larger and more diverse populations are necessary to validate these results and extend the model?s applicability. UR - https://www.jmir.org/2024/1/e54357 UR - http://dx.doi.org/10.2196/54357 UR - http://www.ncbi.nlm.nih.gov/pubmed/39585738 ID - info:doi/10.2196/54357 ER - TY - JOUR AU - Zhang, Xiaoyun AU - Wang, Siyu AU - Yang, Qianqian AU - Zheng, Ruizhi AU - Wang, Long AU - Lin, Hong AU - Wang, Shuangyuan AU - Li, Mian AU - Wang, Tiange AU - Zhao, Zhiyun AU - Lu, Jieli AU - Xu, Min AU - Chen, Yuhong AU - Zheng, Jie AU - Dai, Meng AU - Zhang, Di AU - Wang, Weiqing AU - Ning, Guang AU - Bi, Yufang AU - Xu, Yu PY - 2024/11/20 TI - Sex Difference and Socioeconomic Inequity in Chinese People With Hypertension: National Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e63144 VL - 10 KW - sex difference KW - socioeconomic inequity KW - blood pressure KW - hypertension KW - cross-sectional survey N2 - Background: Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear. Objective: This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study. Methods: A total of 98,658 participants aged ?18 years who have lived in their current residence for ?6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators. Results: Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men. Conclusions: There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension. UR - https://publichealth.jmir.org/2024/1/e63144 UR - http://dx.doi.org/10.2196/63144 ID - info:doi/10.2196/63144 ER - TY - JOUR AU - Alnooh, Ghadah AU - AlTamimi, Z. Jozaa AU - Williams, A. Elizabeth AU - Hawley, S. Mark PY - 2024/11/19 TI - An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study JO - JMIR Form Res SP - e60037 VL - 8 KW - hypertension KW - blood pressure KW - Dietary Approaches to Stop Hypertension KW - DASH diet KW - self-efficacy KW - mobile health KW - mHealth KW - Saudi Arabia KW - mobile phone N2 - Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals? and patients? preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app?s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. UR - https://formative.jmir.org/2024/1/e60037 UR - http://dx.doi.org/10.2196/60037 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60037 ER - TY - JOUR AU - Sattora, Emily AU - Teelin, Karen AU - Prendergast, Christopher AU - Smith, Abigail AU - Evans, James AU - Imdad, Aamer PY - 2024/11/12 TI - Clinical and Biochemical Outcomes in Transgender Individuals Undergoing Hormone Therapy: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e57931 VL - 13 KW - transgender KW - lipid levels KW - hormone therapy KW - biochemical outcomes KW - clinical outcomes KW - comprehensive data KW - systematic review KW - meta-analysis KW - adolescent KW - adults KW - electronic databases KW - testosterone KW - estrogen N2 - Background: Monitoring of various clinical outcomes and parameters, such as lipid levels, is recommended in transgender individuals undergoing hormone therapies. However, comprehensive data to inform these recommendations is scarce. Objective: This study aims to conduct a systematic review and meta-analysis to synthesize evidence from existing literature on the effect of exogenous hormone therapy on clinical and biochemical outcomes for transgender adolescents and adults. Methods: We will search multiple electronic databases and will include prospective and retrospective observational studies with and without a control group. The study population will include transgender individuals undergoing hormone therapy with testosterone or estrogen. Comparisons will include age-matched, cisgender individuals and changes from baseline. Primary outcomes include changes in or the development of abnormal lipid parameters. Secondary outcomes include BMI, weight, height, and blood pressure for age, serum testosterone or estrogen levels, and development of disease including hypertension, diabetes, fatty liver disease, obesity, adverse cardiac events, as well as all-cause mortality. The meta-analysis will pool the studies where applicable, and meta-regressions will be conducted to evaluate effect modifiers. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach will be used to evaluate the overall certainty of evidence. Results: We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. Data collection is ongoing, and the paper is expected to be published in Spring 2025. Conclusions: This systematic review will summarize and evaluate the evidence of the clinical and biochemical outcomes associated with hormone therapies for transgender individuals. Trial Registration: PROSPERO CRD42024483138; https://tinyurl.com/yc4sfvnb International Registered Report Identifier (IRRID): PRR1-10.2196/57931 UR - https://www.researchprotocols.org/2024/1/e57931 UR - http://dx.doi.org/10.2196/57931 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57931 ER - TY - JOUR AU - Hwang, Ha Seung AU - Lee, Hayeon AU - Lee, Hyuk Jun AU - Lee, Myeongcheol AU - Koyanagi, Ai AU - Smith, Lee AU - Rhee, Youl Sang AU - Yon, Keon Dong AU - Lee, Jinseok PY - 2024/11/5 TI - Machine Learning?Based Prediction for Incident Hypertension Based on Regular Health Checkup Data: Derivation and Validation in 2 Independent Nationwide Cohorts in South Korea and Japan JO - J Med Internet Res SP - e52794 VL - 26 KW - machine learning KW - hypertension KW - cardiovascular disease KW - artificial intelligence KW - cause of death KW - cardiovascular risk KW - predictive analytics N2 - Background: Worldwide, cardiovascular diseases are the primary cause of death, with hypertension as a key contributor. In 2019, cardiovascular diseases led to 17.9 million deaths, predicted to reach 23 million by 2030. Objective: This study presents a new method to predict hypertension using demographic data, using 6 machine learning models for enhanced reliability and applicability. The goal is to harness artificial intelligence for early and accurate hypertension diagnosis across diverse populations. Methods: Data from 2 national cohort studies, National Health Insurance Service-National Sample Cohort (South Korea, n=244,814), conducted between 2002 and 2013 were used to train and test machine learning models designed to anticipate incident hypertension within 5 years of a health checkup involving those aged ?20 years, and Japanese Medical Data Center cohort (Japan, n=1,296,649) were used for extra validation. An ensemble from 6 diverse machine learning models was used to identify the 5 most salient features contributing to hypertension by presenting a feature importance analysis to confirm the contribution of each future. Results: The Adaptive Boosting and logistic regression ensemble showed superior balanced accuracy (0.812, sensitivity 0.806, specificity 0.818, and area under the receiver operating characteristic curve 0.901). The 5 key hypertension indicators were age, diastolic blood pressure, BMI, systolic blood pressure, and fasting blood glucose. The Japanese Medical Data Center cohort dataset (extra validation set) corroborated these findings (balanced accuracy 0.741 and area under the receiver operating characteristic curve 0.824). The ensemble model was integrated into a public web portal for predicting hypertension onset based on health checkup data. Conclusions: Comparative evaluation of our machine learning models against classical statistical models across 2 distinct studies emphasized the former?s enhanced stability, generalizability, and reproducibility in predicting hypertension onset. UR - https://www.jmir.org/2024/1/e52794 UR - http://dx.doi.org/10.2196/52794 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52794 ER - TY - JOUR AU - Farapti, Farapti AU - Putri, Amara Sheila AU - Furqonia, Wulida Annisaa AU - Rejeki, Sri Purwo AU - Miftahussurur, Muhammad PY - 2024/10/29 TI - High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) for Blood Pressure Reduction in Older Adults: Protocol for Diet Concept and Randomized Controlled Trial JO - JMIR Res Protoc SP - e56869 VL - 13 KW - sodium KW - potassium KW - spices and herbs KW - blood pressure KW - hypertension KW - elderly KW - vascular KW - kidney KW - gerontology KW - aging KW - protocol study KW - dietary KW - phytochemical KW - anti-hypertensive KW - Indonesia KW - molecular mechanism KW - control group KW - oxidative stress N2 - Background: Hypertension increases with age, often due to high sodium (Na) and low potassium (K) intake. Reducing salt and increasing K intake is challenging, especially for older adults due to taste preferences. Culinary herbs and spices, rich in K, offer a potential solution. The High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) diet has not yet been studied for its effectiveness in lowering blood pressure. Objective: This study aims to create an HPSH-SS diet, analyze its effects on blood pressure in older adults, and study the molecular mechanism occurring in the kidneys and blood vessels influenced by this diet. Methods: This study consists of 2 phases. The first phase involved formulating and assessing the HPSH-SS diet tailored for older adults. The intervention group (IG) received a diet of 1800 kcal/day, with 3500 mg K and 1500 mg Na, while the control group (CG) received 1500 mg K and 2000 mg Na. The diet was administered for 14 days and standardized using the NutriSurvey program and biochemistry analysis by atomic absorbance spectrophotometry (AAS). The second phase was a 14-day parallel randomized controlled trial (RCT) with the older adult participants divided into IG and CG. Primary outcomes included blood pressure; serum potassium; aldosterone; F2 isoprostane; nitric oxide plasma levels; and urine analysis of Na, K, and the Na/K ratio. Confounding variables were controlled through randomization and stratified analysis. Results: The menu formulation and organoleptic assessment of the HPSH-SS diet began in mid-2022 and was approved by the Ethics Committee of the Faculty of Public Health at Universitas Airlangga (78/EA/KEPK/2022) on May 11, 2022. The diet was standardized to achieve daily nutritional values of 1800 kcal energy, 3500 mg K, and 1500 mg Na. K and Na contents were analyzed using AAS from several participants? spice diet menus. Recruitment for the RCT started in March 2023, with approval from the Health Research Ethics Committee Universitas Airlangga School of Medicine, Surabaya (35/EC/KEPK/FKUA/2023). The study was registered from February 9, 2023, to February 9, 2024. Between March and June 2023, 64 participants were recruited, with 32 participants in the IG and CG. The intervention and data collection will take place over 1 year. Data management is in progress, and data analysis is yet to be performed. Conclusions: This RCT protocol hypothesizes that the diet will increase serum K, plasma aldosterone, and nitric oxide levels; decrease plasma F2 isoprostane; increase urinary Na and K levels; lower the urinary Na/K ratio; and reduce systolic and diastolic blood pressure. If effective, it will offer valuable insights into dietary strategies for blood pressure regulation in older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/56869 UR - https://www.researchprotocols.org/2024/1/e56869 UR - http://dx.doi.org/10.2196/56869 UR - http://www.ncbi.nlm.nih.gov/pubmed/39470696 ID - info:doi/10.2196/56869 ER - TY - JOUR AU - Nguyen, Minh Hieu AU - Anderson, William AU - Chou, Shih-Hsiung AU - McWilliams, Andrew AU - Zhao, Jing AU - Pajewski, Nicholas AU - Taylor, Yhenneko PY - 2024/10/28 TI - Predictive Models for Sustained, Uncontrolled Hypertension and Hypertensive Crisis Based on Electronic Health Record Data: Algorithm Development and Validation JO - JMIR Med Inform SP - e58732 VL - 12 KW - machine learning KW - risk prediction KW - predictive model KW - decision support KW - blood pressure KW - cardiovascular KW - electronic health record N2 - Background: Assessing disease progression among patients with uncontrolled hypertension is important for identifying opportunities for intervention. Objective: We aim to develop and validate 2 models, one to predict sustained, uncontrolled hypertension (?2 blood pressure [BP] readings ?140/90 mm Hg or ?1 BP reading ?180/120 mm Hg) and one to predict hypertensive crisis (?1 BP reading ?180/120 mm Hg) within 1 year of an index visit (outpatient or ambulatory encounter in which an uncontrolled BP reading was recorded). Methods: Data from 142,897 patients with uncontrolled hypertension within Atrium Health Greater Charlotte in 2018 were used. Electronic health record?based predictors were based on the 1-year period before a patient?s index visit. The dataset was randomly split (80:20) into a training set and a validation set. In total, 4 machine learning frameworks were considered: L2-regularized logistic regression, multilayer perceptron, gradient boosting machines, and random forest. Model selection was performed with 10-fold cross-validation. The final models were assessed on discrimination (C-statistic), calibration (eg, integrated calibration index), and net benefit (with decision curve analysis). Additionally, internal-external cross-validation was performed at the county level to assess performance with new populations and summarized using random-effect meta-analyses. Results: In internal validation, the C-statistic and integrated calibration index were 0.72 (95% CI 0.71?0.72) and 0.015 (95% CI 0.012?0.020) for the sustained, uncontrolled hypertension model, and 0.81 (95% CI 0.79?0.82) and 0.009 (95% CI 0.007?0.011) for the hypertensive crisis model. The models had higher net benefit than the default policies (ie, treat-all and treat-none) across different decision thresholds. In internal-external cross-validation, the pooled performance was consistent with internal validation results; in particular, the pooled C-statistics were 0.70 (95% CI 0.69?0.71) and 0.79 (95% CI 0.78?0.81) for the sustained, uncontrolled hypertension model and hypertensive crisis model, respectively. Conclusions: An electronic health record?based model predicted hypertensive crisis reasonably well in internal and internal-external validations. The model can potentially be used to support population health surveillance and hypertension management. Further studies are needed to improve the ability to predict sustained, uncontrolled hypertension. UR - https://medinform.jmir.org/2024/1/e58732 UR - http://dx.doi.org/10.2196/58732 ID - info:doi/10.2196/58732 ER - TY - JOUR AU - Zhou, You AU - Li, Si-Jia AU - Huang, Ren-Qian AU - Ma, Hao-Ming AU - Wang, Ao-Qi AU - Tang, Xing-Yi AU - Pei, Run-Yuan AU - Piao, Mei-Hua PY - 2024/10/22 TI - Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e54978 VL - 26 KW - hypertension KW - mHealth KW - app KW - behavior change technique KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. Objective: We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. Methods: We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). Results: We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a ?5.78 mm Hg (95% CI ?7.97 mm Hg to ?3.59 mm Hg; P<.001) reduction in systolic BP and a ?3.28 mm Hg (95% CI ?4.39 mm Hg to ?2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: ?6.50 mm Hg, 95% CI ?9.00 mm Hg to ?3.99 mm Hg vs ?1.54 mm Hg, 95% CI ?4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: ?10.06 mm Hg, 95% CI ?16.42 mm Hg to ?3.70 mm Hg vs ?4.13 mm Hg, 95% CI ?5.50 to ?2.75 mm Hg; P=.07); intervention duration (3 vs ?6 months: ?8.87 mm Hg, 95% CI ?10.90 mm Hg to ?6.83 mm Hg vs ?5.76 mm Hg, 95% CI ?8.74 mm Hg to ?2.77 mm Hg; P=.09); and the number of BCTs (?11 vs <11 BCTs: ?9.68 mm Hg, 95% CI ?13.49 mm Hg to ?5.87 mm Hg vs ?2.88 mm Hg, 95% CI ?3.90 mm Hg to ?1.86 mm Hg; P<.001). Conclusions: The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study?s intervention design and BCT. UR - https://www.jmir.org/2024/1/e54978 UR - http://dx.doi.org/10.2196/54978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54978 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Bruch, Dunja AU - Seifert, Frances AU - Wengemuth, Eileen AU - Heinze, Martin AU - Spethmann, Sebastian AU - May, Susann PY - 2024/9/27 TI - mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users JO - JMIR Form Res SP - e56162 VL - 8 KW - hypertension KW - mobile health KW - mHealth apps KW - digital health KW - patient perspective KW - qualitative study KW - cardiology N2 - Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence. Objective: This study aimed to explore patient-users? perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany. Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis. Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users? hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it. Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s UR - https://formative.jmir.org/2024/1/e56162 UR - http://dx.doi.org/10.2196/56162 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56162 ER - TY - JOUR AU - Johar, Hamimatunnisa AU - Ang, Way Chiew AU - Ismail, Roshidi AU - Kassim, Zaid AU - Su, Tin Tin PY - 2024/9/26 TI - Changes in 10-Year Predicted Cardiovascular Disease Risk for a Multiethnic Semirural Population in South East Asia: Prospective Study JO - JMIR Public Health Surveill SP - e55261 VL - 10 KW - cardiovascular risk trajectory KW - Framingham risk score KW - population-based study KW - low- and middle-income countries N2 - Background: Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established. Objective: This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population. Methods: Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors. Results: Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92% female participants and n=2645, 40.08% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37% (n=2202) of the sample population, while 24.38% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44% (n=567) of male and 41.35% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1% (n=1193) male participants and 10.52% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories. Conclusions: Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized. UR - https://publichealth.jmir.org/2024/1/e55261 UR - http://dx.doi.org/10.2196/55261 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55261 ER - TY - JOUR AU - Kalinowski, Jolaade AU - Bhusal, Sandesh AU - Pagoto, L. Sherry AU - Newton Jr, Robert AU - Waring, E. Molly PY - 2024/9/9 TI - Smart Device Ownership and Use of Social Media, Wearable Trackers, and Health Apps Among Black Women With Hypertension in the United States: National Survey Study JO - JMIR Cardio SP - e59243 VL - 8 KW - Black women KW - Black KW - women KW - tracker KW - trackers KW - wearable KW - wearables KW - hypertension KW - hypertensive KW - cardiology KW - cardiovascular KW - blood pressure KW - social media KW - technology KW - usage KW - digital health KW - eHealth KW - tablet KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - Health Information National Trends Survey KW - HINTS UR - https://cardio.jmir.org/2024/1/e59243 UR - http://dx.doi.org/10.2196/59243 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59243 ER - TY - JOUR AU - Heinert, W. Sara AU - Guzman-Baez, Kelvin AU - Aamir, Affan AU - Penugonda, Ananya AU - Crabtree, F. Benjamin AU - Greene, Kathryn AU - Heckman, J. Carolyn AU - Levy, Phillip AU - Strickland, Ohman Pamela AU - Hudson, V. Shawna PY - 2024/9/6 TI - Developing a Youth-Led Digital Hypertension Education Intervention for Adults With Hypertension: Qualitative Study on Refinement and Acceptability JO - JMIR Form Res SP - e54909 VL - 8 KW - hypertension KW - adolescents KW - adults KW - emergency department KW - digital health intervention KW - dyad intervention KW - intervention development KW - qualitative research KW - youth KW - adolescent KW - teen KW - teens KW - teenager KW - teenagers KW - adult KW - youth-led KW - digital health KW - health education KW - refinement KW - acceptability KW - USA KW - United States KW - care navigation KW - effectiveness KW - formative study KW - prototype KW - self-guided KW - online module KW - online modules KW - engagement KW - blood pressure KW - health knowledge KW - health promotion KW - nutrition education KW - support intervention KW - support KW - supports N2 - Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge. Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control. Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members. Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention?s concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information. Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT. UR - https://formative.jmir.org/2024/1/e54909 UR - http://dx.doi.org/10.2196/54909 UR - http://www.ncbi.nlm.nih.gov/pubmed/39240662 ID - info:doi/10.2196/54909 ER - TY - JOUR AU - He, Yunfan AU - Chen, Han AU - Xiang, Peng AU - Zhao, Min AU - Li, Yingjun AU - Liu, Yongcheng AU - Wang, Tong AU - Liang, Jun AU - Lei, Jianbo PY - 2024/9/3 TI - Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process JO - J Med Internet Res SP - e60773 VL - 26 KW - hypertension management KW - mobile health KW - user satisfaction KW - evaluation indicator system KW - analytic hierarchy process N2 - Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5% (4/91) of the apps achieved a demand fulfillment rate exceeding 80% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. UR - https://www.jmir.org/2024/1/e60773 UR - http://dx.doi.org/10.2196/60773 UR - http://www.ncbi.nlm.nih.gov/pubmed/39226103 ID - info:doi/10.2196/60773 ER - TY - JOUR AU - Xiao, Han AU - Zhou, Zechen AU - Ma, Yujia AU - Li, Xiaoyi AU - Ding, Kexin AU - Dai, Xiaotong AU - Chen, Dafang PY - 2024/8/14 TI - Association of Wearable Device?Measured Step Volume and Variability With Blood Pressure in Older Chinese Adults: Mobile-Based Longitudinal Observational Study JO - J Med Internet Res SP - e50075 VL - 26 KW - older adults KW - physical activity KW - step volume KW - step variability KW - blood pressure KW - wearable devices KW - mHealth apps KW - mobile health apps KW - mobile phone N2 - Background: The paucity of evidence on longitudinal and consecutive recordings of physical activity (PA) and blood pressure (BP) under real-life conditions and their relationships is a vital research gap that needs to be addressed. Objective: This study aims to (1) investigate the short-term relationship between device-measured step volume and BP; (2) explore the joint effects of step volume and variability on BP; and (3) examine whether the association patterns between PA and BP varied across sex, hypertension status, and chronic condition status. Methods: This study used PA data of a prospective cohort of 3070 community-dwelling older adults derived from a mobile health app. Daily step counts, as a proxy of step volume, were derived from wearable devices between 2018 and 2022 and categorized into tertiles (low, medium, and high). Step variability was assessed using the SD of daily step counts. Consecutive daily step count recordings within 0 to 6 days preceding each BP measurement were analyzed. Generalized estimation equation models were used to estimate the individual and joint associations of daily step volume and variability with BP. Stratified analyses by sex, the presence of hypertension, and the number of morbidities were further conducted. Results: A total of 3070 participants, with a median age of 72 (IQR 67-77) years and 71.37% (2191/3070) women, were included. Participants walked a median of 7580 (IQR 4972-10,653) steps and 5523 (IQR 3590-7820) meters per day for a total of 592,597 person-days of PA monitoring. Our results showed that higher levels of daily step volume were associated with lower BP (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure). Compared with participants with low step volume (daily step counts <6000/d) and irregular steps, participants with high step volume (?9500/d) and regular steps showed the strongest decrease in systolic BP (?1.69 mm Hg, 95% CI ?2.2 to ?1.18), while participants with medium step volume (6000/d to <9500/d) and regular steps were associated with the lowest diastolic BP (?1.067 mm Hg, 95% CI ?1.379 to ?0.755). Subgroup analyses indicated generally greater effects on women, individuals with normal BP, and those with only 1 chronic disease, but the effect pattern was varied and heterogeneous between participants with different characteristics. Conclusions: Increased step volume demonstrated a substantial protective effect on BP among older adults with chronic conditions. Furthermore, the beneficial association between step volume and BP was enhanced by regular steps, suggesting potential synergistic protective effects of both increased step volume and step regularity. Targeting both step volume and variability through PA interventions may yield greater benefits in BP control, particularly among participants with hypertension and a higher chronic disease burden. UR - https://www.jmir.org/2024/1/e50075 UR - http://dx.doi.org/10.2196/50075 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50075 ER - TY - JOUR AU - Chen, Tingting AU - Zhao, Wenbo AU - Pei, Qianqian AU - Chen, Yanru AU - Yin, Jinmei AU - Zhang, Min AU - Wang, Cheng AU - Zheng, Jing PY - 2024/8/9 TI - Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e53355 VL - 12 KW - hemodialysis KW - hypertension KW - home blood pressure monitoring KW - eHealth KW - randomized controlled trial N2 - Background: Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. Objective: This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, 50.9% in the web-based HBPM group and n=81, 49.1% in the control group), 145 (87.9%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30% (25/84) to 48% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37% (30/81) to 25% (20/81; ?22=16.82, P<.001; odds ratio 5.11, 95% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; ?=?6.09, 95 % CI ?10.94 to ?1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; ?=?4.93, 95% CI ?7.93 to ?1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=?9.18, P<.001), HBPM Perception Scale (t163=?10.65, P<.001), and HBPM Adherence Scale (t163=?8.04, P<.001) were significantly higher after 6 months of intervention. Conclusions: The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings. Trial Registration: China Clinical Trial Registration Center ChiCTR2100051535; https://www.chictr.org.cn/showproj.html?proj=133286 UR - https://mhealth.jmir.org/2024/1/e53355 UR - http://dx.doi.org/10.2196/53355 ID - info:doi/10.2196/53355 ER - TY - JOUR AU - Kapoor, Melissa AU - Holman, Blair AU - Cohen, Carolyn PY - 2024/8/5 TI - Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study JO - JMIR Cardio SP - e57241 VL - 8 KW - remote photoplethysmography KW - vital signs KW - calibration-free blood pressure monitor KW - medical device KW - hypertension screening KW - home blood pressure monitoring KW - vital KW - vitals KW - device KW - devices KW - hypertension KW - hypertensive KW - cardiovascular KW - cardiology KW - heart KW - blood pressure KW - monitoring KW - monitor KW - mHealth KW - mobile health KW - validation N2 - Background: The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. Objective: This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. Methods: The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 ?Non-invasive Sphygmomanometers?Part 2: Clinical investigation of automated measurement type.? This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app?s BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app?s PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. Results: The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app?s mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. Conclusions: A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension. UR - https://cardio.jmir.org/2024/1/e57241 UR - http://dx.doi.org/10.2196/57241 UR - http://www.ncbi.nlm.nih.gov/pubmed/39102277 ID - info:doi/10.2196/57241 ER - TY - JOUR AU - Yuan, Lei AU - Jiang, Qinqin AU - Liu, Yuqing AU - Liu, Yijun AU - Du, Maolin AU - Sun, Jinhai AU - Li, Meina PY - 2024/8/1 TI - Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e52536 VL - 10 KW - depression KW - older KW - hypertension KW - Fairlie decomposition KW - China KW - older adult KW - elderly N2 - Background: Hypertension is the most prevalent chronic disease among China?s older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China?s older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ?7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ?10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ?100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ?10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution ?9.6%), and comorbidities (contribution ?22.9%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption. UR - https://publichealth.jmir.org/2024/1/e52536 UR - http://dx.doi.org/10.2196/52536 ID - info:doi/10.2196/52536 ER - TY - JOUR AU - Lee, Hyeri AU - Kim, Minji AU - Woo, Selin AU - Park, Jaeyu AU - Kim, Jin Hyeon AU - Kwon, Rosie AU - Koyanagi, Ai AU - Smith, Lee AU - Kim, Seo Min AU - López Sánchez, F. Guillermo AU - Dragioti, Elena AU - Lee, Jinseok AU - Lee, Hayeon AU - Rahmati, Masoud AU - Rhee, Youl Sang AU - Lee, Hyuk Jun AU - Woo, Geol Ho AU - Yon, Keon Dong PY - 2024/7/30 TI - National and Regional Trends in the Prevalence of Hypertension in South Korea Amid the Pandemic, 2009-2022: Nationwide Study of Over 3 Million Individuals JO - JMIR Public Health Surveill SP - e51891 VL - 10 KW - COVID-19 KW - pandemic KW - Korea KW - hypertension KW - HPN KW - high blood pressure KW - prevalence KW - national trends KW - regional trends KW - nationwide study KW - socioeconomic KW - trends KW - participant KW - population based KW - cross-sectional study KW - treatment N2 - Background: Understanding the association between hypertension prevalence and socioeconomic and behavioral variables during a pandemic is essential, and this analysis should extend beyond short-term trends. Objective: This study aims to examine long-term trends in the prevalence of participants diagnosed with and receiving treatment for hypertension, using data collected by a nationally representative survey from 2009 to 2022, which includes the COVID-19 pandemic era. Methods: A nationwide, population-based, cross-sectional study used data collected from the South Korea Community Health Survey between 2009 and 2022. The study sample comprised 3,208,710 Korean adults over a period of 14 years. We aimed to assess trends in the prevalence of participants diagnosed with and receiving treatment for hypertension in the national population from 2009 to 2022, with a specific focus on the COVID-19 pandemic, using weighted linear regression models. Results: Among the included 3,072,546 Korean adults, 794,239 (25.85%) were aged 19-39 years, 1,179,388 (38.38%) were aged 40-59 years; 948,097 (30.86%) were aged 60-79 years, and 150,822 (4.91%) were aged 80 years or older. A total of 1,426,379 (46.42%) were men; 761,896 (24.80%) and 712,264 (23.18%) were diagnosed with and received treatment for hypertension, respectively. Although the overall prevalence over the 14-year period increased, the upward trends of patients diagnosed with and receiving treatment for hypertension decreased during the COVID-19 pandemic era compared with the prepandemic era (? difference for trend during vs before the pandemic ?.101, 95% CI ?0.107 to ?0.094 vs ?.133, 95% CI ?0.140 to ?0.127). Notably, the trends in prevalence during the pandemic were less pronounced in subgroups of older adults (?60 years old) and individuals with higher alcohol consumption (?5 days/month). Conclusions: This nationwide representative study found that the national prevalence of participants diagnosed with and receiving treatment for hypertension increased during the prepandemic era. However, there was a marked decrease in these trends during the prepandemic era, compared with the pandemic era, particularly among specific subgroups at increased risk of negative outcomes. Future studies are needed to evaluate the factors associated with changes in the prevalence of hypertension during the COVID-19 pandemic. UR - https://publichealth.jmir.org/2024/1/e51891 UR - http://dx.doi.org/10.2196/51891 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078683 ID - info:doi/10.2196/51891 ER - TY - JOUR AU - Charifson, Mia AU - Wen, Timothy AU - Zell, Bonnie AU - Vaidya, Priyanka AU - Rios, I. Cynthia AU - Fagbohun, Funsho C. AU - Fulcher, Isabel PY - 2024/7/12 TI - Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study JO - JMIR Mhealth Uhealth SP - e55617 VL - 12 KW - blood pressure KW - hypertension KW - remote patient monitoring KW - pregnancy KW - digital health KW - remote monitoring KW - user engagement KW - users KW - connected KW - unconnected KW - comparison KW - patient engagement KW - prospective pregnancy cohort KW - device KW - devices KW - female KW - females KW - women KW - logistic regression KW - Poisson UR - https://mhealth.jmir.org/2024/1/e55617 UR - http://dx.doi.org/10.2196/55617 ID - info:doi/10.2196/55617 ER - TY - JOUR AU - Buis, R. Lorraine AU - Kim, Junhan AU - Sen, Ananda AU - Chen, Dongru AU - Dawood, Katee AU - Kadri, Reema AU - Muladore, Rachelle AU - Plegue, Melissa AU - Richardson, R. Caroline AU - Djuric, Zora AU - McNaughton, Candace AU - Hutton, David AU - Robert, P. Lionel AU - Park, Young Sun AU - Levy, Phillip PY - 2024/6/28 TI - The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e57863 VL - 12 KW - blood pressure KW - hypertension KW - mobile health KW - mHealth KW - mobile phone KW - smartphone N2 - Background: Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease?related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. Objective: We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. Methods: We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). Results: We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). Conclusions: Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. Trial Registration: ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537 International Registered Report Identifier (IRRID): RR2-10.2196/12601 UR - https://mhealth.jmir.org/2024/1/e57863 UR - http://dx.doi.org/10.2196/57863 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57863 ER - TY - JOUR AU - Terada, Marina AU - Okuhara, Tsuyoshi AU - Yokota, Rie AU - Kiuchi, Takahiro AU - Murakami, Kentaro PY - 2024/6/20 TI - Nutrients and Foods Recommended for Blood Pressure Control on Twitter in Japan: Content Analysis JO - J Med Internet Res SP - e49077 VL - 26 KW - Twitter KW - food KW - nutrition KW - misinformation KW - salt KW - content analysis KW - hypertension KW - blood pressure KW - sodium KW - salt reduction N2 - Background: Management and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter. Objective: This study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control. Methods: A total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated. Results: Of the 2347 tweets, 80% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1% (n=1301), followed by potassium at 8.4% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75% (n=21) of tweets from ?doctors? mentioned salt reduction is effective for hypertension control, while 31.1% (n=74) of tweets from ?health, losing weight, and beauty-related users,? 25.9% (n=429) of tweets from ?general public,? and 23.5% (n=4) tweets from ?dietitian or registered dietitian? denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control. Conclusions: The large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic. UR - https://www.jmir.org/2024/1/e49077 UR - http://dx.doi.org/10.2196/49077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49077 ER - TY - JOUR AU - Arshed, Muhammad AU - Mahmud, Aidalina AU - Minhat, Sakdiah Halimatus AU - Lim, Ying Poh AU - Zakar, Rubeena PY - 2024/6/19 TI - Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e50248 VL - 12 KW - mobile health KW - mHealth KW - intervention KW - medication adherence KW - hypertension KW - low- to middle-income country KW - effectiveness KW - randomized controlled trial KW - Pakistan KW - drug adherence KW - tool KW - mHealth module KW - self-efficacy KW - systolic blood pressure KW - feedback N2 - Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. Results: Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score. Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157 UR - https://mhealth.jmir.org/2024/1/e50248 UR - http://dx.doi.org/10.2196/50248 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50248 ER - TY - JOUR AU - Skolarus, E. Lesli AU - Lin, Chieh Chun AU - Mishra, Sonali AU - Meurer, William AU - Dinh, Mackenzie AU - Whitfield, Candace AU - Bi, Ran AU - Brown, Devin AU - Oteng, Rockefeller AU - Buis, R. Lorraine AU - Kidwell, Kelley PY - 2024/6/12 TI - Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial JO - JMIR Mhealth Uhealth SP - e54946 VL - 12 KW - hypertension KW - self-measured blood pressure KW - mobile health KW - blood pressure KW - emergency KW - blood pressure monitoring KW - risk factor KW - cardiovascular KW - cardiovascular disease KW - utilization KW - feedback KW - care KW - systolic blood pressure KW - emergency department KW - mHealth KW - health disparities KW - engagement N2 - Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency?weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04340-z UR - https://mhealth.jmir.org/2024/1/e54946 UR - http://dx.doi.org/10.2196/54946 ID - info:doi/10.2196/54946 ER - TY - JOUR AU - Lee, Jun Jae AU - Lee, Hee Kyung PY - 2024/6/11 TI - Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study JO - JMIR Public Health Surveill SP - e52182 VL - 10 KW - aged KW - blood pressure KW - cardiovascular diseases KW - hypertension KW - mortality KW - older adults KW - geriatric KW - elderly KW - cardiovascular KW - Korea KW - Korean KW - insurance KW - cohort study KW - systolic KW - risk KW - aging KW - health outcome N2 - Background: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. Objective: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. Methods: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ?160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). Results: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. Conclusions: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years. UR - https://publichealth.jmir.org/2024/1/e52182 UR - http://dx.doi.org/10.2196/52182 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861307 ID - info:doi/10.2196/52182 ER - TY - JOUR AU - Tran, Dieu-My AU - Dingley, Catherine AU - Bonilla, Roger PY - 2024/6/7 TI - mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study JO - JMIR Form Res SP - e48520 VL - 8 KW - blood pressure KW - mHealth KW - self-management KW - students KW - intervention KW - elevated blood pressure KW - college KW - hypertension KW - young adult KW - mobile app KW - smartphone KW - monitoring KW - text messaging KW - text mining N2 - Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ?80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant?s BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. Results: The participants? (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research. UR - https://formative.jmir.org/2024/1/e48520 UR - http://dx.doi.org/10.2196/48520 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848120 ID - info:doi/10.2196/48520 ER - TY - JOUR AU - Cheng, Hui AU - Jia, Zhihui AU - Li, Ting Yu AU - Yu, Xiao AU - Wang, Ji Jia AU - Xie, Jie Yao AU - Hernandez, Jose AU - Wang, X. Harry H. PY - 2024/6/3 TI - Metabolic Score for Insulin Resistance and New-Onset Type 2 Diabetes in a Middle-Aged and Older Adult Population: Nationwide Prospective Cohort Study and Implications for Primary Care JO - JMIR Public Health Surveill SP - e49617 VL - 10 KW - metabolic score for insulin resistance KW - type 2 diabetes mellitus KW - blood pressure KW - longitudinal study KW - primary care N2 - Background: The metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited. Objective: We aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM. Methods: We conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR. Results: During a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9%; 95% CI 58.7%-67.1%) had baseline FPG<110 mg/dL. A SD unit increase in baseline METS-IR was associated with the first incidence of T2DM (adjusted hazard ratio [aHR] 1.33, 95% CI 1.22-1.45; P<.001) in all participants. We obtained similar results in participants with normal baseline BP (aHR 1.41, 95% CI 1.22-1.62; P<.001) and elevated baseline BP (aHR 1.29, 95% CI 1.16-1.44; P<.001). The predictive capability for incident T2DM was improved by adding METS-IR to FPG. In study participants with new-onset T2DM whose baseline FPG was <126 mg/dL and <110 mg/dL, 62.9% (332/527; 95% CI 60%-65.9%) and 58.1% (193/332; 95% CI 54.3%-61.9%) of participants had baseline METS-IR above the cutoff values, respectively. Conclusions: METS-IR was significantly associated with new-onset T2DM, regardless of baseline BP level. Regular monitoring of METS-IR on top of routine blood glucose in clinical practice may add to the ability to enhance the early identification of primary care populations at risk for T2DM. UR - https://publichealth.jmir.org/2024/1/e49617 UR - http://dx.doi.org/10.2196/49617 UR - http://www.ncbi.nlm.nih.gov/pubmed/38569189 ID - info:doi/10.2196/49617 ER - TY - JOUR AU - Leitner, Jared AU - Chiang, Po-Han AU - Agnihotri, Parag AU - Dey, Sujit PY - 2024/5/28 TI - The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial JO - JMIR Cardio SP - e51916 VL - 8 KW - blood pressure KW - hypertension KW - digital health KW - lifestyle change KW - lifestyle medicine KW - wearables KW - remote patient monitoring KW - artificial intelligence KW - AI KW - mobile phone N2 - Background: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. Objective: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)?based lifestyle coaching program on achieving BP control among adults with hypertension. Methods: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. Results: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI ?7.1 to ?4.2; P<.001) and 3.8 mm Hg (95% CI ?4.7 to ?2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI ?12.2 to ?6.9; P<.001) and 5.7 mm Hg (95% CI ?7.6 to ?3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI ?10.1 to ?6.1; P<.001) and 5.1 mm Hg (95% CI ?6.2 to ?3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI ?17.7 to ?10.7; P<.001) and 8.1 mm Hg (95% CI ?10.4 to ?5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. Conclusions: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. Trial Registration: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734 UR - https://cardio.jmir.org/2024/1/e51916 UR - http://dx.doi.org/10.2196/51916 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805253 ID - info:doi/10.2196/51916 ER - TY - JOUR AU - Dinh, Mackenzie AU - Lin, Chieh Chun AU - Whitfield, Candace AU - Farhan, Zahera AU - Meurer, J. William AU - Bailey, Sarah AU - Skolarus, E. Lesli PY - 2024/5/28 TI - Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial JO - JMIR Form Res SP - e54010 VL - 8 KW - hypertension KW - cognition KW - mobile health KW - Bluetooth KW - remote KW - monitoring KW - monitor KW - low income KW - mHealth KW - hypertensive KW - cardiology KW - cardiovascular KW - feasibility KW - acceptability KW - satisfaction KW - RCT KW - randomized controlled trial KW - assessment KW - blood pressure KW - neurological N2 - Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease?related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health?based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message?linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 UR - https://formative.jmir.org/2024/1/e54010 UR - http://dx.doi.org/10.2196/54010 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805251 ID - info:doi/10.2196/54010 ER - TY - JOUR AU - Beverly, A. Elizabeth AU - Koopman-Gonzalez, Sarah AU - Wright, Jackson AU - Dungan, Kathleen AU - Pallerla, Harini AU - Gubitosi-Klug, Rose AU - Baughman, Kristin AU - Konstan, W. Michael AU - Bolen, D. Shari PY - 2024/4/12 TI - Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study JO - JMIR Form Res SP - e55285 VL - 8 KW - health collaborative KW - cardiovascular disease KW - type 2 diabetes KW - needs assessment N2 - Background: The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio?s Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Objective: Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. Methods: A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non?grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). Results: In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non?grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non?grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non?grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non?grant-funded members? choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non?grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non?grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Conclusions: Cardi-OH grant- and non?grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers. UR - https://formative.jmir.org/2024/1/e55285 UR - http://dx.doi.org/10.2196/55285 UR - http://www.ncbi.nlm.nih.gov/pubmed/38607661 ID - info:doi/10.2196/55285 ER - TY - JOUR AU - Wang, Xuzhi AU - Zhang, Yuankai AU - Pathiravasan, H. Chathurangi AU - Ukonu, C. Nene AU - Rong, Jian AU - Benjamin, J. Emelia AU - McManus, D. David AU - Larson, G. Martin AU - Vasan, S. Ramachandran AU - Hamburg, M. Naomi AU - Murabito, M. Joanne AU - Liu, Chunyu AU - Mitchell, F. Gary PY - 2024/4/8 TI - Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study JO - JMIR Cardio SP - e54801 VL - 8 KW - arterial stiffness KW - mobile health KW - mHealth KW - blood pressure KW - blood pressure variability KW - risk factors N2 - Background: Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. Objective: This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. Methods: At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Results: Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). Conclusions: In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span. UR - https://cardio.jmir.org/2024/1/e54801 UR - http://dx.doi.org/10.2196/54801 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587880 ID - info:doi/10.2196/54801 ER - TY - JOUR AU - Sun, Ting AU - Xu, Xuejie AU - Ding, Zenghui AU - Xie, Hui AU - Ma, Linlin AU - Zhang, Jing AU - Xia, Yuxin AU - Zhang, Guoli AU - Ma, Zuchang PY - 2024/4/5 TI - Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e53006 VL - 12 KW - adherence KW - hypertension KW - health behavior KW - mHealth KW - digital health N2 - Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with ?adherence? playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (?7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782 International Registered Report Identifier (IRRID): RR2-10.2196/46883 UR - https://mhealth.jmir.org/2024/1/e53006 UR - http://dx.doi.org/10.2196/53006 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578692 ID - info:doi/10.2196/53006 ER - TY - JOUR AU - Yoon, Sungwon AU - Tan, Min Chao AU - Phang, Kie Jie AU - Liu, Xi Venice AU - Tan, Boon Wee AU - Kwan, Heng Yu AU - Low, Leng Lian PY - 2024/4/4 TI - Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study JO - JMIR Form Res SP - e51848 VL - 8 KW - decision-making KW - diabetes KW - health coach KW - health coaching KW - healthcare professional KW - hypertension KW - patient KW - patient-centered care KW - person-centered care KW - qualitative research KW - self-management KW - shared decision-making N2 - Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient?s stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach?s personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. UR - https://formative.jmir.org/2024/1/e51848 UR - http://dx.doi.org/10.2196/51848 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573763 ID - info:doi/10.2196/51848 ER - TY - JOUR AU - He, Yunfan AU - Zhu, Wei AU - Wang, Tong AU - Chen, Han AU - Xin, Junyi AU - Liu, Yongcheng AU - Lei, Jianbo AU - Liang, Jun PY - 2024/3/28 TI - Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study JO - JMIR Mhealth Uhealth SP - e55199 VL - 12 KW - hypertension management KW - mobile health KW - topic modeling KW - satisfaction KW - 2-factor model KW - comparative study N2 - Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73%) compared with that for American HMAs (73,907/100,125, 73.81%). Chinese users primarily focus on reliability (2165/16,561, 13.07%) and measurement accuracy (2091/16,561, 12.63%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26%) and data synchronization (12,837/100,125, 12.82%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD (?=.354, P<.001), while cost had the most significant impact on ND (?=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD (?=0.312, P<.001), while data synchronization had the most significant impact on ND (?=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. UR - https://mhealth.jmir.org/2024/1/e55199 UR - http://dx.doi.org/10.2196/55199 UR - http://www.ncbi.nlm.nih.gov/pubmed/38547475 ID - info:doi/10.2196/55199 ER - TY - JOUR AU - Ibrahim, Yakubu AU - Basri, Iftida Nurul AU - Nordin, Norshariza AU - Mohd Jamil, Afzan Amilia PY - 2024/3/26 TI - Vitamin D Deficiency and Its Association With Vitamin D Receptor Gene Variants Among Malaysian Women With Hypertensive Disorders in Pregnancy: Protocol for a Nutrigenomics Study JO - JMIR Res Protoc SP - e53722 VL - 13 KW - gestational hypertension KW - preeclampsia KW - hypertensive disorder KW - vitamin D deficiency KW - vitamin D receptor gene polymorphism KW - vitamin D sequence N2 - Background: Vitamin D deficiency has been associated with hypertensive disorders in pregnancy (HDP). The risk of developing HDP was reported to be further augmented among individuals with a vitamin D receptor (VDR) genetic variant. However, the reported roles of VDR variants in hypertensive disorders are inconsistent among different populations. Given the relatively higher incidence of vitamin D deficiency among Malaysian pregnant women and the high incidence of HDP in this population, we hypothesize that there may be associations between the risk of vitamin D deficiency and HDP with VDR genetic variants. Objective: This paper outlines the protocol for a study to determine the association of vitamin D status and VDR sequence variants among Malaysian pregnant women with HDP. Methods: This prospective study consists of two phases. The first phase is a cross-sectional study that will entail gathering medical records, a questionnaire survey, and laboratory testing for vitamin D status, with a planned recruitment of 414 pregnant women. The questionnaire will be utilized to assess the risk factors for vitamin D deficiency. The vitamin D status will be obtained from measurement of the vitamin D (25-hydroxyvitamin D3) level in the blood. The second phase is a case-control study involving a Malay ethnic cohort with vitamin D deficiency. Participants will be divided into two groups with and without HDP (n=150 per group). Genomic DNA will be extracted from the peripheral blood monocytes of participants using the Qiagen DNA blood kit, and VDR sequence variants will be determined using polymerase chain reaction?high-resolution melting (PCR-HRM) analysis. Sanger sequencing will then be used to sequence randomly selected samples corresponding to each identified variant to validate our PCR-HRM results. The VDR genotype and mutation frequencies of BsmI, ApaI, TaqI, and FokI will be statistically analyzed to evaluate their relationships with developing HDP. Results: As of December 2023, 340 subjects have been recruited for the phase 1 study, 63% of whom were determined to have vitamin D deficiency. In the phase 2 study, 50 and 22 subjects have been recruited from the control and case groups, respectively. Recruitment is expected to be completed by March 2024 and all analyses should be completed by August 2024. Conclusions: The outcome of the study will identify the nonmodifiable genetic components contributing to developing vitamin D deficiency leading to HDP. This will in turn enable gaining a better understanding of the contribution of genetic variability to the development of HDP, thus providing more evidence for a need of customized vitamin D supplementation during pregnancy according to the individual variability in the response to vitamin D intake. Trial Registration: ClinicalTrials.gov NCT05659173; https://clinicaltrials.gov/study/NCT05659173 International Registered Report Identifier (IRRID): DERR1-10.2196/53722 UR - https://www.researchprotocols.org/2024/1/e53722 UR - http://dx.doi.org/10.2196/53722 UR - http://www.ncbi.nlm.nih.gov/pubmed/38530345 ID - info:doi/10.2196/53722 ER - TY - JOUR AU - Kargarandehkordi, Ali AU - Slade, Christopher AU - Washington, Peter PY - 2024/3/25 TI - Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study JO - JMIR Res Protoc SP - e55615 VL - 13 KW - stress KW - hypertension KW - precision health KW - personalized artificial intelligence KW - wearables KW - ecological momentary assessments KW - passive sensing KW - mobile phone N2 - Background: Referred to as the ?silent killer,? elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective: The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods: The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results: Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app?s messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions: Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project?s clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/55615 UR - https://www.researchprotocols.org/2024/1/e55615 UR - http://dx.doi.org/10.2196/55615 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526539 ID - info:doi/10.2196/55615 ER - TY - JOUR AU - Allen, S. Katie AU - Valvi, Nimish AU - Gibson, Joseph P. AU - McFarlane, Timothy AU - Dixon, E. Brian PY - 2024/3/13 TI - Electronic Health Records for Population Health Management: Comparison of Electronic Health Record?Derived Hypertension Prevalence Measures Against Established Survey Data JO - Online J Public Health Inform SP - e48300 VL - 16 KW - public health informatics KW - surveillance KW - chronic conditions KW - electronic health record KW - health management KW - hypertension KW - public health KW - prevalence KW - population-based survey N2 - Background: Hypertension is the most prevalent risk factor for mortality globally. Uncontrolled hypertension is associated with excess morbidity and mortality, and nearly one-half of individuals with hypertension do not have the condition under control. Data from electronic health record (EHR) systems may be useful for community hypertension surveillance, filling a gap in local public health departments? community health assessments and supporting the public health data modernization initiatives currently underway. To identify patients with hypertension, computable phenotypes are required. These phenotypes leverage available data elements?such as vitals measurements and medications?to identify patients diagnosed with hypertension. However, there are multiple methodologies for creating a phenotype, and the identification of which method most accurately reflects real-world prevalence rates is needed to support data modernization initiatives. Objective: This study sought to assess the comparability of 6 different EHR-based hypertension prevalence estimates with estimates from a national survey. Each of the prevalence estimates was created using a different computable phenotype. The overarching goal is to identify which phenotypes most closely align with nationally accepted estimations. Methods: Using the 6 different EHR-based computable phenotypes, we calculated hypertension prevalence estimates for Marion County, Indiana, for the period from 2014 to 2015. We extracted hypertension rates from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. We used the two 1-sided t test (TOST) to test equivalence between BRFSS- and EHR-based prevalence estimates. The TOST was performed at the overall level as well as stratified by age, gender, and race. Results: Using both 80% and 90% CIs, the TOST analysis resulted in 2 computable phenotypes demonstrating rough equivalence to BRFSS estimates. Variation in performance was noted across phenotypes as well as demographics. TOST with 80% CIs demonstrated that the phenotypes had less variance compared to BRFSS estimates within subpopulations, particularly those related to racial categories. Overall, less variance occurred on phenotypes that included vitals measurements. Conclusions: This study demonstrates that certain EHR-derived prevalence estimates may serve as rough substitutes for population-based survey estimates. These outcomes demonstrate the importance of critically assessing which data elements to include in EHR-based computer phenotypes. Using comprehensive data sources, containing complete clinical data as well as data representative of the population, are crucial to producing robust estimates of chronic disease. As public health departments look toward data modernization activities, the EHR may serve to assist in more timely, locally representative estimates for chronic disease prevalence. UR - https://ojphi.jmir.org/2024/1/e48300 UR - http://dx.doi.org/10.2196/48300 UR - http://www.ncbi.nlm.nih.gov/pubmed/38478904 ID - info:doi/10.2196/48300 ER - TY - JOUR AU - Hofner, Michael AU - Hurnaus, Patrick AU - DiStefano, Dan AU - Philip, Shaji AU - Kim, Sarah AU - Shaw, Julie AU - Waring, Chander Avantika PY - 2024/3/13 TI - Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study JO - JMIR Diabetes SP - e53835 VL - 9 KW - asynchronous KW - blood pressure KW - cardiology KW - chronic disease KW - cohort KW - diabetes mellitus therapy KW - diabetes KW - diabetics KW - eHealth KW - e-health KW - HbA1c KW - health disparities KW - heart KW - hemoglobin A1c KW - hypertension therapy KW - hypertension KW - hypertensive KW - remote care KW - retrospective KW - telehealth KW - telemedicine KW - virtual care N2 - Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients? first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by ?1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by ?2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by ?2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by ?1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. UR - https://diabetes.jmir.org/2024/1/e53835 UR - http://dx.doi.org/10.2196/53835 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363585 ID - info:doi/10.2196/53835 ER - TY - JOUR AU - Wang, Jie AU - Tan, Fangqin AU - Wang, Zhenzhong AU - Yu, Yiwen AU - Yang, Jingsong AU - Wang, Yueqing AU - Shao, Ruitai AU - Yin, Xuejun PY - 2024/2/16 TI - Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review JO - JMIR Public Health Surveill SP - e51802 VL - 10 KW - care cascade KW - hypertension KW - diabetes KW - scoping review KW - hypertension and diabetes care KW - review N2 - Background: Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade. Objective: This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade. Methods: The method of this scoping review has been guided by the framework by Arksey and O?Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management. Results: A total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings. Conclusions: This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes. UR - https://publichealth.jmir.org/2024/1/e51802 UR - http://dx.doi.org/10.2196/51802 UR - http://www.ncbi.nlm.nih.gov/pubmed/38149840 ID - info:doi/10.2196/51802 ER - TY - JOUR AU - Kormanis, Aryn AU - Quinones, Selina AU - Obermiller, Corey AU - Denizard-Thompson, Nancy AU - Palakshappa, Deepak PY - 2024/2/13 TI - Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study JO - JMIR Cardio SP - e54530 VL - 8 KW - social determinants of health KW - health-related social needs KW - mobile health KW - health information technology KW - feasibility KW - mobile phone KW - SMS text messaging KW - message KW - pilot study KW - patients KW - patient KW - hypertension KW - screening N2 - Background: Health-related social needs are associated with poor health outcomes, increased acute health care use, and impaired chronic disease management. Given these negative outcomes, an increasing number of national health care organizations have recommended that the health system screen and address unmet health-related social needs as a routine part of clinical care, but there are limited data on how to implement social needs screening in clinical settings to improve the management of chronic diseases such as hypertension. SMS text messaging could be an effective and efficient approach to screen patients; however, there are limited data on the feasibility of using it. Objective: We conducted a cross-sectional study of patients with hypertension to determine the feasibility of using SMS text messaging to screen patients for unmet health-related social needs. Methods: We randomly selected 200 patients (?18 years) from 1 academic health system. Patients were included if they were seen at one of 17 primary care clinics that were part of the academic health system and located in Forsyth County, North Carolina. We limited the sample to patients seen in one of these clinics to provide tailored information about local community-based resources. To ensure that the participants were still patients within the clinic, we only included those who had a visit in the previous 3 months. The SMS text message included a link to 6 questions regarding food, housing, and transportation. Patients who screened positive and were interested received a subsequent message with information about local resources. We assessed the proportion of patients who completed the questions. We also evaluated for the differences in the demographics between patients who completed the questions and those who did not using bivariate analyses. Results: Of the 200 patients, the majority were female (n=109, 54.5%), non-Hispanic White (n=114, 57.0%), and received commercial insurance (n=105, 52.5%). There were no significant differences in demographics between the 4446 patients who were eligible and the 200 randomly selected patients. Of the 200 patients included, the SMS text message was unable to be delivered to 9 (4.5%) patients and 17 (8.5%) completed the social needs questionnaire. We did not observe a significant difference in the demographic characteristics of patients who did versus did not complete the questionnaire. Of the 17, a total of 5 (29.4%) reported at least 1 unmet need, but only 2 chose to receive resource information. Conclusions: We found that only 8.5% (n=17) of patients completed a SMS text message?based health-related social needs questionnaire. SMS text messaging may not be feasible as a single modality to screen patients in this population. Future research should evaluate if SMS text message?based social needs screening is feasible in other populations or effective when paired with other screening modalities. UR - https://cardio.jmir.org/2024/1/e54530 UR - http://dx.doi.org/10.2196/54530 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349714 ID - info:doi/10.2196/54530 ER - TY - JOUR AU - Tran, C. Karen AU - Mak, Meagan AU - Kuyper, M. Laura AU - Bittman, Jesse AU - Mangat, Birinder AU - Lindsay, Heather AU - Kim Sing, Chad AU - Xu, Liang AU - Wong, Hubert AU - Dawes, Martin AU - Khan, Nadia AU - Ho, Kendall PY - 2024/1/30 TI - Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study JO - JMIR Form Res SP - e49592 VL - 8 KW - hypertension KW - remote-home monitoring KW - feasibility study KW - health monitor KW - telehealth KW - pilot study KW - mobile phone KW - monitoring KW - telemonitoring KW - blood pressure KW - emergency department KW - morbidity KW - mortality KW - primary care KW - physician care KW - management KW - hypertension medication N2 - Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Objective: Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Methods: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient?s condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. Results: A total of 46 multiethnic patients (mean age 63, SD 17 years, 69%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40% (56/139) and 88% (49/56), respectively. The proportion of participants that completed ?80% of home BP measurements at 1 and 3 months were 67% (31/46) and 41% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4% (30/42) and 85.7% (36/42) respectively. Mean home systolic and diastolic BP improved by ?13/?5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76%, 25/33) were highly satisfied with the HBPT program and 76% (25/33) found digital health tools easy to use. Conclusions: HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control. UR - https://formative.jmir.org/2024/1/e49592 UR - http://dx.doi.org/10.2196/49592 UR - http://www.ncbi.nlm.nih.gov/pubmed/38111177 ID - info:doi/10.2196/49592 ER - TY - JOUR AU - Liu, Fang AU - Song, Ting AU - Yu, Ping AU - Deng, Ning AU - Guan, Yingping AU - Yang, Yang AU - Ma, Yuanji PY - 2023/12/19 TI - Efficacy of an mHealth App to Support Patients? Self-Management of Hypertension: Randomized Controlled Trial JO - J Med Internet Res SP - e43809 VL - 25 KW - mobile app KW - mHealth KW - mobile health KW - smartphone KW - high blood pressure KW - medication adherence KW - reminder KW - health education KW - motivation KW - hypertension control KW - hypertension KW - blood pressure KW - self-management N2 - Background: Hypertension is a significant global disease burden. Mobile health (mHealth) offers a promising means to provide patients with hypertension with easy access to health care services. Yet, its efficacy needs to be validated, especially in lower-income areas with a high-salt diet. Objective: This study aims to assess the efficacy of an mHealth app?based intervention in supporting patients? self-management of hypertension. Methods: A 2-arm randomized controlled trial was conducted among 297 patients with hypertension at the General Hospital of Ningxia Medical University, Ningxia Hui Autonomous Region, China. Participants selected via convenience sampling were randomly allocated into intervention and control groups. Intervention group participants were trained and asked to use an mHealth app named Blood Pressure Assistant for 6 months. They could use the app to record and upload vital signs, access educational materials, and receive self-management reminders and feedback from health care providers based on the analysis of the uploaded data. Control group participants received usual care. Blood pressure (BP) and 2 questionnaire surveys about hypertension knowledge and lifestyle behavior were used to assess all participants at baseline and 6 months. Data analysis was performed with SPSS software using 2-tailed t tests and a chi-square test. Results: There were no significant differences in baseline characteristics and medication use between the 2 groups (all P>.05). After 6 months, although both groups show a significant pre-post improvement (P<.001 each), the BP control rate (ie, the proportion of patients with a systolic BP of <140 mm Hg and diastolic BP of <90 mm Hg) in the intervention group was better than that in the control group (100/111, 90.1% vs 75/115, 65.2%; P<.001). The mean systolic and diastolic BP were significantly reduced by 25.83 (SD 8.99) and 14.28 (SD 3.74) mm Hg in the intervention group (P<.001) and by 21.83 (SD 6.86) and 8.87 (SD 4.22) mm Hg in the control group (P<.001), respectively. The differences in systolic and diastolic BP between the 2 groups were significant (P<.001 and P=.01, respectively). Hypertension knowledge significantly improved only in the intervention group in both pre-post and intergroup comparisons (both P<.001). However, only intragroup improvement was observed for lifestyle behaviors in the intervention group (P<.001), including medication adherence (P<.001), healthy diet (P=.02), low salt intake (P<.001), and physical exercises (P=.02), and no significant difference was observed in the control group or on intergroup comparisons. Conclusions: This research shows that the mHealth app?based intervention has the potential to improve patient health knowledge and support self-management among them toward a healthier lifestyle, including medication adherence, low-salt diets, and physical exercises, thereby achieving optimal BP control. Further research is still needed to verify the specific effects of these interventions. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026437; https://www.chictr.org.cn/showproj.html?proj=38801 UR - https://www.jmir.org/2023/1/e43809 UR - http://dx.doi.org/10.2196/43809 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113071 ID - info:doi/10.2196/43809 ER - TY - JOUR AU - Wang, Yijun AU - Guo, Fuding AU - Wang, Jun AU - Li, Zeyan AU - Tan, Wuping AU - Xie, Mengjie AU - Yang, Xiaomeng AU - Duan, Shoupeng AU - Song, Lingpeng AU - Cheng, Siyi AU - Liu, Zhihao AU - Liu, Hengyang AU - Qiao, Jiaming AU - Wang, Yueyi AU - Zhou, Liping AU - Zhou, Xiaoya AU - Jiang, Hong AU - Yu, Lilei PY - 2023/12/4 TI - Efficacy of a WeChat-Based Multimodal Digital Transformation Management Model in New-Onset Mild to Moderate Hypertension: Randomized Clinical Trial JO - J Med Internet Res SP - e52464 VL - 25 KW - digital health care KW - mHealth KW - mobile health KW - apps KW - applications KW - controlled trials KW - digital transformation KW - precision KW - multimodal KW - precision medicine KW - hypertension KW - blood pressure KW - WeChat KW - social media KW - self-management KW - mobile phone N2 - Background: The advantages of multimodal digitally transformed mobile health management for patients diagnosed with mild to moderate hypertension are not yet established. Objective: We aim to evaluate the therapeutic benefits of a novel WeChat-based multimodal digital transforming management model in mobile health blood pressure (BP) management. Methods: This randomized controlled clinical trial included 175 individuals with new-onset mild to moderate hypertension who were admitted to our center between September and October 2022. The patients were randomly assigned to either the multimodal intervention group (n=88) or the usual care group (n=87). The primary composite outcome was home and office BP differences after 6 months. The major secondary outcomes were 6-month quality-of-life scores, including the self-rating anxiety scale, self-rating depression scale, and Pittsburgh Sleep Quality Index. Results: The mean home BP decreased from 151.74 (SD 8.02)/94.22 (SD 9.32) to 126.19 (SD 8.45)/82.28 (SD 9.26) mm Hg in the multimodal intervention group and from 150.78 (SD 7.87)/91.53 (SD 9.78) to 133.48 (SD 10.86)/84.45 (SD 9.19) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of ?8.25 mm Hg (95% CI ?11.71 to ?4.78 mm Hg; P<.001) and ?4.85 mm Hg (95% CI ?8.41 to ?1.30 mm Hg; P=.008), respectively. The mean office BP decreased from 153.64 (SD 8.39)/93.56 (SD 8.45) to 127.81 (SD 8.04)/ 82.16 (SD 8.06) mm Hg in the multimodal intervention group and from 151.48 (SD 7.14)/(91.31 (SD 9.61) to 134.92 (SD 10.11)/85.09 (SD 8.26) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of ?9.27 mm Hg (95% CI ?12.62 to ?5.91 mm Hg; P<.001) and ?5.18 mm Hg (95% CI ?8.47 to ?1.89 mm Hg; P=.002), respectively. From baseline to 6 months, home BP control <140/90 mm Hg was achieved in 64 (72.7%) patients in the multimodal intervention group and 46 (52.9%) patients in the usual care group (P=.007). Meanwhile, home BP control <130/80 mm Hg was achieved in 32 (36.4%) patients in the multimodal intervention group and 16 (18.4%) patients in the usual care group (P=.008). After 6 months, there were significant differences in the quality-of-life total and graded scores, including self-rating anxiety scale scores (P=.04), self-rating depression scale scores (P=.03), and Pittsburgh Sleep Quality Index scores (P<.001), in the multimodal intervention group compared with the usual care group. Conclusions: The WeChat-based multimodal intervention model improved the BP control rates and lowered the BP levels more than the usual care approach. The multimodal digital transforming management model for hypertension represents an emerging medical practice that utilizes the individual?s various risk factor profiles for primary care and personalized therapy decision-making in patients with hypertension. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200063550; https://www.chictr.org.cn/showproj.html?proj=175816 UR - https://www.jmir.org/2023/1/e52464 UR - http://dx.doi.org/10.2196/52464 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048156 ID - info:doi/10.2196/52464 ER - TY - JOUR AU - Einhorn, Julian AU - Murphy, R. Andrew AU - Rogal, S. Shari AU - Suffoletto, Brian AU - Irizarry, Taya AU - Rollman, L. Bruce AU - Forman, E. Daniel AU - Muldoon, F. Matthew PY - 2023/12/4 TI - Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews JO - JMIR Cardio SP - e51316 VL - 7 KW - mHealth KW - digital intervention KW - qualitative research KW - provider stakeholders KW - hypertension KW - home blood pressure monitoring KW - implementation research KW - short-messaging system KW - remote monitoring KW - qualitative analysis KW - messaging program KW - blood pressure KW - monitoring KW - cardiovascular KW - disease KW - text messaging KW - text mining KW - self-management KW - mobile phone N2 - Background: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. Objective: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. Methods: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. Results: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient?s home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. Conclusions: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. Trial Registration: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4 UR - https://cardio.jmir.org/2023/1/e51316 UR - http://dx.doi.org/10.2196/51316 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048147 ID - info:doi/10.2196/51316 ER - TY - JOUR AU - Schwab, Josephine AU - Wachinger, Jonas AU - Munana, Richard AU - Nabiryo, Maxencia AU - Sekitoleko, Isaac AU - Cazier, Juliette AU - Ingenhoff, Rebecca AU - Favaretti, Caterina AU - Subramonia Pillai, Vasanthi AU - Weswa, Ivan AU - Wafula, John AU - Emmrich, Valentin Julius AU - Bärnighausen, Till AU - Knauf, Felix AU - Knauss, Samuel AU - Nalwadda, K. Christine AU - Sudharsanan, Nikkil AU - Kalyesubula, Robert AU - McMahon, A. Shannon PY - 2023/11/30 TI - Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e46614 VL - 12 KW - Uganda KW - hypertension KW - mobile health KW - mHealth KW - mobile money KW - pooled financing KW - medication availability KW - human-centered design KW - mixed methods KW - mobile phone N2 - Background: Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (>90% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. Objective: This study aims to design and pilot-test a mobile money?based intervention to increase the availability of antihypertensive medication and lower clients? out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. Methods: We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. Results: As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. Conclusions: Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. Trial Registration: German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922 International Registered Report Identifier (IRRID): DERR1-10.2196/46614 UR - https://www.researchprotocols.org/2023/1/e46614 UR - http://dx.doi.org/10.2196/46614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032702 ID - info:doi/10.2196/46614 ER - TY - JOUR AU - Lee, R. David AU - Chenoweth, Matthew AU - Chuong, H. Linh AU - Villaflores, W. Chad AU - Cuevas, Miguel AU - Vangala, Sitaram AU - Borenstein, Jeff AU - Kwak, Hannah AU - Chima-Melton, Chidinma AU - Han, Maria AU - Skootsky, A. Samuel AU - Chan Tack, Therese AU - Branagan, Linda AU - Martin, Heather AU - Gupta, Reshma AU - Phan, Linda AU - Sanchez, A. Michael AU - Malaak, M. Mina AU - Dermenchyan, Anna AU - Pearson, N. Kandyce AU - Altunyan, Marine AU - Barakat, F. Peter AU - Pablo, Ray AU - Sarkisian, Catherine PY - 2023/10/30 TI - A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial JO - JMIR Res Protoc SP - e45915 VL - 12 KW - blood pressure KW - EHR KW - electronic health record KW - hypertension KW - hypertensive KW - improvement science KW - monitor KW - monitoring KW - randomized controlled trial KW - RCT KW - remote blood pressure monitoring N2 - Background: Hypertension is a major contributor to various adverse health outcomes. Although previous studies have shown the benefits of home blood pressure (BP) monitoring over office-based measurements, there is limited evidence comparing the effectiveness of whether a BP monitor integrated into the electronic health record is superior to a nonintegrated BP monitor. Objective: In this paper, we describe the protocol for a pragmatic multisite implementation of a quality improvement initiative directly comparing integrated to nonintegrated BP monitors for hypertension improvement. Methods: We will conduct a randomized, comparative effectiveness trial at 3 large academic health centers across California. The 3 sites will enroll a total of 660 participants (approximately n=220 per site), with 330 in the integrated BP monitor arm and 330 in the nonintegrated BP control arm. The primary outcome of this study will be the absolute difference in systolic BP in mm Hg from enrollment to 6 months. Secondary outcome measures include binary measures of hypertension (controlled vs uncontrolled), hypertension-related health complications, hospitalizations, and death. The list of possible participants will be generated from a central data warehouse. Randomization will occur after enrollment in the study. Participants will use their assigned BP monitor and join site-specific hypertension interventions. Cross-site learning will occur at regular all-site meetings facilitated by the University of California, Los Angeles Value-Based Care Research Consortium. A pre- and poststudy questionnaire will be conducted to further evaluate participants? perspectives regarding their BP monitor. Linear mixed effects models will be used to compare the primary outcome measure between study arms. Mixed effects logistic regression models will be used to compare secondary outcome measures between study arms. Results: The study will start enrolling participants in the second quarter of 2023 and will be completed by the first half of 2024. Results will be published by the end of 2024. Conclusions: This pragmatic trial will contribute to the growing field of chronic care management using remote monitoring by answering whether a hypertension intervention coupled with an electronic health record integrated home BP monitor improves patients? hypertension better than a hypertension intervention with a nonintegrated BP monitor. The outcomes of this study may help health system decision makers determine whether to invest in integrated BP monitors for vulnerable patient populations. Trial Registration: ClinicalTrials.gov NCT05390502; clinicaltrials.gov/study/NCT05390502 International Registered Report Identifier (IRRID): PRR1-10.2196/45915 UR - https://www.researchprotocols.org/2023/1/e45915 UR - http://dx.doi.org/10.2196/45915 UR - http://www.ncbi.nlm.nih.gov/pubmed/37902819 ID - info:doi/10.2196/45915 ER - TY - JOUR AU - Nakrys, Marius AU - Valinskas, Sarunas AU - Aleknavicius, Kasparas AU - Jonusas, Justinas PY - 2023/10/17 TI - Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study JO - JMIR Cardio SP - e48454 VL - 7 KW - mobile app KW - Cardi.Health KW - blood pressure KW - engagement KW - app KW - pilot study KW - hypertension KW - effective KW - blood pressure control KW - self-monitoring KW - medication KW - management KW - users KW - use N2 - Background: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. Objective: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. Methods: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9%) men and 231 (68.1%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). Results: The study?s main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease (?21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95% CI 1.074-3.528; P=.03). Conclusions: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results?active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg. UR - https://cardio.jmir.org/2023/1/e48454 UR - http://dx.doi.org/10.2196/48454 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847544 ID - info:doi/10.2196/48454 ER - TY - JOUR AU - Sun, Ting AU - Zhao, Huanhuan AU - Ding, Zenghui AU - Xie, Hui AU - Ma, Linlin AU - Zhang, Yu AU - Wang, Yingying AU - Yang, Yinju AU - Xu, Chunyi AU - Sun, Yining AU - Xu, Xuejie AU - Ma, Zuchang PY - 2023/9/12 TI - Evaluating a WeChat-Based Health Behavioral Digital Intervention for Patients With Hypertension: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e46883 VL - 12 KW - adherence KW - community health KW - hypertension KW - health behavior KW - mobile phone N2 - Background: Hypertension is the most prevalent chronic condition and a significant risk factor for cardiovascular and kidney diseases. The efficacy of health behavioral interventions in blood pressure (BP) control has been demonstrated by a large and expanding body of literature, with ?adherence? playing a crucial role. WeChat is the most common social communication mobile app in China, and it has been shown to be an acceptable delivery platform for delivering health interventions. The WeChat-based health behavioral digital intervention program (WHBDIP) showed high feasibility and efficacy. However, the results regarding BP improvement between the WHBDIP and control groups were inconsistent. Objective: The objective of this study is to develop a WHBDIP and assess its efficacy in controlling BP and improving adherence among patients with hypertension. Methods: A 2-arm, parallel-group, and randomized trial design was used. Patients older than 60 years and with hypertension were randomly assigned to either the control group or the experimental group, which received a 12-week intervention. The program, primarily developed based on the Behavior Change Wheel (BCW) theory, offers health education on exercise, diet, BP monitoring, and medicine adherence (MA). It also includes other behavior interventions guided by an intervention manual, incorporating behavior change techniques (BCTs). The primary outcomes encompass BP and adherence indicators, while the secondary outcomes encompass cardiovascular function indicators, body composition indicators, learning performance, satisfaction, and acceptability. The exercise and blood pressure monitoring adherence (BPMA) indicators for the WHBDIP group were assessed weekly via WeChat during the initial 3 months, while other outcome data for both groups will be collected at the baseline assessment phase, 3 months after the intervention, and 1 year after the program. Results: The trial will assess the efficacy of WHBDIP for patients with hypertension (N=68). The WHBDIP seeks to enhance participants' knowledge of healthy behaviors and assist patients in developing positive health behaviors to improve their health outcomes. Patient recruitment for individuals with hypertension commenced on September 5, 2022, and concluded on September 19, 2022. The 3-month intervention and phased data collection were finalized in January 2023. Data analysis will commence in August 2023, and the final 1-year health outcome results will be collected in September 2023. Conclusions: A successful WHBDIP will establish the management mode as a feasible approach for hypertension management in the community. Additionally, it will pave the way for the development of related mobile health programs. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://tinyurl.com/mwyv67wk International Registered Report Identifier (IRRID): PRR1-10.2196/46883 UR - https://www.researchprotocols.org/2023/1/e46883 UR - http://dx.doi.org/10.2196/46883 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698909 ID - info:doi/10.2196/46883 ER - TY - JOUR AU - Jones, M. Lenette AU - Piscotty Jr, J. Ronald AU - Sullivan, Stephen AU - Manzor Mitrzyk, Beatriz AU - Ploutz-Snyder, J. Robert AU - Ghosh, Bidisha AU - Veinot, Tiffany PY - 2023/9/11 TI - Psychometric Evaluation of the Modes of Health Information Acquisition, Sharing, and Use Questionnaire: Prospective Cross-Sectional Observational Study JO - J Med Internet Res SP - e44772 VL - 25 KW - psychometric evaluation KW - health information behavior KW - construct validity KW - reliability KW - chronic illness KW - MHIASU KW - hypertension N2 - Background: Health information is a critical resource for individuals with health concerns and conditions, such as hypertension. Enhancing health information behaviors may help individuals to better manage chronic illness. The Modes of Health Information Acquisition, Sharing, and Use (MHIASU) is a 23-item questionnaire that measures how individuals with health risks or chronic illness acquire, share, and use health information. Yet this measure has not been psychometrically evaluated in a large national sample. Objective: The objective of this study was to evaluate the psychometric properties of the self-administered MHIASU in a large, diverse cohort of individuals living with a chronic illness. Methods: Sharing Information, a prospective, observational study, was launched in August 2018 and used social media campaigns to advertise to Black women. Individuals who were interested in participating clicked on the advertisements and were redirected to a Qualtrics eligibility screener. To meet eligibility criteria individuals had to self-identify as a Black woman, be diagnosed with hypertension by a health care provider, and live in the United States. A total of 320 Black women with hypertension successfully completed the eligibility screener and then completed a web-based version of the MHIASU questionnaire. We conducted a psychometric evaluation of the MHIASU using exploratory factor analysis. The evaluation included item review, construct validity, and reliability. Results: Construct validity was established using exploratory factor analysis with principal axis factoring. The analysis was constricted to the expected domains. Interitem correlations were examined for possible item extraction. There were no improvements in factor structure with the removal of items with high interitem correlation (n=3), so all items of the MHIASU were retained. As anticipated, the instrument was found to have 3 subscales: acquisition, sharing, and use. Reliability was high for all 3 subscales, as evidenced by Cronbach ? scores of .81 (acquisition), .81 (sharing), and .93 (use). Factor 3 (use of health information) explained the maximum variance (74%). Conclusions: Construct validity and reliability of the web-based, self-administered MHIASU was demonstrated in a large national cohort of Black women with hypertension. Although this sample was highly educated and may have had higher digital literacy compared to other samples not recruited via social media, the population captured (Black women living with hypertension) are often underrepresented in research and are particularly vulnerable to this chronic condition. Future studies can use the MHIASU to examine health information behavior in other diverse populations managing health concerns and conditions. UR - https://www.jmir.org/2023/1/e44772 UR - http://dx.doi.org/10.2196/44772 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695669 ID - info:doi/10.2196/44772 ER - TY - JOUR AU - Ganie, Ashraf Mohd AU - Chowdhury, Subhankar AU - Suri, Vanita AU - Joshi, Beena AU - Bhattacharya, Kumar Prasanta AU - Agrawal, Sarita AU - Malhotra, Neena AU - Sahay, Rakesh AU - Jabbar, Khadar Puthiyaveettil AU - Rozati, Roya AU - Wani, Ahmad Imtiyaz AU - Shukla, Amlin AU - Arora, Taruna AU - Rashid, Haroon PY - 2023/9/6 TI - Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study JO - JMIR Public Health Surveill SP - e43199 VL - 9 KW - Indian Council of Medical Research?polycystic ovary syndrome study KW - ICMR-PCOS study KW - noncommunicable diseases KW - disease surveillance KW - obesity KW - hypertension KW - anthropometry KW - healthy reproductive-age women KW - socioeconomic status N2 - Background: A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. Objective: This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. Methods: We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research?PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. Results: Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. Conclusions: Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. International Registered Report Identifier (IRRID): RR2-10.2196/23437 UR - https://publichealth.jmir.org/2023/1/e43199 UR - http://dx.doi.org/10.2196/43199 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672315 ID - info:doi/10.2196/43199 ER - TY - JOUR AU - Wu, Justin AU - Napoleone, Jenna AU - Linke, Sarah AU - Noble, Madison AU - Turken, Michael AU - Rakotz, Michael AU - Kirley, Kate AU - Folk Akers, Jennie AU - Juusola, Jessie AU - Jasik, Bradner Carolyn PY - 2023/8/24 TI - Long-Term Results of a Digital Hypertension Self-Management Program: Retrospective Cohort Study JO - JMIR Cardio SP - e43489 VL - 7 KW - hypertension KW - digital health program KW - home measurement KW - self-management KW - behavior change N2 - Background: Digital health programs that incorporate frequent blood pressure (BP) self-monitoring and support for behavior change offer a scalable solution for hypertension management. Objective: We examined the impact of a digital hypertension self-management and lifestyle change support program on BP over 12 months. Methods: Data were analyzed from a retrospective observational cohort of commercially insured members (n=1117) that started the Omada for Hypertension program between January 1, 2019, and September 30, 2021. Paired t tests and linear regression were used to measure the changes in systolic blood pressure (SBP) over 12 months overall and by SBP control status at baseline (?130 mm Hg vs <130 mm Hg). Results: Members were on average 50.9 years old, 50.8% (n=567) of them were female, 60.5% (n=675) of them were White, and 70.5% (n=788) of them had uncontrolled SBP at baseline (?130 mm Hg). At 12 months, all members (including members with controlled and uncontrolled BP at baseline) and those with uncontrolled SBP at baseline experienced significant mean reductions in SBP (mean ?4.8 mm Hg, 95% CI ?5.6 to ?4.0; ?8.1 mm Hg, 95% CI ?9.0 to ?7.1, respectively; both P<.001). Members with uncontrolled SBP at baseline also had significant reductions in diastolic blood pressure (?4.7 mm Hg; 95% CI ?5.3 to ?4.1), weight (?6.5 lbs, 95% CI ?7.7 to ?5.3; 2.7% weight loss), and BMI (?1.1 kg/m2; 95% CI ?1.3 to ?0.9; all P<.001). Those with controlled SBP at baseline maintained within BP goal range. Additionally, 48% (418/860) of members with uncontrolled BP at baseline experienced enough change in BP to improve their BP category. Conclusions: This study provides real-world evidence that a comprehensive digital health program involving hypertension education, at-home BP monitoring, and behavior change coaching support was effective for self-managing hypertension over 12 months. UR - https://cardio.jmir.org/2023/1/e43489 UR - http://dx.doi.org/10.2196/43489 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463311 ID - info:doi/10.2196/43489 ER - TY - JOUR AU - Park, Sangil AU - Woo, Geol Ho AU - Kim, Soeun AU - Kim, Sunyoung AU - Lim, Hyunjung AU - Yon, Keon Dong AU - Rhee, Youl Sang PY - 2023/8/21 TI - Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study JO - JMIR Form Res SP - e48332 VL - 7 KW - hypertension KW - blood pressure KW - diabetes KW - glucose KW - digital health technology KW - effectiveness KW - application KW - blood glucose KW - systolic KW - diastolic KW - management KW - consumer KW - cost KW - monitoring N2 - Background: Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. Objective: We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. Methods: Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. Results: A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (?5.4 mm Hg, 95% CI ?7.0 to ?3.9) and DBP (?2.4 mm Hg, 95% CI ?3.4 to ?1.4) in participants without hypertension and FBG level in all participants (those without diabetes, ?4.4 mg/dL, 95% CI ?7.9 to ?1.0 and those with diabetes, ?3.2 mg/dL, 95% CI ?5.4 to ?1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (?10.9 mg/dL, 95% CI ?31.1 to ?5.3) compared to those using only a digital health app (P=.006). Conclusions: Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring. UR - https://formative.jmir.org/2023/1/e48332 UR - http://dx.doi.org/10.2196/48332 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603401 ID - info:doi/10.2196/48332 ER - TY - JOUR AU - Li, Wen-Wen AU - Toh, Prisca PY - 2023/7/27 TI - WeChat-Based Intervention for Chinese Immigrants With Hypertension: Development and Evaluation Study JO - Asian Pac Isl Nurs J SP - e45769 VL - 7 KW - social media KW - hypertension KW - medication adherence KW - Chinese immigrants KW - WeChat KW - blood pressure KW - BP N2 - Background: Despite Chinese immigrants having a higher or comparable proportion of hypertension (HTN) compared to non-Hispanic White and Hispanic individuals, there are no effective technology-based intervention studies that target HTN management in Chinese immigrants in the United States. Objective: The aim of this study was to develop and pilot-test the efficacy of a culturally and linguistically sensitive social media?based intervention (WeChat) for Chinese immigrants to improve blood pressure (BP) control, antihypertensive medication adherence, and self-efficacy. Methods: The study was conducted in 2020 with a pre- and posttest design (N=20). A WeChat-based intervention was implemented using one 20-minute video presentation plus one 20-minute nurse counseling session via WeChat at the baseline, followed by 4 biweekly 20-minute nurse counseling sessions via WeChat calls. The primary outcome (BP control) and secondary outcomes, including medication adherence and self-efficacy in HTN management, were measured at baseline and at 6 months. Results: The participants? mean age was 68.9 (SD 10.2; range: 51-86) years. The majority of the participants were female (n=13, 65%), had a high school degree or less (n=15, 75%), were married (n=16, 80%), not religious (n=13, 65%), and not employed (n=12, 60%). The results showed that the mean baseline systolic BP was 131.43 (SD 9.61) mmHg, and the mean diastolic BP was 79.79 (SD 9.62) mmHg. The 6-month outcome showed a reduction of systolic BP (?0.74, SD 9.18 mmHg; P=.05) and diastolic BP (?0.96, SD 6.92 mmHg; P=.001). The mean score for medication adherence at baseline was 4.50 (SD 1.70), and it significantly improved to 3.65 (SD 1.18) at 6 months (reversely scored; possible range was 1-5, with 1 being the best score; P=.001). Self-efficacy in HTN management had a trend in reduction from a baseline score of 8.28 (SD 1.25) decreasing to 7.93 (SD 1.48) at 6 months, with a mean difference of 0.34 (SD 2.02), with a score of 0 indicating the lowest self-efficacy and a score of 10 indicating the highest self-efficacy. Conclusions: Our WeChat-based HTN management program showed a significant improvement in diastolic BP and medication adherence as well as a trend of reduction for systolic BP and self-efficacy in managing HTN in Chinese immigrants. Compared to the traditional health care system, the proposed WeChat-based HTN management program has a low cost and is easy to implement. Thus, further investigation is recommended to generate further results. This intervention should be tested across different regions and clinical settings to verify the findings. The long-term goal is to implement the intervention in clinical settings to help Chinese immigrants at large achieve better HTN management. UR - https://apinj.jmir.org/2023/1/e45769 UR - http://dx.doi.org/10.2196/45769 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498663 ID - info:doi/10.2196/45769 ER - TY - JOUR AU - Poblete, Yareli Jacqueline AU - Vawter, Lauren Natalie AU - Lewis, Virginia Sydney AU - Felisme, Marc Earl AU - Mohn, Adriana Paloma AU - Shea, Jennifer AU - Northrup, William Adam AU - Liu, Jie AU - Al-Rousan, Tala AU - Godino, Gideon Job PY - 2023/7/24 TI - Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study JO - JMIR Hum Factors SP - e46313 VL - 10 KW - hypertension KW - blood pressure KW - digital health KW - health education KW - self-measured blood pressure monitoring KW - remote patient monitoring N2 - Background: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. Objective: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device?s cost (16 days of measurements in any 30-day period). Methods: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (?16 days in any rolling 30-day window) and a lenient definition (?1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. Results: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Conclusions: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated. UR - https://humanfactors.jmir.org/2023/1/e46313 UR - http://dx.doi.org/10.2196/46313 UR - http://www.ncbi.nlm.nih.gov/pubmed/37486745 ID - info:doi/10.2196/46313 ER - TY - JOUR AU - Wu, Zhiyuan AU - Zhang, Haiping AU - Wang, Yutao AU - Li, Zhiwei AU - Li, Xia AU - Tao, Lixin AU - Guo, Xiuhua PY - 2023/7/4 TI - Temporal and Bidirectional Association Between Blood Pressure Variability and Arterial Stiffness: Cross-Lagged Cohort Study JO - JMIR Public Health Surveill SP - e45324 VL - 9 KW - blood pressure variability KW - brachial-ankle pulse wave velocity KW - arterial stiffness KW - cross-lagged panel analysis N2 - Background: The causal relationship between blood pressure variability (BPV) and arterial stiffness remains debated. Objective: This study aimed to explore the temporal and bidirectional associations between long-term BPV and arterial stiffness using a cohort design with multiple surveys. Methods: Participants from the Beijing Health Management Cohort who underwent health examinations from visit 1 (2010-2011) to visit 5 (2018-2019) were enrolled in this study. Long-term BPV was defined as intraindividual variation using the coefficient of variation (CV) and SD. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). The bidirectional relationship between BPV and arterial stiffness was explored using cross-lagged analysis and linear regression models, with records before and after visit 3 categorized as phase 1 and phase 2, respectively. Results: Of the 1506 participants, who were a mean of 56.11 (SD 8.57) years old, 1148 (76.2%) were male. The cross-lagged analysis indicated that the standardized coefficients of BPV at phase 1 directing to the baPWV level at phase 2 were statistically significant but not vice-versa. The adjusted regression coefficients of the CV were 4.708 (95% CI 0.946-8.470) for systolic blood pressure, 3.119 (95% 0.166-6.073) for diastolic pressure, and 2.205 (95% CI 0.300-4.110) for pulse pressure. The coefficients of the SD were 4.208 (95% CI 0.177-8.239) for diastolic pressure and 4.247 (95% CI 0.448-8.046) for pulse pressure. The associations were predominant in the subgroup with hypertension, but we did not observe any significant association of baPWV level with subsequent BPV indices. Conclusions: The findings supported a temporal relationship between long-term BPV and arterial stiffness level, especially among people with hypertension. UR - https://publichealth.jmir.org/2023/1/e45324 UR - http://dx.doi.org/10.2196/45324 UR - http://www.ncbi.nlm.nih.gov/pubmed/37402142 ID - info:doi/10.2196/45324 ER - TY - JOUR AU - Nishizaki, Yuji AU - Kuroki, Haruo AU - Ishii, So AU - Ohtsu, Shigeyuki AU - Watanabe, Chizuru AU - Nishizawa, Hiroto AU - Nagao, Masashi AU - Nojima, Masanori AU - Watanabe, Ryo AU - Sato, Daisuke AU - Sato, Kensuke AU - Kawata, Yumi AU - Wada, Hiroo AU - Toyoda, Goichiro AU - Ohbayashi, Katsumi PY - 2023/6/8 TI - Determining Optimal Intervals for In-Person Visits During Video-Based Telemedicine Among Patients With Hypertension: Cluster Randomized Controlled Trial JO - JMIR Cardio SP - e45230 VL - 7 KW - hypertension KW - Japan KW - lost productivity time KW - patient satisfaction KW - telemedicine N2 - Background: Introducing telemedicine in outpatient treatment may improve patient satisfaction and convenience. However, the optimal in-person visit interval for video-based telemedicine among patients with hypertension remains unreported in Japan. Objective: We determined the optimal in-person visit interval for video-based telemedicine among patients with hypertension. Methods: This was a cluster randomized controlled noninferiority trial. The target sites were 8 clinics in Japan that had a telemedicine system, and the target patients were individuals with essential hypertension. Among patients receiving video-based telemedicine, those who underwent in-person visits at 6-month intervals were included in the intervention group, and those who underwent in-person visits at 3-month intervals were included in the control group. The follow-up period of the participants was 6 months. The primary end point of the study was the change in systolic blood pressure, and the secondary end points were the rate of treatment continuation after 6 months, patient satisfaction, health economic evaluation, and safety evaluation. Results: Overall, 64 patients were enrolled. Their mean age was 54.5 (SD 10.3) years, and 60.9% (39/64) of patients were male. For the primary end point, the odds ratio for the estimated difference in the change in systolic blood pressure between the 2 groups was 1.18 (90% CI ?3.68 to 6.04). Notably, the criteria for noninferiority were met. Patient satisfaction was higher in the intervention group than in the control group. Furthermore, the indirect costs indicated that lost productivity was significantly lesser in the intervention group than in the control group. Moreover, the treatment continuation rate did not differ between the intervention and control groups, and there were no adverse events in either group. Conclusions: Blood pressure control status and safety did not differ between the intervention and control groups. In-person visits at 6-month intervals may cause a societal cost reduction and improve patient satisfaction during video-based telemedicine. Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000040953; https://tinyurl.com/2p8devm9 UR - https://cardio.jmir.org/2023/1/e45230 UR - http://dx.doi.org/10.2196/45230 UR - http://www.ncbi.nlm.nih.gov/pubmed/37161483 ID - info:doi/10.2196/45230 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Bayuo, Jonathan AU - Wong, Yuet Frances Kam AU - Chow, Sum Karen Kit AU - Wong, Man Siu AU - Lau, Ki Avis Cheuk PY - 2023/5/1 TI - The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial JO - J Med Internet Res SP - e43678 VL - 25 KW - adults KW - application KW - apps KW - behavior KW - community KW - depression KW - diabetes KW - disease KW - hypertension KW - intervention KW - mHealth KW - older adults KW - proactive KW - program KW - self-efficacy KW - self-management KW - technology KW - usage N2 - Background: Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time. Objective: We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app. Methods: This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months? postintervention (T3) to ascertain the sustained effect. Results: A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (?21=6.81, P=.009). Improvements in self-efficacy (?=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (?=?1.98, 95% CI ?3.78 to ?0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (?=?1.38, 95% CI ?1.98 to ?0.78, P<.001), with a marginal increase at T3. Conclusions: The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth. Trial Registration: ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212 International Registered Report Identifier (IRRID): RR2-10.1159/000509129 UR - https://www.jmir.org/2023/1/e43678 UR - http://dx.doi.org/10.2196/43678 UR - http://www.ncbi.nlm.nih.gov/pubmed/37126378 ID - info:doi/10.2196/43678 ER - TY - JOUR AU - Jones, M. Lenette AU - de Marco, Kayla AU - Keener, Katharine AU - Monroe, E. Korrey PY - 2023/4/27 TI - Blood Pressure and Self-management in Black Women With Hypertension: Protocol Revisions to the Brain Relationships Among Information, Neuroprocessing, and Self-Management Study Due to the COVID-19 Pandemic JO - JMIR Res Protoc SP - e43849 VL - 12 KW - Black KW - BRAINS KW - COVID-19 pandemic KW - eHealth KW - Facebook KW - hypertension KW - protocol KW - videoconferencing KW - web-based KW - women N2 - Background: The COVID-19 pandemic and the halt to in-person research activities beginning in March 2020 brought new challenges to protocol development and implementation. Due to the pandemic, we had to revise our protocol for the Brain Relationships Among Information, Neuroprocessing, and Self-Management (BRAINS) study, which was designed to examine health information behavior, brain activity, diabetes status, and self-management behavior among Black women with hypertension. Objective: This report outlines 7 steps describing how our research team (1) revised the BRAINS study protocol, (2) implemented a remote method of data collection, and (3) mitigated the challenges we faced. Methods: Prior to March 2020, Black women with hypertension were invited to participate in the BRAINS study to undergo a functional magnetic resonance imaging scan, complete surveys, have their blood pressure measured, and have their blood drawn. After these measures were collected, participants would receive phone calls from a dietician to complete two 24-hour dietary recalls using the Nutrition Data System for Research. Our revised protocol relied on a web-based, interactive approach. Participants received a study kit that included an Omron automatic home blood pressure monitor and a hemoglobin A1c kit from the DTIL laboratory. In a Zoom meeting with each participant, our team played an introductory video, administered surveys (via Qualtrics), and guided participants through measuring their blood pressure and performing a finger stick to collect a blood sample for hemoglobin A1c testing. We examined cognitive function using the TestMyBrain Digital Neuropsychology Toolkit, as we were unable to access the functional magnetic resonance imaging laboratory to assess brain activity. The 7 steps in revising our protocol were as follows: conceptualizing the move from in-person to remote study activities (step 1); contacting the funders (step 2); submitting changes for Institutional Review Board approval (step 3); preparing to implement the revised protocol (step 4); implementing the study changes (step 5); mitigating challenges (step 6); and evaluating protocol implementation (step 7). Results: Approximately 1700 individuals responded to web-based advertisements about the BRAINS study. A total of 131 individuals completed our eligibility screener. We conducted our first Zoom appointment in July 2020 and our last Zoom appointment in September 2020. Using our revised strategies, a total of 99 participants completed all study measures within a 3-month period. Conclusions: In this report, we discuss successes and challenges in revising our protocol and reaching our population of interest remotely, safely, and effectively. The information we have outlined can help researchers create similar protocols to reach and conduct research remotely with diverse populations, such as individuals who are unable to participate in studies in person. International Registered Report Identifier (IRRID): DERR1-10.2196/43849 UR - https://www.researchprotocols.org/2023/1/e43849 UR - http://dx.doi.org/10.2196/43849 UR - http://www.ncbi.nlm.nih.gov/pubmed/37104029 ID - info:doi/10.2196/43849 ER - TY - JOUR AU - Susanto, Tantut AU - Rasny, Hanny AU - Kurdi, Fahruddin AU - Yunanto, Adi Rismawan AU - Rahmawati, Ira PY - 2023/4/3 TI - Management of Hypertension Using a Plant-Based Diet Among Farmers: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e41146 VL - 12 KW - hypertension KW - farming KW - plant-based diet KW - nursing N2 - Background: Farmers in Indonesia have a high risk for hypertension owing to their lifestyle and working environment. Diet management is a solution to reduce hypertension, and Indonesia has natural resources in the agricultural sector that could help manage hypertension. Optimizing vegetable and fruit intake in a plant-based diet (PBD) could help maintain blood pressure among farmers in Indonesia. Objective: This study aims to explore the health problem of hypertension and the characteristics of local food sources to formulate a PBD menu for treating hypertension, as well as assess the prevalence of hypertension, level of acceptability of a PBD, and associated sociodemographic factors. Further, we want to examine the effectiveness of a community-based nursing program for managing hypertension using a PBD. Methods: We will use the exploratory sequential mixed methods approach. There will be a qualitative study (phase I) in 2022 and a quantitative study (phase II) in 2023. We will analyze data using a thematic framework in phase I. In phase II, the study will involve (1) questionnaire development and validation; (2) examination of the prevalence of hypertension, the level of acceptability of a PBD, and the associated factors; and (3) a randomized controlled trial. We will recruit farmers with hypertension who meet the study criteria. Moreover, in phase II, we will invite expert nurses and nutritionists to assess the face and content validity of the questionnaire. We will use multiple logistic regression models to estimate the associated sociodemographic factors and the level of acceptability of a PBD. Furthermore, a linear generalized estimating equation will be used to estimate the parameters of a generalized linear model with a possible unmeasured correlation between observations from different time points for systolic and diastolic blood pressure. Results: A model PBD for hypertension management is expected to be developed. In 2022, we will collect information on hypertension and the characteristics of local food sources for managing hypertension, and will formulate a PBD menu to treat hypertension among farmers. In 2023, we will develop a questionnaire to assess the acceptability of a PBD to manage hypertension among farmers, the prevalence of hypertension, and the sociodemographic factors associated with hypertension among farmers. We will implement a community-based nursing program for managing hypertension using a PBD among farmers. Conclusions: The PBD model will not be readily available for other agricultural areas since validation of local food variation is required to design the menu. We expect contributions from the local government to implement the intervention as one of the policies in the management of hypertension for farmers in the agricultural plantation areas of Jember. This program may also be implemented in other agricultural countries with similar problems, so that hypertension can be optimally treated among farmers. International Registered Report Identifier (IRRID): PRR1-10.2196/41146 UR - https://www.researchprotocols.org/2023/1/e41146 UR - http://dx.doi.org/10.2196/41146 UR - http://www.ncbi.nlm.nih.gov/pubmed/37010908 ID - info:doi/10.2196/41146 ER - TY - JOUR AU - Chen, Botian AU - Dou, Yuqi AU - Yu, Xue AU - Ma, Defu PY - 2023/3/20 TI - Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study JO - J Med Internet Res SP - e42896 VL - 25 KW - hypertension KW - internet-based health management KW - blood pressure control KW - longitudinal study KW - health management KW - primary care KW - online based KW - eHealth KW - telehealth KW - telemedicine N2 - Background: In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China. Objective: We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies. Methods: This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ?18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects? health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant. Results: A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control. Conclusions: Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension. UR - https://www.jmir.org/2023/1/e42896 UR - http://dx.doi.org/10.2196/42896 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939826 ID - info:doi/10.2196/42896 ER - TY - JOUR AU - Khalid, Ayisha AU - Dong, Quanfang AU - Chuluunbaatar, Enkhzaya AU - Haldane, Victoria AU - Durrani, Hammad AU - Wei, Xiaolin PY - 2023/3/14 TI - Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review JO - J Med Internet Res SP - e42134 VL - 25 KW - telemedicine KW - hypertension KW - diabetes KW - implementation science KW - mobile phone N2 - Background: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results: Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels. UR - https://www.jmir.org/2023/1/e42134 UR - http://dx.doi.org/10.2196/42134 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917174 ID - info:doi/10.2196/42134 ER - TY - JOUR AU - Eyles, Helen AU - Grey, Jacqueline AU - Jiang, Yannan AU - Umali, Elaine AU - McLean, Rachael AU - Te Morenga, Lisa AU - Neal, Bruce AU - Rodgers, Anthony AU - Doughty, N. Robert AU - Ni Mhurchu, Cliona PY - 2023/3/9 TI - Effectiveness of a Sodium-Reduction Smartphone App and Reduced-Sodium Salt to Lower Sodium Intake in Adults With Hypertension: Findings From the Salt Alternatives Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e43675 VL - 11 KW - mobile health KW - mHealth KW - smartphone KW - smartphone app KW - cardiovascular disease KW - sodium KW - salt KW - blood pressure KW - technology KW - reduced-sodium salt KW - mobile phone N2 - Background: Even modest reductions in blood pressure (BP) can have an important impact on population-level morbidity and mortality from cardiovascular disease. There are 2 promising approaches: the SaltSwitch smartphone app, which enables users to scan the bar code of a packaged food using their smartphone camera and receive an immediate, interpretive traffic light nutrition label on-screen alongside a list of healthier, lower-salt options in the same food category; and reduced-sodium salts (RSSs), which are an alternative to regular table salt that are lower in sodium and higher in potassium but have a similar mouthfeel, taste, and flavor. Objective: Our aim was to determine whether a 12-week intervention with a sodium-reduction package comprising the SaltSwitch smartphone app and an RSS could reduce urinary sodium excretion in adults with high BP. Methods: A 2-arm parallel randomized controlled trial was conducted in New Zealand (target n=326). Following a 2-week baseline period, adults who owned a smartphone and had high BP (?140/85 mm Hg) were randomized in a 1:1 ratio to the intervention (SaltSwitch smartphone app + RSS) or control (generic heart-healthy eating information from The Heart Foundation of New Zealand). The primary outcome was 24-hour urinary sodium excretion at 12 weeks estimated via spot urine. Secondary outcomes were urinary potassium excretion, BP, sodium content of food purchases, and intervention use and acceptability. Intervention effects were assessed blinded using intention-to-treat analyses with generalized linear regression adjusting for baseline outcome measures, age, and ethnicity. Results: A total of 168 adults were randomized (n=84, 50% per group) between June 2019 and February 2020. Challenges associated with the COVID-19 pandemic and smartphone technology detrimentally affected recruitment. The adjusted mean difference between groups was 547 (95% CI ?331 to 1424) mg for estimated 24-hour urinary sodium excretion, 132 (95% CI ?1083 to 1347) mg for urinary potassium excretion, ?0.66 (95% CI ?3.48 to 2.16) mm Hg for systolic BP, and 73 (95% CI ?21 to 168) mg per 100 g for the sodium content of food purchases. Most intervention participants reported using the SaltSwitch app (48/64, 75%) and RSS (60/64, 94%). SaltSwitch was used on 6 shopping occasions, and approximately 1/2 tsp per week of RSS was consumed per household during the intervention. Conclusions: In this randomized controlled trial of a salt-reduction package, we found no evidence that dietary sodium intake was reduced in adults with high BP. These negative findings may be owing to lower-than-anticipated engagement with the trial intervention package. However, implementation and COVID-19?related challenges meant that the trial was underpowered, and it is possible that a real effect may have been missed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000352101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377044 and Universal Trial U1111-1225-4471 UR - https://mhealth.jmir.org/2023/1/e43675 UR - http://dx.doi.org/10.2196/43675 UR - http://www.ncbi.nlm.nih.gov/pubmed/36892914 ID - info:doi/10.2196/43675 ER - TY - JOUR AU - Ko, Jisook AU - Wang, Jing AU - Chung, L. Misook AU - Sharma, Kumar PY - 2023/2/13 TI - Examining the Individual Response to a Low-Sodium Diet in Patients with Hypertension: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e39058 VL - 12 KW - adherence to low-sodium diet intervention KW - adherence KW - metabolite profile KW - salt sensitivity KW - digital self-monitoring KW - hypertension KW - salt KW - blood pressure KW - sodium KW - diet KW - metabolite KW - nutrition KW - metabolomics KW - precision medicine KW - personalized KW - personalization KW - RCT KW - randomized controlled trial KW - genetics KW - genomics KW - chronic disease KW - chronic condition KW - urinary KW - dietary KW - dietary sodium KW - hypertensive patient KW - cardiovascular disease N2 - Background: Excessive dietary sodium intake is an independent risk factor for hypertension and cardiovascular disease (CVD). Despite the large body of evidence concerning the effects of dietary interventions on blood pressure (BP) and CVD outcomes, trials have often reported low adherence to decreased sodium intake, likely due in part to heterogeneous BP responses. To address the challenges, recent clinical findings suggested a precise and personalized dietary approach that seeks to deliver more preventive and practical dietary advice than the ?one-size-fits-all? guidelines and weighs the personal risk of developing specific diseases. Objective: The purpose of this pilot randomized controlled trial was to test the feasibility and preliminary efficacy of integrating the use of mobile technology and metabolomics with a low-sodium diet intervention in patients with hypertension to develop personalized low-sodium diet programs. Additionally, the study will examine the associations of urine metabolites with urinary sodium levels and BP control based on the hypothesis that targeted urine metabolites. In this report, we describe the design and protocol of the pilot trial. Methods: A total of 40 patients with hypertension will be randomly assigned to either a 8-week low-sodium diet group (n=20) or a standard care group (n=20). Each week, intervention participants went through individual sessions with an interventionist via videoconferencing to discuss low-sodium diet regimens, patients? food choices, and BP tracks on mobile apps. The control group followed their usual care for hypertension management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, systolic, and diastolic BPs were measured at the baseline and at 8 weeks. The primary outcomes of this study include the feasibility of conducting a randomized controlled trial (RCT) by reporting recruitment, retention, and completion statistics. The preliminary effects of intervention will be tested by a generalized estimating equation model. Results: This pilot RCT study was approved by the institutional review board at the University of Texas Health San Antonio in January 2021. The first participant was enrolled in April 2021, and currently, 26 participants were enrolled. All data collection is expected to conclude by March 2023, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. Conclusions: The findings of this proposed study will establish a comprehensive knowledge base for future research and development of personalized dietary interventions to promote adherence to dietary strategies and self-management of chronic disease using the Precision Health approach for millions of Americans who are struggling with uncontrolled hypertension. Trial Registration: ClinicalTrials.gov NCT04764253; https://clinicaltrials.gov/ct2/show/NCT04764253 International Registered Report Identifier (IRRID): DERR1-10.2196/39058 UR - https://www.researchprotocols.org/2023/1/e39058 UR - http://dx.doi.org/10.2196/39058 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780210 ID - info:doi/10.2196/39058 ER - TY - JOUR AU - Oh, Sung-Hee AU - Kim, Dohyang AU - Hwang, Jinseub AU - Kang, Jae-Heon AU - Kwon, Yeongkeun AU - Kwon, Jin-Won PY - 2023/2/3 TI - Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study JO - JMIR Public Health Surveill SP - e42190 VL - 9 KW - prevention and control KW - cardiovascular diseases KW - diabetes mellitus KW - hypertension KW - extended Cox regression KW - cohort study N2 - Background: Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. Objective: We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. Methods: This population-based retrospective study was conducted using data from the Korean National Health Insurance Service?National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. Results: Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group. Conclusions: This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology. UR - https://publichealth.jmir.org/2023/1/e42190 UR - http://dx.doi.org/10.2196/42190 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735297 ID - info:doi/10.2196/42190 ER - TY - JOUR AU - Yuan, Zhichao AU - Wang, Hai-Jun AU - Li, Qin AU - Su, Tao AU - Yang, Jie AU - Chen, Junjun AU - Peng, Yuanzhou AU - Zhou, Shuang AU - Bao, Heling AU - Luo, Shusheng AU - Wang, Hui AU - Liu, Jue AU - Han, Na AU - Guo, Yuming AU - Ji, Yuelong PY - 2023/1/23 TI - Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study JO - JMIR Public Health Surveill SP - e41442 VL - 9 KW - air pollution KW - PM2.5 KW - PM1 KW - hypertensive disorders of pregnancy KW - preconceptional period KW - lag effect KW - pregnancy KW - hypertension KW - hypertensive disorders KW - risk KW - pollutants KW - exposure KW - maternal health KW - perinatal health KW - pollution N2 - Background: Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs). Objective: We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale. Methods: Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM2.5 and PM1. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure?reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed. Results: A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7% (1520/22,570). Our findings showed that PM1 and PM2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM1 during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM1 and PM2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95% CI 1.007-1.042; HR 1.007, 95% CI 1.000-1.015, respectively, per 10 ?g/m3 increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs. Conclusions: Exposure to PM1 and PM2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs. UR - https://publichealth.jmir.org/2023/1/e41442 UR - http://dx.doi.org/10.2196/41442 UR - http://www.ncbi.nlm.nih.gov/pubmed/36689262 ID - info:doi/10.2196/41442 ER - TY - JOUR AU - Dorr, David AU - D'Autremont, Chris AU - Richardson, E. Joshua AU - Bobo, Michelle AU - Terndrup, Christopher AU - Dunne, J. M. AU - Cheng, Anthony AU - Rope, Robert PY - 2023/1/23 TI - Patient-Facing Clinical Decision Support for High Blood Pressure Control: Patient Survey JO - JMIR Cardio SP - e39490 VL - 7 KW - high blood pressure KW - hypertension KW - clinical decision support KW - shared decision-making KW - blood pressure control KW - decision-making support KW - patient engagement KW - patient support tool N2 - Background: High blood pressure (HBP) affects nearly half of adults in the United States and is a major factor in heart attacks, strokes, kidney disease, and other morbidities. To reduce risk, guidelines for HBP contain more than 70 recommendations, including many related to patient behaviors, such as home monitoring and lifestyle changes. Thus, the patient?s role in controlling HBP is crucial. Patient-facing clinical decision support (CDS) tools may help patients adhere to evidence-based care, but customization is required. Objective: Our objective was to understand how to adapt CDS to best engage patients in controlling HBP. Methods: We conducted a mixed methods study with two phases: (1) survey-guided interviews with a limited cohort and (2) a nationwide web-based survey. Participation in each phase was limited to adults aged between 18 and 85 years who had been diagnosed with hypertension. The survey included general questions that assessed goal setting, treatment priorities, medication load, comorbid conditions, satisfaction with blood pressure (BP) management, and attitudes toward CDS, and also a series of questions regarding A/B preferences using paired information displays to assess perceived trustworthiness of potential CDS user interface options. Results: We conducted 17 survey-guided interviews to gather patient needs from CDS, then analyzed results and created a second survey of 519 adults with clinically diagnosed HBP. A large majority of participants reported that BP control was a high priority (83%), had monitored BP at home (82%), and felt comfortable using technology (88%). Survey respondents found displays with more detailed recommendations more trustworthy (56%-77% of them preferred simpler displays), especially when incorporating social trust and priorities from providers and patients like them, but had no differences in action taken. Conclusions: Respondents to the survey felt that CDS capabilities could help them with HBP control. The more detailed design options for BP display and recommendations messaging were considered the most trustworthy yet did not differentiate perceived actions. UR - https://cardio.jmir.org/2023/1/e39490 UR - http://dx.doi.org/10.2196/39490 UR - http://www.ncbi.nlm.nih.gov/pubmed/36689260 ID - info:doi/10.2196/39490 ER - TY - JOUR AU - Chew, Evelyn AU - Teo, Huang Sok AU - Tang, Ee Wern AU - Ng, Liang David Wei AU - Koh, Huat Gerald Choon AU - Teo, Ying Valerie Hui PY - 2023/1/5 TI - Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views JO - JMIR Hum Factors SP - e36072 VL - 10 KW - telemedicine KW - hypertension KW - remote blood pressure monitoring KW - health IT KW - primary health care KW - trust KW - health care provider relationship KW - blood pressure KW - primary care KW - qualitative study KW - health care workers KW - patients N2 - Background: Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider. Objective: To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship. Methods: A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust. Results: In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients? distrust of technology, clinicians? concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk). Conclusions: Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care. UR - https://humanfactors.jmir.org/2023/1/e36072 UR - http://dx.doi.org/10.2196/36072 UR - http://www.ncbi.nlm.nih.gov/pubmed/36602847 ID - info:doi/10.2196/36072 ER - TY - JOUR AU - Tang, Dongfeng AU - Zhou, Yiheng AU - Long, Chengxu AU - Tang, Shangfeng PY - 2022/11/22 TI - The Association of Midday Napping With Hypertension Among Chinese Adults Older Than 45 Years: Cross-sectional Study JO - JMIR Public Health Surveill SP - e38782 VL - 8 IS - 11 KW - hypertension KW - risk factor KW - midday napping KW - BMI KW - mediation effect N2 - Background: Hypertension is one of the main public health issues around worldwide, and midday napping is a popular habit. The association between the two remains to be explored. Objective: The goal of the research was to explore the association of midday napping with hypertension. Methods: This study separately selected 11,439, 12,689, and 9464 Chinese respondents aged over 45 years from the China Health and Retirement Longitudinal Study 2011, 2015, and 2018 data sets. Binary logistic regression was used to explore the association of midday napping with hypertension, and the 3-step method was used to test the mediation effect of BMI. Results: Among all respondents, the prevalence rates of hypertension were 24.6% (2818/11439) in 2011, 21.1% (2683/12689) in 2015, and 22.1% (2092/9464) in 2018. Midday napping was positively correlated with hypertension. In 2011 and 2015, napping 60 to 90 minutes had the greatest odds ratios [OR] (OR2011 1.705, OR2015 1.494). In 2018, the biggest OR came from the group napping 30 to 60 minutes (OR 1.223), and ORs of different napping durations decreased from 2011 to 2018. In addition, BMI had a partial mediation effect in 2015 and 2018. Conclusions: Midday napping is a potential risk factor for hypertension with BMI acting as a mediator. To prevent hypertension, avoiding prolonged duration of midday napping and taking action to maintain a normal BMI level are recommended. UR - https://publichealth.jmir.org/2022/11/e38782 UR - http://dx.doi.org/10.2196/38782 UR - http://www.ncbi.nlm.nih.gov/pubmed/36279195 ID - info:doi/10.2196/38782 ER - TY - JOUR AU - Alnooh, Ghadah AU - Alessa, Tourkiah AU - Hawley, Mark AU - de Witte, Luc PY - 2022/11/2 TI - The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review JO - JMIR Cardio SP - e35876 VL - 6 IS - 2 KW - DASH diet KW - Dietary Approaches to Stop Hypertension KW - smartphone app KW - mobile app KW - blood pressure N2 - Background: Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP. Objective: This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use. Methods: The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration?s Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health. Results: A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use. Conclusions: There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. UR - https://cardio.jmir.org/2022/2/e35876 UR - http://dx.doi.org/10.2196/35876 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322108 ID - info:doi/10.2196/35876 ER - TY - JOUR AU - Branch, H. OraLee AU - Rikhy, Mohit AU - Auster-Gussman, A. Lisa AU - Lockwood, G. Kimberly AU - Graham, A. Sarah PY - 2022/10/27 TI - Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App?Based Hypertension Care Program: Observational Study JO - JMIR Form Res SP - e38215 VL - 6 IS - 10 KW - high blood pressure KW - obesity KW - weight loss KW - conversational artificial intelligence KW - lifestyle coaching N2 - Background: Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. Objective: This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Methods: Participants (N=864) had a baseline systolic BP (SBP) ?120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. Results: By month 3, there was a significant drop of ?5.4 mm Hg (95% CI ?6.5 to ?4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ?5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of ?12.4 mm Hg (SE 1.2 mm Hg) by month 3 and ?13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by ?5.2 mm Hg (SE 0.8) mm Hg by month 3 and ?7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by ?1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (?=.11; P<.001), percent weight change (?=?.36; P=.02), and initial BMI (?=?.56; P<.001) were significantly associated with the likelihood of lowering SBP ?5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was ?0.0024 (95% CI ?0.0052 to 0; P=.002). Conclusions: A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ?5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss. UR - https://formative.jmir.org/2022/10/e38215 UR - http://dx.doi.org/10.2196/38215 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301618 ID - info:doi/10.2196/38215 ER - TY - JOUR AU - Yang, Yuting AU - Hou, Mengchi AU - Gong, Xue AU - Guo, Rui AU - Feng, Lin Xing AU - Tian, Rui PY - 2022/10/26 TI - Quality Assessment of Hypertension Treatment?Related Information on WeChat: Cross-sectional Study JO - J Med Internet Res SP - e38567 VL - 24 IS - 10 KW - quality assessment KW - hypertension KW - WeChat KW - DISCERN instrument N2 - Background: The WeChat platform has become a primary source for medical information in China. However, no study has been conducted to explore the quality of information on WeChat for the treatment of hypertension, the leading chronic condition. Objective: This study aimed to explore the quality of information in articles on WeChat that are related to hypertension treatment from the aspects of credibility, concreteness, accuracy, and completeness. Methods: We searched for all information related to hypertension treatment on WeChat based on several inclusion and exclusion criteria. We used 2 tools to evaluate information quality, and 2 independent reviewers performed the assessment with the 2 tools separately. First, we adopted the DISCERN instrument to assess the credibility and concreteness of the treatment information, with the outcomes classified into five grades: excellent, good, fair, poor, and very poor. Second, we applied the Chinese Guidelines for Prevention and Treatment of Hypertension (2018 edition) to evaluate the accuracy and completeness of the article information with regard to specific medical content. Third, we combined the results from the 2 assessments to arrive at the overall quality of the articles and explored the differences between, and associations of, the 2 independent assessments. Results: Of the 223 articles that were retrieved, 130 (58.3%) full texts were included. Of these 130 articles, 81 (62.3%) described therapeutic measures for hypertension. The assessment based on the DISCERN instrument reported a mean score of 31.22 (SD 8.46). There were no articles rated excellent (mean score >63); most (111/130, 85.4%) of the articles did not refer to the consequences?in particular, quality of life?of no treatment. For specific medical content, adherence to the Chinese Guidelines for Prevention and Treatment of Hypertension was generally low in terms of accuracy and completeness, and there was much erroneous information. The overall mean quality score was 10.18 (SD 2.22) for the 130 articles, and the scores differed significantly across the 3 types (P=.03) and 5 sources (P=.02). Articles with references achieved higher scores for quality than those reporting none (P<.001). The results from the DISCERN assessment and the medical content scores were highly correlated (?=0.58; P<.001). Conclusions: The quality of hypertension treatment?related information on the WeChat platform is low. Future work is warranted to regulate information sources and strengthen references. For the treatment of hypertension, crucial information on the consequences of no treatment is urgently needed. UR - https://www.jmir.org/2022/10/e38567 UR - http://dx.doi.org/10.2196/38567 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287598 ID - info:doi/10.2196/38567 ER - TY - JOUR AU - Xue, Qun AU - Zhang, Xuewu AU - Liu, Rong AU - Guan, Xiaoqin AU - Li, Guocheng AU - Zhao, Linhai AU - Wang, Qian AU - Wang, Debin AU - Shen, Xingrong PY - 2022/10/11 TI - Differentiated Effects and Determinants of Home Blood Pressure Telemonitoring: Three-Year Cohort Study in Jieshou, Anhui, China JO - J Med Internet Res SP - e37648 VL - 24 IS - 10 KW - blood pressure KW - home telemonitoring KW - effect KW - influence factors KW - China N2 - Background: Home blood pressure telemonitoring (HBPT) is witnessing rapid diffusion worldwide. Contemporary studies documented mainly short-term (6-12 months) effects of HBPT, and there are limited data about its uptake. Objective: The aim of this study was to explore the 3-year use and determinants of HBPT, and the interactions with systolic and diastolic blood pressure (SBP/DBP) and overall blood pressure (BP) control rate. Methods: HBPT records were obtained from a 3-year cohort of 5658 patients with hypertension in Jieshou, Anhui, China, and data from a structured household survey of a random sample (n=3005) of the cohort. The data analysis comprised (1) timeline trajectories of the rates of monthly active HBPT and mean SBP/DBP for overall and subgroups of patients with varied start-month SBP/DBP; and (2) multivariable linear, logistic, and percentile regression analyses using SBP/DBP, BP control rate, and yearly times of HBPT as the dependent variable, respectively. Results: HBPT was followed by mixed changes in mean monthly SBP/DBP for varied patient groups. The magnitude of changes ranged from ?43 to +39 mmHg for SBP and from ?27 to +15 mmHg for DBP. The monthly rates of active HBPT all exhibited a rapid and then gradually slower decline. When controlled for commonly reported confounders, times of HBPT in the last year were found to have decreasing correlation coefficients for SBP/DBP (from 0.16 to ?0.35 and from 0.11 to ?0.35, respectively) and for BP control rate (from 0.53 to ?0.62). Conclusions: HBPT had major and ?target-converging? effects on SBP/DBP. The magnitude of changes was much greater than commonly reported. BP, variation in BP, and time were the most important determinants of HBPT uptake. Age, education, duration of hypertension, family history, and diagnosis of hypertension complications were also linked to the uptake but at weaker strength. There is a clear need for differentiated thinking over the application and assessment of HBPT, and for identifying and correcting/leveraging potential outdated/new opportunities or beliefs. UR - https://www.jmir.org/2022/10/e37648 UR - http://dx.doi.org/10.2196/37648 UR - http://www.ncbi.nlm.nih.gov/pubmed/36114000 ID - info:doi/10.2196/37648 ER - TY - JOUR AU - Abid, Leila AU - Hammami, Rania AU - Abdesselem, Salem AU - Boudiche, Selim AU - Hédi, Slima Ben AU - Sayahi, Khaled AU - Bahloul, Amine AU - Chamtouri, Ikram AU - Charfeddine, Salma AU - Rais, Lamia AU - Drissa, Meriem AU - Ben Kaab, Badreddine AU - Ibn hadj amor, Hassen AU - Ben Fatma, Lilia AU - Garbaa, Riadh AU - Boukhris, Sabrine AU - Emna, Allouche AU - Ben Halima, Manel AU - Amdouni, Nesrine AU - Ghorbel, Shayma AU - Soudani, Sabrine AU - Khaled, Imen AU - Triki, Syrine AU - Bouazizi, Feten AU - Jemai, Imen AU - Abdeljalil, Ouday AU - Ammar, Yemna AU - Farah, Amani AU - Neji, Adnen AU - Oumaya, Zeineb AU - Seghaier, Sana AU - Mokrani, Samir AU - Thawaba, Hamza AU - Sarray, Hela AU - Ouaghlani, Khalil AU - Thabet, Houssem AU - Mnif, Zeineb AU - Fatma, Masmoudi Boujelben AU - Sghaier, Mohamed AU - Khalifa, Roueida AU - Fourati, Sami AU - Kammoun, Yassmine AU - Abid, Syrine AU - Hamza, Chiheb AU - Ben Jeddou, Syrine AU - Sabbah, Lassaad AU - Lakhdhar, Rim AU - Dammak, Najla AU - Sellami, Tarak AU - Herbegue, Basma AU - Koubaa, Alia AU - Triki, Faten AU - Ellouze, Tarek AU - Hmoudi, Aicha AU - Ben Ameur, Ikhlas AU - Boukhchina, Mongi Mohamed AU - Abid, Neila AU - Ouechtati, Wejdene AU - Nasrallah, Nizar AU - Houidi, Yousra AU - Mghaieth Zghal, Fathia AU - Elhem, Ghodhbane AU - Chayeb, Mounira AU - Sarra, Chenik AU - Kaabachi, Samira AU - Saadaoui, Nizar AU - Ben Ameur, Ines AU - Affes, Moufida AU - Ouali, Sana AU - Chaker, Mouna AU - Naana, Hela AU - Meriem, Dghim AU - Jarrar, Mourad AU - Mnif, Jihen AU - Turki, Ahmed AU - Zairi, Ihsen AU - Langar, Jamel AU - Dardouri, Safa AU - Hachaichi, Imen AU - Chettaoui, Rafik AU - Smat, Wajih AU - Chakroun, Amel AU - Mzoughi, Khadija AU - Mechmeche, Rachid AU - Ben Halima, Afef AU - Ben Kahla Koubaa, Sahar AU - Chtourou, Slim AU - Mohamed abdelkader, Maalej AU - Ayari, Mohsen AU - Hadrich, Moufid AU - Rami, Tlili AU - Azaiez, Fares AU - Bouhlel, Imen AU - Sahnoun, Samir AU - Jerbi, Habib AU - Imtinene, Mrad Ben AU - Riahi, Leila AU - Sahnoun, Mohamed AU - Ben Jemaa, Abdelhamid AU - Ben Salem, Amal AU - Rekik, Bassem AU - Ben Doudou, Maroua AU - Boujnah, Rachid Mohamed AU - Joulak, Anissa AU - Omar, Abid AU - Razgallah, Rabie AU - Sami, Milouchi AU - Neffati, Elyes AU - Gamra, Habib AU - Ben Youssef, Soraya AU - Sdiri, Wissem AU - Ben Halima, Nejeh AU - Ben Ameur, Youssef AU - Kachboura, Salem AU - Kraiem, Sondes AU - Fehri, Wafa AU - Zakhama, Lilia AU - Bezdah, leila AU - Mohamed Sami, Mourali AU - Drissa, Habiba AU - Maatouk, Faouzi Mohamed AU - Kammoun, Samir AU - Addad, Faouzi PY - 2022/9/2 TI - Design and Rationale of the National Observational Multicentric Tunisian Registry of Hypertension: Protocol for Evaluating Hypertensive Patient Care in Clinical Practice JO - JMIR Res Protoc SP - e21878 VL - 11 IS - 9 KW - National Tunisian Registry KW - hypertension N2 - Background: This study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. Objective: This study will provide us an overview of hypertension (HTN) management in Tunisia and the degree of adherence of practitioners to international recommendations. Methods: This is a national observational cross-sectional multicenter study that will include patients older than 18 years with HTN for a duration of 4 weeks, managed in the public sector from primary and secondary care centers as well as patients managed in the private sector. Every participating patient signed a consent form. The study will exclude patients undergoing dialysis. The parameters that will be evaluated are demographic and anthropometric data, lifestyle habits, blood pressure levels, lipid profiles, treatment, and adherence to treatment. The data are collected via the web interface in the Dacima Clinical Suite. Results: The study began on April 15, 2019 and ended on May 15, 2019. During this period, we included 25,890 patients with HTN. Data collection involved 321 investigators from 24 Tunisian districts. The investigators were doctors working in the private and public sectors. Conclusions: Observational studies are extremely useful in improving the management of HTN in developing countries. Trial Registration: ClinicalTrials.gov NCT04013503; https://clinicaltrials.gov/ct2/show/NCT04013503 International Registered Report Identifier (IRRID): DERR1-10.2196/21878 UR - https://www.researchprotocols.org/2022/9/e21878 UR - http://dx.doi.org/10.2196/21878 UR - http://www.ncbi.nlm.nih.gov/pubmed/36053572 ID - info:doi/10.2196/21878 ER - TY - JOUR AU - Te, Vannarath AU - Wouters, Edwin AU - Buffel, Veerle AU - Van Damme, Wim AU - van Olmen, Josefien AU - Ir, Por PY - 2022/9/2 TI - Generation of Cascades of Care for Diabetes and Hypertension Care Continuum in Cambodia: Protocol for a Population-Based Survey Protocol JO - JMIR Res Protoc SP - e36747 VL - 11 IS - 9 KW - diabetes KW - hypertension KW - cascade of care KW - implementation research KW - care models KW - population-based survey KW - continuum of care N2 - Background: Cardiovascular diseases (CVDs) were accountable for 24% of the total deaths in Cambodia, one of the low- and middle-income countries, where primary health care (PHC) settings generally do not perform well in the early detection, diagnosis, and monitoring of leading risk factors for CVDs, that is, type 2 diabetes (T2D) and hypertension (HT). Integrated care for T2D and HT in the Cambodian PHC system remains limited, with more than two-thirds of the population never having had their blood glucose measured and more than half of the population with T2D having not received treatment, with only few of them achieving recommended treatment targets. With regard to care for T2D and HT in the public health care system, 3 care models are being scaled up, including (1) a hospital-based model, (2) a health center?based model, and (3) a community-based model. These 3 care models are implemented in isolation with relatively little interaction between each other. The question arises as to what extent the 3 care models have performed in providing care to patients with T2D or HT or both in Cambodia. Objective: This protocol aims to show how to use primary data from a population-based survey to generate data for the cascades of care to assess the continuum of care for T2D and HT across different care models. Methods: We adapt the HIV test-treat-retain cascade of care to assess the continuum of care for patients living with T2D and HT. The cascade-of-care approach outlines the sequential steps in long-term care: testing, diagnosis, linkage with care, retention in care, adherence to treatment, and reaching treatment targets. Five operational districts (ODs) in different provinces will be purposefully selected out of 103 ODs across the country. The population-based survey will follow a multistage stratified random cluster sampling, with expected recruitment of 5280 eligible individuals aged 40 and over as the total sample size. Data collection process will follow the STEPS (STEPwise approach to NCD risk factor surveillance) survey approach, with modification of the sequence of the steps to adapt the data collection to the study context. Data collection involves 3 main steps: (1) structured interviews with questionnaires, (2) anthropometric measurements, and (3) biochemical measurements. Results: As of December 2021, the recruitment process was completed, with 5072 eligible individuals participating in the data collection; however, data analysis is pending. Results are expected to be fully available in mid-2022. Conclusions: The cascade of care will allow us to identify leakages in the system as well as the unmet need for care. Identifying gaps in the health system is vital to improve efficiency and effectiveness of its performance. This study protocol and its expected results will help implementers and policy makers to assess scale-up and adapt strategies for T2D and HT care in Cambodia. Trial Registration: International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064 International Registered Report Identifier (IRRID): DERR1-10.2196/36747 UR - https://www.researchprotocols.org/2022/9/e36747 UR - http://dx.doi.org/10.2196/36747 UR - http://www.ncbi.nlm.nih.gov/pubmed/36053576 ID - info:doi/10.2196/36747 ER - TY - JOUR AU - Kassavou, Aikaterini AU - Wang, Michael AU - Mirzaei, Venus AU - Shpendi, Sonia AU - Hasan, Rana PY - 2022/7/12 TI - The Association Between Smartphone App?Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis JO - JMIR Mhealth Uhealth SP - e34767 VL - 10 IS - 7 KW - self-monitoring KW - smartphone apps KW - behavior change KW - hypertension KW - blood pressure KW - mobile health KW - mHealth KW - mobile app KW - self-management KW - lifestyle N2 - Background: Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. Objective: This systematic literature review evaluates the extent to which smartphone app?based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. Methods: A systematic search of 7 databases was conducted in August 2021. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. The search strategy was developed using keywords from previous reviews and relevant literature. Trials involving adults, published after the year 2000, and in the English language were considered for inclusion. The random-effects meta-analysis method was used to account for the distribution of the effect across the studies. Results: We identified 4638 articles, of which 227 were included for full-text screening. A total of 15 randomized controlled trials were included in the review. In total, 7415 patients with hypertension were included in the meta-analysis. The results indicate that app-based behavioral self-monitoring interventions had a small but significant effect in reducing systolic blood pressure (SBP), on average, by 1.64 mmHg (95% CI 2.73-0.55, n=7301; odds ratio [OR] 1.60, 95% CI 0.74-3.42, n=114) and in improving changes in medication adherence behavior (standardized mean difference [SMD] 0.78, 95% CI 0.22-1.34) compared to usual care or minimal intervention. The review found the intervention had a small effect on supporting improvements in healthy diet by changing habits related to high sodium food (SMD ?0.44, 95% CI ?0.79 to ?0.08) and a trend, although insignificant, toward supporting smoking cessation, low alcohol consumption, and better physical activity behaviors. A subgroup analysis found that behavioral self-monitoring interventions combined with tailored advice resulted in higher and significant changes in both SBP and diastolic blood pressure (DBP) in comparison to those not providing tailored advice (SBP: ?2.92 mmHg, 95% CI ?3.94 to ?1.90, n=3102 vs ?0.72 mmHg, 95% CI ?1.67 to 0.23, n=4199, ?2=9.65, P=.002; DBP: ?2.05 mmHg, 95% CI ?3.10 to ?1.01, n=968 vs 1.54 mmHg, 95% CI ?0.53 to 3.61, n=400, ?2=9.19, P=.002). Conclusions: Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has a modest but potentially clinically significant effect on blood pressure reduction. Future studies could use rigorous methods to explore its effects on supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision. Trial Registration: PROSPERO CRD42019136158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136158 UR - https://mhealth.jmir.org/2022/7/e34767 UR - http://dx.doi.org/10.2196/34767 UR - http://www.ncbi.nlm.nih.gov/pubmed/35819830 ID - info:doi/10.2196/34767 ER - TY - JOUR AU - Baratta, Juliana AU - Brown-Johnson, Cati AU - Safaeinili, Nadia AU - Goldman Rosas, Lisa AU - Palaniappan, Latha AU - Winget, Marcy AU - Mahoney, Megan PY - 2022/6/10 TI - Patient and Health Professional Perceptions of Telemonitoring for Hypertension Management: Qualitative Study JO - JMIR Form Res SP - e32874 VL - 6 IS - 6 KW - hypertension KW - remote blood pressure monitoring KW - precision health KW - mobile phone N2 - Background: Hypertension is the most prevalent and important risk factor for cardiovascular disease, affecting nearly 50% of the US adult population; however, only 30% of these patients achieve controlled blood pressure (BP). Incorporating strategies into primary care that take into consideration individual patient needs, such as remote BP monitoring, may improve hypertension management. Objective: From March 2018 to December 2018, Stanford implemented a precision health pilot called Humanwide, which aimed to leverage high-technology and high-touch medicine to tailor individualized care for conditions such as hypertension. We examined multi-stakeholder perceptions of hypertension management in Humanwide to evaluate the program?s acceptability, appropriateness, feasibility, and sustainability. Methods: We conducted semistructured interviews with 16 patients and 15 health professionals to assess their experiences with hypertension management in Humanwide. We transcribed and analyzed the interviews using a hybrid approach of inductive and deductive analysis to identify common themes around hypertension management and consensus methods to ensure reliability and validity. Results: A total of 63% (10/16) of the patients and 40% (6/15) of the health professionals mentioned hypertension in the context of Humanwide. These participants reported that remote BP monitoring improved motivation, BP control, and overall clinic efficiency. The health professionals discussed feasibility challenges, including the time needed to analyze BP data and provide individualized feedback, integration of BP data, technological difficulties with the BP cuff, and decreased patient use of remote BP monitoring over time. Conclusions: Remote BP monitoring for hypertension management in Humanwide was acceptable to patients and health professionals and appropriate for care. Important challenges need to be addressed to improve the feasibility and sustainability of this approach by leveraging team-based care, engaging patients to sustain remote BP monitoring, standardizing electronic medical record integration of BP measurements, and finding more user-friendly BP cuffs. UR - https://formative.jmir.org/2022/6/e32874 UR - http://dx.doi.org/10.2196/32874 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687380 ID - info:doi/10.2196/32874 ER - TY - JOUR AU - Abba, Mustapha AU - Nduka, Chidozie AU - Anjorin, Seun AU - Mohamed, Shukri AU - Agogo, Emmanuel AU - Uthman, Olalekan PY - 2022/5/18 TI - One Hundred Years of Hypertension Research: Topic Modeling Study JO - JMIR Form Res SP - e31292 VL - 6 IS - 5 KW - hypertension KW - high blood pressure KW - machine learning KW - topic modeling KW - latent Dirichlet allocation KW - LDA KW - cardiovascular KW - research trends N2 - Background: Due to scientific and technical advancements in the field, published hypertension research has developed substantially during the last decade. Given the amount of scientific material published in this field, identifying the relevant information is difficult. We used topic modeling, which is a strong approach for extracting useful information from enormous amounts of unstructured text. Objective: This study aims to use a machine learning algorithm to uncover hidden topics and subtopics from 100 years of peer-reviewed hypertension publications and identify temporal trends. Methods: The titles and abstracts of hypertension papers indexed in PubMed were examined. We used the latent Dirichlet allocation model to select 20 primary subjects and then ran a trend analysis to see how popular they were over time. Results: We gathered 581,750 hypertension-related research articles from 1900 to 2018 and divided them into 20 topics. These topics were broadly categorized as preclinical, epidemiology, complications, and therapy studies. Topic 2 (evidence review) and topic 19 (major cardiovascular events) are the key (hot topics). Most of the cardiopulmonary disease subtopics show little variation over time, and only make a small contribution in terms of proportions. The majority of the articles (414,206/581,750; 71.2%) had a negative valency, followed by positive (119, 841/581,750; 20.6%) and neutral valency (47,704/581,750; 8.2%). Between 1980 and 2000, negative sentiment articles fell somewhat, while positive and neutral sentiment articles climbed substantially. Conclusions: The number of publications has been increasing exponentially over the period. Most of the uncovered topics can be grouped into four categories (ie, preclinical, epidemiology, complications, and treatment-related studies). UR - https://formative.jmir.org/2022/5/e31292 UR - http://dx.doi.org/10.2196/31292 UR - http://www.ncbi.nlm.nih.gov/pubmed/35583933 ID - info:doi/10.2196/31292 ER - TY - JOUR AU - Gardiner, Paula AU - McGonigal, Lisa AU - Villa, Ariel AU - Kovell, C. Lara AU - Rohela, Pallavi AU - Cauley, Andrew AU - Rinker, Diana AU - Olendzki, Barbara PY - 2022/5/16 TI - Our Whole Lives for Hypertension and Cardiac Risk Factors?Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial JO - JMIR Form Res SP - e29227 VL - 6 IS - 5 KW - hypertension KW - health disparities KW - teaching kitchen KW - technology KW - mindfulness KW - low income KW - medical group visits KW - mobile phone N2 - Background: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results: Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants? average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income 23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9% and 5.3%, respectively). On the contrary, the input rate of medicine intake was high (84.0%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3% and 87.3%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (?0.519 kg vs 0 kg), BMI (?0.133 kg/m2 vs ?0.167 kg/m2), body composition (body fat ?0.255% vs 0.172%), blood pressure (systolic ?0.226 mm Hg vs ?2.839 mm Hg), and HbA1c (?0.269% vs ?0.009%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group. Conclusions: Although smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels. UR - https://mhealth.jmir.org/2022/1/e27192 UR - http://dx.doi.org/10.2196/27192 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014961 ID - info:doi/10.2196/27192 ER - TY - JOUR AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Huang, Ching-Chang AU - Lee, Jen-Kuang AU - Yu, Jiun-Yu AU - Ho, Yi-Lwun PY - 2022/1/10 TI - The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study JO - J Med Internet Res SP - e22957 VL - 24 IS - 1 KW - blood pressure KW - variability KW - telehealth KW - hypertension KW - cardiovascular disease KW - chronic disease KW - heart KW - digital platform KW - cohort KW - management KW - intervention N2 - Background: Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. Objective: The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP. Methods: This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05%) patients who received home BP surveillance for ?56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated. Results: Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2±9.2 to 133.7±10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8±3.4 to 7.3±3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3±2.5 to 5.9±2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95% CI 1.18-3.89). Conclusions: Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD. UR - https://www.jmir.org/2022/1/e22957 UR - http://dx.doi.org/10.2196/22957 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006089 ID - info:doi/10.2196/22957 ER - TY - JOUR AU - Breil, Bernhard AU - Salewski, Christel AU - Apolinário-Hagen, Jennifer PY - 2022/1/6 TI - Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey JO - JMIR Cardio SP - e31617 VL - 6 IS - 1 KW - patient acceptance of health care KW - mobile apps KW - blood pressure KW - mobile health KW - health applications KW - technology acceptance KW - patients KW - physicians KW - digital health N2 - Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients? preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. UR - https://cardio.jmir.org/2022/1/e31617 UR - http://dx.doi.org/10.2196/31617 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989683 ID - info:doi/10.2196/31617 ER - TY - JOUR PY - 2021// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e11842 VL - 13 IS - 3 UR - UR - http://dx.doi.org/10.5210/ojphi.v13i3.11842 UR - http://www.ncbi.nlm.nih.gov/pubmed/35079322 ID - info:doi/10.5210/ojphi.v13i3.11842 ER - TY - JOUR AU - Park, Dohyun AU - Cho, Jin Soo AU - Kim, Kyunga AU - Woo, Hyunki AU - Kim, Eun Jee AU - Lee, Jin-Young AU - Koh, Janghyun AU - Lee, JeanHyoung AU - Choi, Soo Jong AU - Chang, Kyung Dong AU - Choi, Yoon-Ho AU - Chung, In Ji AU - Cha, Chul Won AU - Jeong, Soon Ok AU - Jekal, Yong Se AU - Kang, Mira PY - 2021/12/8 TI - Prediction Algorithms for Blood Pressure Based on Pulse Wave Velocity Using Health Checkup Data in Healthy Korean Men: Algorithm Development and Validation JO - JMIR Med Inform SP - e29212 VL - 9 IS - 12 KW - blood pressure KW - pulse transit time KW - pulse wave velocity KW - prediction model KW - algorithms KW - medical informatics KW - wearable devices N2 - Background: Pulse transit time and pulse wave velocity (PWV) are related to blood pressure (BP), and there were continuous attempts to use these to predict BP through wearable devices. However, previous studies were conducted on a small scale and could not confirm the relative importance of each variable in predicting BP. Objective: This study aims to predict systolic blood pressure and diastolic blood pressure based on PWV and to evaluate the relative importance of each clinical variable used in BP prediction models. Methods: This study was conducted on 1362 healthy men older than 18 years who visited the Samsung Medical Center. The systolic blood pressure and diastolic blood pressure were estimated using the multiple linear regression method. Models were divided into two groups based on age: younger than 60 years and 60 years or older; 200 seeds were repeated in consideration of partition bias. Mean of error, absolute error, and root mean square error were used as performance metrics. Results: The model divided into two age groups (younger than 60 years and 60 years and older) performed better than the model without division. The performance difference between the model using only three variables (PWV, BMI, age) and the model using 17 variables was not significant. Our final model using PWV, BMI, and age met the criteria presented by the American Association for the Advancement of Medical Instrumentation. The prediction errors were within the range of about 9 to 12 mmHg that can occur with a gold standard mercury sphygmomanometer. Conclusions: Dividing age based on the age of 60 years showed better BP prediction performance, and it could show good performance even if only PWV, BMI, and age variables were included. Our final model with the minimal number of variables (PWB, BMI, age) would be efficient and feasible for predicting BP. UR - https://medinform.jmir.org/2021/12/e29212 UR - http://dx.doi.org/10.2196/29212 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889753 ID - info:doi/10.2196/29212 ER - TY - JOUR AU - DeLaughter, L. Kathryn AU - Fix, M. Gemmae AU - McDannold, E. Sarah AU - Pope, Charlene AU - Bokhour, G. Barbara AU - Shimada, L. Stephanie AU - Calloway, Rodney AU - Gordon, S. Howard AU - Long, A. Judith AU - Miano, A. Danielle AU - Cutrona, L. Sarah PY - 2021/12/1 TI - Incorporating African American Veterans? Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol JO - JMIR Res Protoc SP - e29423 VL - 10 IS - 12 KW - texting KW - African American KW - hypertension KW - self-management KW - mobile phone N2 - Background: Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients? daily lives. Objective: In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods: We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results: Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions: We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration: ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID): DERR1-10.2196/29423 UR - https://www.researchprotocols.org/2021/12/e29423 UR - http://dx.doi.org/10.2196/29423 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855617 ID - info:doi/10.2196/29423 ER - TY - JOUR AU - Montgomery, M. Robert AU - Boucher, M. Eliane AU - Honomichl, D. Ryan AU - Powell, A. Tyler AU - Guyton, L. Sharelle AU - Bernecker, L. Samantha AU - Stoeckl, Elizabeth Sarah AU - Parks, C. Acacia PY - 2021/11/19 TI - The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data JO - JMIR Cardio SP - e32351 VL - 5 IS - 2 KW - digital mental health KW - digital health KW - mobile apps KW - mobile health KW - internet-based intervention KW - happiness KW - subjective well-being KW - anxiety KW - cardiovascular health KW - high blood pressure KW - high cholesterol KW - diabetes KW - cardiovascular disease risk KW - real-world data N2 - Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks? exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. UR - https://cardio.jmir.org/2021/2/e32351 UR - http://dx.doi.org/10.2196/32351 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806986 ID - info:doi/10.2196/32351 ER - TY - JOUR AU - Alessa, Tourkiah AU - Hawley, Mark AU - de Witte, Luc PY - 2021/11/17 TI - Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study JO - JMIR Mhealth Uhealth SP - e29207 VL - 9 IS - 11 KW - app KW - hypertension KW - self-management KW - mHealth KW - blood pressure KW - support KW - Saudi Arabia KW - cardiology KW - heart KW - effective KW - security N2 - Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants? attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users? data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients? and doctors? discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. UR - https://mhealth.jmir.org/2021/11/e29207 UR - http://dx.doi.org/10.2196/29207 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787586 ID - info:doi/10.2196/29207 ER - TY - JOUR AU - Yang, Yujie AU - Zheng, Jing AU - Du, Zhenzhen AU - Li, Ye AU - Cai, Yunpeng PY - 2021/11/10 TI - Accurate Prediction of Stroke for Hypertensive Patients Based on Medical Big Data and Machine Learning Algorithms: Retrospective Study JO - JMIR Med Inform SP - e30277 VL - 9 IS - 11 KW - stroke KW - medical big data KW - electronic health records KW - machine learning KW - risk prediction KW - hypertension N2 - Background: Stroke risk assessment is an important means of primary prevention, but the applicability of existing stroke risk assessment scales in the Chinese population has always been controversial. A prospective study is a common method of medical research, but it is time-consuming and labor-intensive. Medical big data has been demonstrated to promote disease risk factor discovery and prognosis, attracting broad research interest. Objective: We aimed to establish a high-precision stroke risk prediction model for hypertensive patients based on historical electronic medical record data and machine learning algorithms. Methods: Based on the Shenzhen Health Information Big Data Platform, a total of 57,671 patients were screened from 250,788 registered patients with hypertension, of whom 9421 had stroke onset during the 3-year follow-up. In addition to baseline characteristics and historical symptoms, we constructed some trend characteristics from multitemporal medical records. Stratified sampling according to gender ratio and age stratification was implemented to balance the positive and negative cases, and the final 19,953 samples were randomly divided into a training set and test set according to a ratio of 7:3. We used 4 machine learning algorithms for modeling, and the risk prediction performance was compared with the traditional risk scales. We also analyzed the nonlinear effect of continuous characteristics on stroke onset. Results: The tree-based integration algorithm extreme gradient boosting achieved the optimal performance with an area under the receiver operating characteristic curve of 0.9220, surpassing the other 3 traditional machine learning algorithms. Compared with 2 traditional risk scales, the Framingham stroke risk profiles and the Chinese Multiprovincial Cohort Study, our proposed model achieved better performance on the independent validation set, and the area under the receiver operating characteristic value increased by 0.17. Further nonlinear effect analysis revealed the importance of multitemporal trend characteristics in stroke risk prediction, which will benefit the standardized management of hypertensive patients. Conclusions: A high-precision 3-year stroke risk prediction model for hypertensive patients was established, and the model's performance was verified by comparing it with the traditional risk scales. Multitemporal trend characteristics played an important role in stroke onset, and thus the model could be deployed to electronic health record systems to assist in more pervasive, preemptive stroke risk screening, enabling higher efficiency of early disease prevention and intervention. UR - https://medinform.jmir.org/2021/11/e30277 UR - http://dx.doi.org/10.2196/30277 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757322 ID - info:doi/10.2196/30277 ER - TY - JOUR AU - Abid, Leila AU - Kammoun, Ikram AU - Ben Halima, Manel AU - Charfeddine, Salma AU - Ben Slima, Hedi AU - Drissa, Meriem AU - Mzoughi, Khadija AU - Mbarek, Dorra AU - Riahi, Leila AU - Antit, Saoussen AU - Ben Halima, Afef AU - Ouechtati, Wejdene AU - Allouche, Emna AU - Mechri, Mehdi AU - Yousfi, Chedi AU - Khorchani, Ali AU - Abid, Omar AU - Sammoud, Kais AU - Ezzaouia, Khaled AU - Gtif, Imen AU - Ouali, Sana AU - Triki, Feten AU - Hamdi, Sonia AU - Boudiche, Selim AU - Chebbi, Marwa AU - Hentati, Mouna AU - Farah, Amani AU - Triki, Habib AU - Ghardallou, Houda AU - Raddaoui, Haythem AU - Zayed, Sofien AU - Azaiez, Fares AU - Omri, Fadwa AU - Zouari, Akram AU - Ben Ali, Zine AU - Najjar, Aymen AU - Thabet, Houssem AU - Chaker, Mouna AU - Mohamed, Samar AU - Chouaieb, Marwa AU - Ben Jemaa, Abdelhamid AU - Tangour, Haythem AU - Kammoun, Yassmine AU - Bouhlel, Mahmoud AU - Azaiez, Seifeddine AU - Letaief, Rim AU - Maskhi, Salah AU - Amri, Aymen AU - Naanaa, Hela AU - Othmani, Raoudha AU - Chahbani, Iheb AU - Zargouni, Houcine AU - Abid, Syrine AU - Ayari, Mokdad AU - ben Ameur, Ines AU - Gasmi, Ali AU - ben Halima, Nejeh AU - Haouala, Habib AU - Boughzela, Essia AU - Zakhama, Lilia AU - ben Youssef, Soraya AU - Nasraoui, Wided AU - Boujnah, Rachid Mohamed AU - Barakett, Nadia AU - Kraiem, Sondes AU - Drissa, Habiba AU - Ben Khalfallah, Ali AU - Gamra, Habib AU - Kachboura, Salem AU - Bezdah, Leila AU - Baccar, Hedi AU - Milouchi, Sami AU - Sdiri, Wissem AU - Ben Omrane, Skander AU - Abdesselem, Salem AU - Kanoun, Alifa AU - Hezbri, Karima AU - Zannad, Faiez AU - Mebazaa, Alexandre AU - Kammoun, Samir AU - Mourali, Sami Mohamed AU - Addad, Faouzi PY - 2021/10/27 TI - Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study JO - JMIR Res Protoc SP - e12262 VL - 10 IS - 10 KW - heart failure KW - acute heart failure KW - chronic heart failure KW - diagnosis KW - prognosis KW - treatment N2 - Background: The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). Objective: The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. Methods: A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. Results: At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. Conclusions: The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial Registration: ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID): DERR1-10.2196/12262 UR - https://www.researchprotocols.org/2021/10/e12262 UR - http://dx.doi.org/10.2196/12262 UR - http://www.ncbi.nlm.nih.gov/pubmed/34704958 ID - info:doi/10.2196/12262 ER - TY - JOUR AU - Menon, Jaideep AU - Numpeli, Mathews AU - Kunjan, P. Sajeev AU - Karimbuvayilil, V. Beena AU - Sreedevi, Aswathy AU - Panniyamakkal, Jeemon AU - Suseela, P. Rakesh AU - Thachathodiyil, Rajesh AU - Banerjee, Amitava PY - 2021/10/22 TI - A Sustainable Community-Based Model of Noncommunicable Disease Risk Factor Surveillance (Shraddha-Jagrithi Project): Protocol for a Cohort Study JO - JMIR Res Protoc SP - e27299 VL - 10 IS - 10 KW - non-communicable diseases KW - surveillance KW - accredited social health activist KW - panchayat (village) KW - primary health centre KW - spoke and hub KW - cardiovascular KW - public health KW - hypertension KW - health services KW - health center KW - diabetes N2 - Background: India has a massive noncommunicable disease (NCD) burden, at an enormous cost to the individual, family, society, and health system at large, despite which prevention and surveillance are relatively neglected. If diagnosed early and treated adequately, risk factors for atherosclerotic cardiovascular disease would help decrease the mortality and morbidity burden. Surveillance for NCDs, creating awareness, positive lifestyle changes, and treatment are the proven measures known to prevent the progression of the disease. India is in a stage of rapid epidemiological transition, with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country in the future. A previous study done by the same investigators in a population of >100,000 revealed poor awareness, treatment of NCDs, and poor adherence to medicines in individuals with CVD. Objective: This study aimed at assessing a sustainable, community-based surveillance model for NCDs with corporate support fully embedded in the public health system. Methods: Frontline health workers will check all individuals in the target group (?age 30 years) with further follow-up and treatment planned in a ?spoke and hub? model using the public health system of primary health centers as spokes to the hubs of taluk or district hospitals. All data entry done by frontline health workers will be on a tablet PC, ensuring rapid acquisition and transfer of participant health details to primary health centers for further follow-up and treatment. Results: The model will be evaluated based on the utilization rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centers for risk stratification and care, and community-level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow-up treatment at no cost to the individual entirely through the tiered public health system of the state and country. Conclusions: Surveillance for NCDs is an essential facet of health care presently lacking in India. Atherosclerotic cardiovascular disease has a long gestation period in progression to the symptomatic phase of the disease, during which timely preventive and lifestyle measures would help prevent disease progression if implemented. Unfortunately, several asymptomatic individuals have never tested their plasma glucose, serum lipid levels, or blood pressure and are unaware of their disease status. Our model, implemented through the public health system using frontline health workers, would ensure individuals aged?30 years at risk of disease are identified, and necessary lifestyle modifications and treatments are given. In addition, the surveillance at the community level would help create a general awareness of NCDs and lead to healthier lifestyle habits. Trial Registration: Clinical Trial Registry India CTRI/2018/07/014856; https://tinyurl.com/4saydnxf International Registered Report Identifier (IRRID): DERR1-10.2196/27299 UR - https://www.researchprotocols.org/2021/10/e27299 UR - http://dx.doi.org/10.2196/27299 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677141 ID - info:doi/10.2196/27299 ER - TY - JOUR AU - Payne Riches, Sarah AU - Piernas, Carmen AU - Aveyard, Paul AU - Sheppard, P. James AU - Rayner, Mike AU - Albury, Charlotte AU - Jebb, A. Susan PY - 2021/10/21 TI - A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e26233 VL - 9 IS - 10 KW - salt reduction KW - behavior change KW - mobile health KW - mHealth KW - smartphone app KW - mobile phone N2 - Background: A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective: The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention?s effectiveness. Methods: This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results: A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions: The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962 UR - https://mhealth.jmir.org/2021/10/e26233 UR - http://dx.doi.org/10.2196/26233 UR - http://www.ncbi.nlm.nih.gov/pubmed/34673535 ID - info:doi/10.2196/26233 ER - TY - JOUR AU - Vera Cruz dos Santos, Daniela AU - Coelho de Soárez, Patrícia AU - Cavero, Victoria AU - U Rocha, I. Thaís AU - Aschar, Suzana AU - Daley, Louise Kate AU - Garcia Claro, Heloísa AU - Abud Scotton, George AU - Fernandes, Ivan AU - Diez-Canseco, Francisco AU - Brandt, Rebeca Lena AU - Toyama, Mauricio AU - Martins Castro, Carolina Hellen AU - Miranda, Jaime J. AU - Araya, Ricardo AU - Quayle, Julieta AU - Rossi Menezes, Paulo PY - 2021/10/13 TI - A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru JO - JMIR Res Protoc SP - e26164 VL - 10 IS - 10 KW - cost-effectiveness KW - depression KW - diabetes KW - hypertension KW - noncommunicable diseases KW - randomized trials KW - low- and middle-income countries KW - mHealth KW - task shifting KW - behavioral activation N2 - Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top?down and bottom?up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID): DERR1-10.2196/26164 UR - https://www.researchprotocols.org/2021/10/e26164 UR - http://dx.doi.org/10.2196/26164 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643538 ID - info:doi/10.2196/26164 ER - TY - JOUR AU - Stollfuss, Barbara AU - Richter, Manuel AU - Drömann, Daniel AU - Klose, Hans AU - Schwaiblmair, Martin AU - Gruenig, Ekkehard AU - Ewert, Ralf AU - Kirchner, C. Martin AU - Kleinjung, Frank AU - Irrgang, Valeska AU - Mueller, Christian PY - 2021/10/8 TI - Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP) JO - J Med Internet Res SP - e25163 VL - 23 IS - 10 KW - 6-minute walk distance KW - 6MWD KW - Breelib KW - daily physical activity KW - digital monitoring KW - health-related quality of life KW - iloprost KW - Ventavis KW - inhalation behavior KW - mobile phone KW - pulmonary arterial hypertension KW - PAH KW - sleeping behavior KW - behavior KW - sleep KW - monitoring KW - physical activity KW - heart KW - cardiology N2 - Background: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. Objective: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. Methods: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro?B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). Results: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4 km, IQR ?0.2 to 1.9; daily step count: median 591, IQR ?509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). Conclusions: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. Trial Registration: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407 International Registered Report Identifier (IRRID): RR2-10.2196/12144 UR - https://www.jmir.org/2021/10/e25163 UR - http://dx.doi.org/10.2196/25163 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623313 ID - info:doi/10.2196/25163 ER - TY - JOUR AU - Schukraft, Sara AU - Boukhayma, Assim AU - Cook, Stéphane AU - Caizzone, Antonino PY - 2021/10/7 TI - Remote Blood Pressure Monitoring With a Wearable Photoplethysmographic Device (Senbiosys): Protocol for a Single-Center Prospective Clinical Trial JO - JMIR Res Protoc SP - e30051 VL - 10 IS - 10 KW - continuous blood pressure monitoring KW - photoplethysmography KW - arterial line KW - Senbiosys KW - wearable devices KW - blood pressure KW - remote monitoring KW - continuous monitoring KW - mHealth KW - mobile health N2 - Background: Wearable devices can provide user-friendly, accurate, and continuous blood pressure (BP) monitoring to assess patients? vital signs and achieve remote patient management. Remote BP monitoring can substantially improve BP control. The newest cuffless BP monitoring devices have emerged in patient care using photoplethysmography. Objective: The Senbiosys trial aims to compare BP measurements of a new device capturing a photoplethysmography signal on the finger versus invasive measurements performed in patients with an arterial catheter in the intensive care unit (ICU) or referred for a coronarography at the Hospital of Fribourg. Methods: The Senbiosys study is a single-center, single-arm, prospective trial. The study population consists of adult patients undergoing coronarography or patients in the ICU with an arterial catheter in place. This study will enroll 35 adult patients, including 25 patients addressed for a coronarography and 10 patients in the ICU. The primary outcome is the assessment of mean bias (95% CI) for systolic BP, diastolic BP, and mean BP between noninvasive and invasive BP measurements. Secondary outcomes include a reliability index (Qualification Index) for BP epochs and count of qualified epochs. Results: Patient recruitment started in June 2021. Results are expected to be published by December 2021. Conclusions: The findings of the Senbiosys trial are expected to improve remote BP monitoring. The diagnosis and treatment of hypertension should benefit from these advancements. Trial Registration: ClinicalTrials.gov NCT04379986; https://clinicaltrials.gov/ct2/show/NCT04379986 International Registered Report Identifier (IRRID): PRR1-10.2196/30051 UR - https://www.researchprotocols.org/2021/10/e30051 UR - http://dx.doi.org/10.2196/30051 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617912 ID - info:doi/10.2196/30051 ER - TY - JOUR AU - Wu, Dan AU - An, Jiye AU - Yu, Ping AU - Lin, Hui AU - Ma, Li AU - Duan, Huilong AU - Deng, Ning PY - 2021/9/28 TI - Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis JO - J Med Internet Res SP - e25630 VL - 23 IS - 9 KW - hypertension KW - health care services KW - mHealth KW - patient engagement KW - electronic follow-up KW - cluster analysis N2 - Background: Hypertension is a long-term medical condition. Electronic and mobile health care services can help patients to self-manage this condition. However, not all management is effective, possibly due to different levels of patient engagement (PE) with health care services. Health care provider follow-up is an intervention to promote PE and blood pressure (BP) control. Objective: This study aimed to discover and characterize patterns of PE with a hypertension self-management app, investigate the effects of health care provider follow-up on PE, and identify the follow-up effects on BP in each PE pattern. Methods: PE was represented as the number of days that a patient recorded self-measured BP per week. The study period was the first 4 weeks for a patient to engage in the hypertension management service. K-means algorithm was used to group patients by PE. There was compliance follow-up, regular follow-up, and abnormal follow-up in management. The follow-up effect was calculated by the change in PE (CPE) and the change in systolic blood pressure (CSBP, SBP) before and after each follow-up. Chi-square tests and z scores were used to ascertain the distribution of gender, age, education level, SBP, and the number of follow-ups in each cluster. The follow-up effect was identified by analysis of variances. Once a significant effect was detected, Bonferroni multiple comparisons were further conducted to identify the difference between 2 clusters. Results: Patients were grouped into 4 clusters according to PE: (1) PE started low and dropped even lower (PELL), (2) PE started high and remained high (PEHH), (3) PE started high and dropped to low (PEHL), and (4) PE started low and rose to high (PELH). Significantly more patients over 60 years old were found in the PEHH cluster (P?.05). Abnormal follow-up was significantly less frequent (P?.05) in the PELL cluster. Compliance follow-up and regular follow-up can improve PE. In the clusters of PEHH and PELH, the improvement in PE in the first 3 weeks and the decrease in SBP in all 4 weeks were significant after follow-up. The SBP of the clusters of PELL and PELH decreased more (?6.1 mmHg and ?8.4 mmHg) after follow-up in the first week. Conclusions: Four distinct PE patterns were identified for patients engaging in the hypertension self-management app. Patients aged over 60 years had higher PE in terms of recording self-measured BP using the app. Once SBP reduced, patients with low PE tended to stop using the app, and a continued decline in PE occurred simultaneously with the increase in SBP. The duration and depth of the effect of health care provider follow-up were more significant in patients with high or increased engagement after follow-up. UR - https://www.jmir.org/2021/9/e25630 UR - http://dx.doi.org/10.2196/25630 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581680 ID - info:doi/10.2196/25630 ER - TY - JOUR AU - Villarino, Tito Resti AU - Arcay, Asuncion Christopher AU - Temblor, Concepcion Maria AU - Villarino, Lorence Maureen AU - Bagsit, Rosita AU - Ocampo, Lanndon AU - Bernard, Paquito PY - 2021/9/24 TI - The Effects of Lifestyle Intervention Using the Modified Beliefs, Attitude, Subjective Norms, Enabling Factors Model in Hypertension Management: Quasi-Experimental Study JO - JMIR Cardio SP - e20297 VL - 5 IS - 2 KW - hypertension KW - BASNEF KW - blood pressure KW - medication adherence N2 - Background: Hypertension is a serious health issue and a significant risk factor for cardiovascular disease and stroke. Although various health education models have been used to improve lifestyle in patients with hypertension, the findings have been inconsistent. Objective: This study aims to assess the effects of a lifestyle intervention program using a modified Beliefs, Attitude, Subjective Norms, Enabling Factors (BASNEF) model among nonadherent participants with hypertension in managing elevated blood pressure (BP) levels. Methods: This study reports a quantitative quasi-experimental research work, particularly using a repeated-measures design of the within-subjects approach on the 50 nonadherent patients who received a diagnosis of essential hypertension in Cebu, Philippines. The research participants received 5 sessions of training based on a modified BASNEF model. An adherence instrument was used as an evaluation platform. The first phase gathers participants' relevant profiles and background, and the final phase gathers participants' systolic BP, diastolic BP, heart rate, and adherence scores. Results: The results indicate that the phase 1 mean systolic readings (146.50, SD 19.59) differ significantly from the phase 4 mean systolic readings (134.92, SD 15.24). They also suggest that the lifestyle intervention based on session III or phase IV behavioral intention in the BASNEF model microgroup sessions positively affects BP readings among the research participants. Conclusions: This study has established that the BASNEF model approach can be a good BP management technique. UR - https://cardio.jmir.org/2021/2/e20297 UR - http://dx.doi.org/10.2196/20297 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559063 ID - info:doi/10.2196/20297 ER - TY - JOUR AU - Tam, Lon Hon AU - Wong, Ling Eliza Mi AU - Cheung, Kin AU - Chung, Fung Siu PY - 2021/9/22 TI - Effectiveness of Text Messaging Interventions on Blood Pressure Control Among Patients With Hypertension: Systematic Review of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e24527 VL - 9 IS - 9 KW - text messaging KW - hypertension KW - blood pressure KW - mHealth KW - meta-analysis N2 - Background: Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice. Objective: This review aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging. Methods: A systematic review was conducted and reported on in accordance with PRISMA guideline. Participants were aged 18 years and older and diagnosed with primary hypertension. The included studies used text messaging as a component of the intervention. We searched for randomized controlled trials published until June 30, 2020, from the following health-related electronic databases: Embase, Medline, CINAHL Complete, PsycINFO, and Scopus. Data were extracted for qualitative synthesis and meta-analysis. The Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study, and the quality of the included studies was assessed independently by two authors. Results: Twelve studies met the inclusion criteria. The overall methodological quality was fair (mean score 5.75). The frequency of text message delivery varied from daily to biweekly. Health education was identified in 4 studies as an additional intervention with text messaging. The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no significant difference in BP reduction between studies that lasted 6 months or less and those that lasted more than 7 months. Seven studies that lasted 6 months or less involving 1428 patients with hypertension were pooled for further meta-analysis. Text messages delivered at a lower frequency (once per week or less) had a small effect on SBP reduction (effect size 0.35, P<.01) and DBP reduction (effect size 0.28, P=.01). In addition, the use of a text messaging intervention halved the odds of uncontrolled BP among patients with hypertension in 6 months (odds ratio 0.46, P=.02). Conclusions: This review found that a text messaging intervention was effective in BP control. One-way text messaging delivered in a weekly manner was suggested to be effective and required fewer resources. Future studies should use different forms of text message and be integrated into other interventions to improve adherence behaviors and BP control among patients with hypertension. UR - https://mhealth.jmir.org/2021/9/e24527 UR - http://dx.doi.org/10.2196/24527 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550078 ID - info:doi/10.2196/24527 ER - TY - JOUR AU - Park, Sulki AU - Kum, Hye-Chung AU - Morrisey, A. Michael AU - Zheng, Qi AU - Lawley, A. Mark PY - 2021/9/6 TI - Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study JO - J Med Internet Res SP - e29018 VL - 23 IS - 9 KW - telemedicine KW - hypertension KW - Medicaid KW - blood pressure KW - pulse KW - telemonitoring KW - mobile phone N2 - Background: Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence. UR - https://www.jmir.org/2021/9/e29018 UR - http://dx.doi.org/10.2196/29018 UR - http://www.ncbi.nlm.nih.gov/pubmed/34486977 ID - info:doi/10.2196/29018 ER - TY - JOUR AU - Yatabe, Junichi AU - Yatabe, Sasaki Midori AU - Okada, Rika AU - Ichihara, Atsuhiro PY - 2021/8/31 TI - Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial JO - JMIR Cardio SP - e27347 VL - 5 IS - 2 KW - blood pressure management KW - digital health KW - web-based medicine KW - prospective study KW - telemonitoring KW - blood pressure KW - monitoring KW - telemedicine KW - telehealth KW - efficacy KW - hypertension KW - video conference KW - safety KW - Japan N2 - Background: The burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience. Objective: This study examined the efficacy and safety of telemedicine for the management of hypertension in Japan. Methods: Patients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network?attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting. Results: Initial screening was completed by 99 patients, 54% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; P=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3% vs 70.0%; P=.01), and significant adverse events were not observed. Conclusions: We present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation. Trial Registration: UMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b UR - https://cardio.jmir.org/2021/2/e27347 UR - http://dx.doi.org/10.2196/27347 UR - http://www.ncbi.nlm.nih.gov/pubmed/34321194 ID - info:doi/10.2196/27347 ER - TY - JOUR AU - Ganti, Venu AU - Carek, M. Andrew AU - Jung, Hewon AU - Srivatsa, V. Adith AU - Cherry, Deborah AU - Johnson, Neicey Levather AU - Inan, T. Omer PY - 2021/8/2 TI - Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study JO - JMIR Mhealth Uhealth SP - e27466 VL - 9 IS - 8 KW - wearable sensing KW - pulse transit time KW - cuffless blood pressure KW - noninvasive blood pressure estimation KW - health equity KW - mobile phone N2 - Background: Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities. Objective: In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)?based device for monitoring BP in a diverse population. Methods: We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. Results: Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness. Conclusions: Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity. UR - https://mhealth.jmir.org/2021/8/e27466 UR - http://dx.doi.org/10.2196/27466 UR - http://www.ncbi.nlm.nih.gov/pubmed/34338646 ID - info:doi/10.2196/27466 ER - TY - JOUR AU - Yin, Xuejun AU - Liu, Hueiming AU - Webster, Jacqui AU - Trieu, Kathy AU - Huffman, D. Mark AU - Miranda, Jaime J. AU - Marklund, Matti AU - Wu, Y. Jason H. AU - Cobb, K. Laura AU - Li, Chun Ka AU - Pearson, Sallie-Anne AU - Neal, Bruce AU - Tian, Maoyi PY - 2021/7/14 TI - Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan JO - JMIR Public Health Surveill SP - e27423 VL - 7 IS - 7 KW - low-sodium salt KW - salt substitute KW - availability KW - formulation KW - labeling KW - price KW - sodium KW - salt KW - blood pressure KW - cardiology N2 - Background: Regular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. Objective: The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Methods: Low-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords ?salt substitute,? ?low-sodium salt,? ?potassium salt,? ?mineral salt,? and ?sodium reduced salt? in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. Results: A total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight; regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. Conclusions: Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. International Registered Report Identifier (IRRID): RR2-10.1111/jch.14054 UR - https://publichealth.jmir.org/2021/7/e27423 UR - http://dx.doi.org/10.2196/27423 UR - http://www.ncbi.nlm.nih.gov/pubmed/33985938 ID - info:doi/10.2196/27423 ER - TY - JOUR AU - Sardana, Mayank AU - Lin, Honghuang AU - Zhang, Yuankai AU - Liu, Chunyu AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Manders, S. Emily AU - Fusco, Kelsey AU - Kornej, Jelena AU - Hammond, M. Michael AU - Spartano, Nicole AU - Pathiravasan, H. Chathurangi AU - Kheterpal, Vik AU - Nowak, Christopher AU - Borrelli, Belinda AU - Murabito, M. Joanne AU - McManus, D. David PY - 2021/6/24 TI - Association of Habitual Physical Activity With Home Blood Pressure in the Electronic Framingham Heart Study (eFHS): Cross-sectional Study JO - J Med Internet Res SP - e25591 VL - 23 IS - 6 KW - hypertension KW - primary prevention KW - eCohort KW - physical activity KW - smartwatch KW - Apple Watch KW - home blood pressure N2 - Background: When studied in community-based samples, the association of physical activity with blood pressure (BP) remains controversial and is perhaps dependent on the intensity of physical activity. Prior studies have not explored the association of smartwatch-measured physical activity with home BP. Objective: We aimed to study the association of habitual physical activity with home BP. Methods: Consenting electronic Framingham Heart Study (eFHS) participants were provided with a study smartwatch (Apple Watch Series 0) and Bluetooth-enabled home BP cuff. Participants were instructed to wear the watch daily and transmit BP values weekly. We measured habitual physical activity as the average daily step count determined by the smartwatch. We estimated the cross-sectional association between physical activity and average home BP using linear mixed effects models adjusting for age, sex, wear time, antihypertensive drug use, and familial structure. Results: We studied 660 eFHS participants (mean age 53 years, SD 9 years; 387 [58.6%] women; 602 [91.2%] White) who wore the smartwatch 5 or more hours per day for 30 or more days and transmitted three or more BP readings. The mean daily step count was 7595 (SD 2718). The mean home systolic and diastolic BP (mmHg) were 122 (SD 12) and 76 (SD 8). Every 1000 increase in the step count was associated with a 0.49 mmHg lower home systolic BP (P=.004) and 0.36 mmHg lower home diastolic BP (P=.003). The association, however, was attenuated and became statistically nonsignificant with further adjustment for BMI. Conclusions: In this community-based sample of adults, higher daily habitual physical activity measured by a smartwatch was associated with a moderate, but statistically significant, reduction in home BP. Differences in BMI among study participants accounted for the majority of the observed association. UR - https://www.jmir.org/2021/6/e25591/ UR - http://dx.doi.org/10.2196/25591 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185019 ID - info:doi/10.2196/25591 ER - TY - JOUR AU - Song, Ting AU - Liu, Fang AU - Deng, Ning AU - Qian, Siyu AU - Cui, Tingru AU - Guan, Yingping AU - Arnolda, Leonard AU - Zhang, Zhenyu AU - Yu, Ping PY - 2021/6/21 TI - A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis JO - J Med Internet Res SP - e25522 VL - 23 IS - 6 KW - patient experience KW - mHealth KW - mobile phone KW - mobile app KW - intervention KW - self-management KW - high blood pressure KW - chronic disease management KW - qualitative research N2 - Background: Hypertension affects over 15% of the world?s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective: This study aims to explore patients? perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods: A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results: The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions: The mHealth service extended the traditional hypertension care model beyond the hospital and clinician?s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions. UR - https://www.jmir.org/2021/6/e25522 UR - http://dx.doi.org/10.2196/25522 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152272 ID - info:doi/10.2196/25522 ER - TY - JOUR AU - Lv, Meina AU - Wu, Tingting AU - Jiang, Shaojun AU - Chen, Wenjun AU - Zhang, Jinhua PY - 2021/6/11 TI - Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - JMIR Mhealth Uhealth SP - e24116 VL - 9 IS - 6 KW - stroke KW - systolic blood pressure KW - mHealth KW - telemedicine KW - meta-analysis KW - self-management N2 - Background: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. Methods: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95% CI and 95% prediction interval (PI) were calculated. Results: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD ?5.49; 95% CI ?7.87 to ?3.10; P<.001; 95% PI ?10.46 to ?0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD ?9.09; 95% CI ?12.71 to ?5.46; P<.001) or only telephone (MD ?4.34; 95% CI ?6.55 to ?2.13; P<.001; 95% PI ?7.24 to ?1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ?1 week (MD ?6.51; 95% CI ?9.36 to ?3.66; P<.001; 95% PI ?12.91 to ?0.10) or a baseline systolic blood pressure ?140 mm Hg (MD ?6.15; 95% CI ?9.44 to ?2.86; P<.001; 95% PI ?13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. Conclusions: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke. UR - https://mhealth.jmir.org/2021/6/e24116 UR - http://dx.doi.org/10.2196/24116 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114961 ID - info:doi/10.2196/24116 ER - TY - JOUR AU - Bilger, Marcel AU - Koong, Leng Agnes Ying AU - Phoon, Yun Ian Kwong AU - Tan, Chuan Ngiap AU - Bahadin, Juliana AU - Bairavi, Joann AU - Batcagan-Abueg, M. Ada Portia AU - Finkelstein, A. Eric PY - 2021/6/9 TI - Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e27496 VL - 10 IS - 6 KW - telemedicine KW - home blood pressure monitoring KW - behavior change KW - hypertension KW - financial incentive KW - medication adherence KW - remote titration N2 - Background: Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective: The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods: This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results: This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions: Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration: ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID): DERR1-10.2196/27496 UR - https://www.researchprotocols.org/2021/6/e27496 UR - http://dx.doi.org/10.2196/27496 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106085 ID - info:doi/10.2196/27496 ER - TY - JOUR AU - Huang, Ching-Chang AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Lee, Jen-Kuang AU - Hsu, Tse-Pin AU - Wu, Hui-Wen AU - Chuang, Pao-Yu AU - Chen, Ming-Fong AU - Ho, Yi-Lwun PY - 2021/6/8 TI - The Association Between Short-term Exposure to Ambient Air Pollution and Patient-Level Home Blood Pressure Among Patients With Chronic Cardiovascular Diseases in a Web-Based Synchronous Telehealth Care Program: Retrospective Study JO - JMIR Public Health Surveill SP - e26605 VL - 7 IS - 6 KW - ambient air pollution KW - blood pressure KW - cardiovascular disease KW - chronic disease KW - climate KW - home blood pressure KW - particulate matter KW - pollution KW - remote monitoring KW - telehealth care KW - telemonitoring KW - weather N2 - Background: The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature. Objective: This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP). Methods: Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO2, particulate matter with a diameter of <10 µm, particulate matter with a diameter of <2.5 µm, and SO2) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP). Results: A total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP. Conclusions: Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease. UR - https://publichealth.jmir.org/2021/6/e26605 UR - http://dx.doi.org/10.2196/26605 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100764 ID - info:doi/10.2196/26605 ER - TY - JOUR AU - Andersson, Ulrika AU - Bengtsson, Ulrika AU - Ranerup, Agneta AU - Midlöv, Patrik AU - Kjellgren, Karin PY - 2021/6/3 TI - Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone JO - J Med Internet Res SP - e26143 VL - 23 IS - 6 KW - eHealth KW - digital health KW - hypertension KW - mobile phones KW - patient-professional partnership KW - person-centered care KW - self-management N2 - Background: The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. Objective: The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient?s own mobile phone. Methods: Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. Results: Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient?s understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. Conclusions: The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working. Trial Registration: ClinicalTrials.gov NCT03554382; https://clinicaltrials.gov/ct2/show/NCT03554382 UR - https://www.jmir.org/2021/6/e26143 UR - http://dx.doi.org/10.2196/26143 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081021 ID - info:doi/10.2196/26143 ER - TY - JOUR AU - Kerr, M. Kim AU - Elliott, Greg C. AU - Benza, L. Raymond AU - Channick, N. Richard AU - Chin, M. Kelly AU - Davis, Duane R. AU - Jain, Sonia AU - LaCroix, Z. Andrea AU - Madani, M. Michael AU - McLaughlin, V. Vallerie AU - Park, H. Myung AU - Tapson, F. Victor AU - Auger, R. William PY - 2021/5/25 TI - The United States Chronic Thromboembolic Pulmonary Hypertension Registry: Protocol for a Prospective, Longitudinal Study JO - JMIR Res Protoc SP - e25397 VL - 10 IS - 5 KW - CTEPH KW - pulmonary hypertension KW - pulmonary embolism KW - registry KW - surgical KW - nonsurgical KW - therapy KW - treatment N2 - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare sequela of acute pulmonary embolism that is treatable when recognized. Awareness of this disease has increased with recent advancements in therapeutic options, but delays in diagnosis remain common, and diagnostic and treatment guidelines are often not followed. Data gathered from international registries have improved our understanding of CTEPH, but these data may not be applicable to the US population owing to differences in demographics and medical practice patterns. Objective: The US CTEPH Registry (US-CTEPH-R) was developed to provide essential information to better understand the demographics, risk factors, evaluation, and treatment of CTEPH in the United States, as well as the short- and long-term outcomes of surgical and nonsurgical therapies in the modern treatment era. Methods: Thirty sites throughout the United States enrolled 750 subjects in this prospective, longitudinal, observational registry of patients newly diagnosed with CTEPH. Enrollment criteria included a mean pulmonary artery pressure ?25 mmHg by right heart catheterization and radiologic confirmation of CTEPH by a multidisciplinary adjudication committee. Following enrollment, subjects were followed biannually until the conclusion of the study. Quality of life surveys were administered at enrollment and biannually, and all other testing was at the discretion of the treating clinician. Details regarding surgical therapy, balloon pulmonary angioplasty, and medical therapy were collected at enrollment and at follow-up, as well as information related to health care utilization and survival. Results: Data from this registry will improve understanding of the demographics, risk factors, and treatment patterns of patients with CTEPH, and the longitudinal impact of therapies on quality of life, health care utilization, and survival. Conclusions: This manuscript details the methodology and design of the first large, prospective, longitudinal registry of patients with CTEPH in the United States. Trial Registration: ClinicalTrials.gov NCT02429284; https://www.clinicaltrials.gov/ct2/show/NCT02429284 International Registered Report Identifier (IRRID): DERR1-10.2196/25397 UR - https://www.researchprotocols.org/2021/5/e25397 UR - http://dx.doi.org/10.2196/25397 UR - http://www.ncbi.nlm.nih.gov/pubmed/33848258 ID - info:doi/10.2196/25397 ER - TY - JOUR AU - Campos, L. Claudia AU - Jones, Deanna AU - Snively, M. Beverly AU - Rocco, Michael AU - Pedley, Carolyn AU - Atwater, Sara AU - Moore, B. Justin PY - 2021/5/14 TI - Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e18984 VL - 10 IS - 5 KW - hypertension KW - home blood pressure monitoring KW - telehealth KW - medication adherence KW - SMS KW - health disparities N2 - Background: A decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown. Objective: The objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications. Methods: We will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients? medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control. Results: Our study was funded in July 2020. As of May 2021, we have enrolled 6 participants. Conclusions: Our findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials. Trial Registration: ClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242 International Registered Report Identifier (IRRID): PRR1-10.2196/18984 UR - https://www.researchprotocols.org/2021/5/e18984 UR - http://dx.doi.org/10.2196/18984 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988513 ID - info:doi/10.2196/18984 ER - TY - JOUR AU - Etminani, Kobra AU - Göransson, Carina AU - Galozy, Alexander AU - Norell Pejner, Margaretha AU - Nowaczyk, S?awomir PY - 2021/5/12 TI - Improving Medication Adherence Through Adaptive Digital Interventions (iMedA) in Patients With Hypertension: Protocol for an Interrupted Time Series Study JO - JMIR Res Protoc SP - e24494 VL - 10 IS - 5 KW - medication adherence KW - hypertension KW - digital intervention KW - mHealth KW - artificial intelligence N2 - Background: There is a strong need to improve medication adherence (MA) for individuals with hypertension in order to reduce long-term hospitalization costs. We believe this can be achieved through an artificial intelligence agent that helps the patient in understanding key individual adherence risk factors and designing an appropriate intervention plan. The incidence of hypertension in Sweden is estimated at approximately 27%. Although blood pressure control has increased in Sweden, barely half of the treated patients achieved adequate blood pressure levels. It is a major risk factor for coronary heart disease and stroke as well as heart failure. MA is a key factor for good clinical outcomes in persons with hypertension. Objective: The overall aim of this study is to design, develop, test, and evaluate an adaptive digital intervention called iMedA, delivered via a mobile app to improve MA, self-care management, and blood pressure control for persons with hypertension. Methods: The study design is an interrupted time series. We will collect data on a daily basis, 14 days before, during 6 months of delivering digital interventions through the mobile app, and 14 days after. The effect will be analyzed using segmented regression analysis. The participants will be recruited in Region Halland, Sweden. The design of the digital interventions follows the just-in-time adaptive intervention framework. The primary (distal) outcome is MA, and the secondary outcome is blood pressure. The design of the digital intervention is developed based on a needs assessment process including a systematic review, focus group interviews, and a pilot study, before conducting the longitudinal interrupted time series study. Results: The focus groups of persons with hypertension have been conducted to perform the needs assessment in a Swedish context. The design and development of digital interventions are in progress, and the interventions are planned to be ready in November 2020. Then, the 2-week pilot study for usability evaluation will start, and the interrupted time series study, which we plan to start in February 2021, will follow it. Conclusions: We hypothesize that iMedA will improve medication adherence and self-care management. This study could illustrate how self-care management tools can be an additional (digital) treatment support to a clinical one without increasing burden on health care staff. Trial Registration: ClinicalTrials.gov NCT04413500; https://clinicaltrials.gov/ct2/show/NCT04413500 International Registered Report Identifier (IRRID): DERR1-10.2196/24494 UR - https://www.researchprotocols.org/2021/5/e24494 UR - http://dx.doi.org/10.2196/24494 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978593 ID - info:doi/10.2196/24494 ER - TY - JOUR AU - Oladeji, Olubusola AU - Zhang, Chi AU - Moradi, Tiam AU - Tarapore, Dharmesh AU - Stokes, C. Andrew AU - Marivate, Vukosi AU - Sengeh, D. Moinina AU - Nsoesie, O. Elaine PY - 2021/4/29 TI - Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study JO - JMIR Public Health Surveill SP - e24348 VL - 7 IS - 4 KW - obesity KW - overweight KW - Africa KW - chronic diseases KW - hypertension KW - digital phenotype KW - infodemiology KW - infoveillance N2 - Background: The prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors. Objective: The objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa. Methods: We obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance. Results: The study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence. Conclusions: Information-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys. UR - https://publichealth.jmir.org/2021/4/e24348 UR - http://dx.doi.org/10.2196/24348 UR - http://www.ncbi.nlm.nih.gov/pubmed/33913815 ID - info:doi/10.2196/24348 ER - TY - JOUR AU - Holyoke, Paul AU - Yogaratnam, Karthika AU - Kalles, Elizabeth PY - 2021/4/23 TI - Web-Based Smartphone Algorithm for Calculating Blood Pressure From Photoplethysmography Remotely in a General Adult Population: Validation Study JO - J Med Internet Res SP - e19187 VL - 23 IS - 4 KW - blood pressure measurement KW - remote monitoring KW - hypertension N2 - Background: Outside of a clinical setting, oscillometric devices make remote monitoring of blood pressure and virtual care more convenient and feasible. HeartBeat Technologies Ltd developed a novel approach to measuring blood pressure remotely after an initial blood pressure reading by a nurse using the conventional measurement method. Using a finger pulse oximeter, a photoplethysmogram wave is transmitted by Bluetooth to a smartphone or tablet. A smartphone app (MediBeat) transmits the photoplethysmogram to a server for analysis by a proprietary algorithm?the person?s current blood pressure is sent back to the smartphone and to the individual?s health care provider. Objective: This study sought to determine whether the HeartBeat algorithm calculates blood pressure as accurately as required by the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) for validation of blood pressure measuring devices. Methods: ESH-IP2 requirements, modified to conform to a more recent international consensus statement, were followed. The ESH-IP2 establishes strict guidelines for the conduct and reporting of any validation of any device to measure blood pressure, including using the standard manual blood pressure instrument as a comparator and specific required accuracy levels for low, medium, and high ranges of blood pressure readings. The consensus statement requires a greater number of study participants for each of the blood pressure ranges. The validation of the accuracy of the algorithm was conducted with a Contec CMS50EW pulse oximeter and a Samsung Galaxy XCover 4 smartphone. Results: The differences between the HeartBeat-calculated and the manually measured blood pressures of 62 study participants did not meet the ESH-IP2 standards for accuracy for either systolic or diastolic blood pressure measurements. There was no discernible pattern in the inaccuracies of the HeartBeat-calculated measurements. Conclusions: The October 4, 2019 version of the HeartBeat algorithm, implemented in combination with the MediBeat app, a pulse oximeter, and an Android smartphone, was not sufficiently accurate for use in a general adult population. Trial Registration: ClinicalTrials.gov NCT04082819; http://clinicaltrials.gov/ct2/show/NCT04082819 UR - https://www.jmir.org/2021/4/e19187 UR - http://dx.doi.org/10.2196/19187 UR - http://www.ncbi.nlm.nih.gov/pubmed/33890856 ID - info:doi/10.2196/19187 ER - TY - JOUR AU - Bonner, Carissa AU - Cvejic, Erin AU - Ayre, Julie AU - Isautier, Jennifer AU - Semsarian, Christopher AU - Nickel, Brooke AU - Batcup, Carys AU - Pickles, Kristen AU - Dodd, Rachael AU - Cornell, Samuel AU - Copp, Tessa AU - McCaffery, J. Kirsten PY - 2021/3/30 TI - The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study JO - JMIRx Med SP - e25610 VL - 2 IS - 1 KW - public health KW - global health KW - COVID-19 KW - hypertension KW - risk KW - strategy KW - mental health KW - behavior KW - response KW - anxiety KW - vaccine KW - retrospective KW - perception KW - prevention KW - intention N2 - Background: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. Objective: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Methods: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Results: Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80%). Conclusions: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. UR - https://xmed.jmir.org/2021/1/e25610 UR - http://dx.doi.org/10.2196/25610 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076628 ID - info:doi/10.2196/25610 ER - TY - JOUR AU - Baderol Allam, Najihah Fatimah AU - Ab Hamid, Ramadan Mohd AU - Buhari, Sabariah Siti AU - Md Noor, Harrinni PY - 2021/3/15 TI - Web-Based Dietary and Physical Activity Intervention Programs for Patients With Hypertension: Scoping Review JO - J Med Internet Res SP - e22465 VL - 23 IS - 3 KW - hypertension KW - blood pressure KW - education KW - website-based KW - dietary intake KW - physical activity N2 - Background: Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario. Objective: In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity?related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities. Methods: This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included. Results: Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention?related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies. Conclusions: We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension. UR - https://www.jmir.org/2021/3/e22465 UR - http://dx.doi.org/10.2196/22465 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720036 ID - info:doi/10.2196/22465 ER - TY - JOUR AU - Walcott-Bryant, Aisha AU - Ogallo, William AU - Remy, L. Sekou AU - Tryon, Katherine AU - Shena, Winnie AU - Bosker-Kibacha, Marloes PY - 2021/2/17 TI - Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya JO - J Med Internet Res SP - e18899 VL - 23 IS - 2 KW - hypertension KW - health information systems KW - mobile phone KW - private sector KW - Kenya N2 - Background: Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector. Objective: The aim of this study is to assess stakeholders? perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods: We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results: The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients? care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology. Conclusions: The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter. UR - http://www.jmir.org/2021/2/e18899/ UR - http://dx.doi.org/10.2196/18899 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595446 ID - info:doi/10.2196/18899 ER - TY - JOUR AU - Alessa, Tourkiah AU - S Hawley, Mark AU - Alsulamy, Nouf AU - de Witte, Luc PY - 2021/2/9 TI - Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia JO - JMIR Mhealth Uhealth SP - e24177 VL - 9 IS - 2 KW - mHealth KW - mobile phone KW - hypertension KW - usability KW - acceptance KW - user satisfaction N2 - Background: The use of smartphone apps to assist in the self-management of hypertension is becoming increasingly common, but few commercially available apps have the potential to be effective along with adequate security and privacy measures in place. In a previous study, we identified 5 apps that are potentially effective and safe, and based on the preferences of doctors and patients, one (Cora Health) was selected as the most suitable app for use in a Saudi context. However, there is currently no evidence of its usability and acceptance among potential users. Indeed, there has been little research into the usability and acceptance of hypertension apps in general, and less research considers this in the Gulf Region. Objective: This study aims to evaluate the acceptance and usability of the selected app in the Saudi context. Methods: This study used a mixed methods approach with 2 studies: a usability test involving patients in a controlled setting performing predefined tasks and a real-world usability study where patients used the app for 4 weeks. In the usability test, participants were asked to think aloud while performing the tasks, and an observer recorded the number of tasks they completed. At the end of the real-world pilot study, participants were interviewed, and the mHealth App Usability Questionnaire was completed. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. Results: In total, 10 patients completed study 1. The study found that app usability was moderate and that participants needed some familiarization time before they could use the app proficiently. Some usability issues were revealed, related to app accessibility and navigation, and a few tasks remained uncompleted by most people. A total of 20 patients completed study 2, with a mean age of 51.6 (SD 11.7) years. Study 2 found that the app was generally acceptable and easy to use, with some similar usability issues identified. Participants stressed the importance of practice and training to use it more easily and proficiently. Participants had a good engagement level with 48% retention at the end of study 2, with most participants? engagement being classed as meaningful. The most recorded data were blood pressure, followed by stress and medication, and the most accessed feature was viewing graphs of data trends. Conclusions: This study shows that a commercially available app can be usable and acceptable in the self-management of hypertension but also found a considerable number of possibilities for improvement, which needs to be considered in future app development. The results show that there is potential for a commercially available app to be used in large-scale studies of hypertension self-management if suggestions for improvements are addressed. UR - http://mhealth.jmir.org/2021/2/e24177/ UR - http://dx.doi.org/10.2196/24177 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560237 ID - info:doi/10.2196/24177 ER - TY - JOUR AU - Wongvibulsin, Shannon AU - Habeos, E. Evagelia AU - Huynh, P. Pauline AU - Xun, Helen AU - Shan, Rongzi AU - Porosnicu Rodriguez, A. Kori AU - Wang, Jane AU - Gandapur, K. Yousuf AU - Osuji, Ngozi AU - Shah, M. Lochan AU - Spaulding, M. Erin AU - Hung, George AU - Knowles, Kellen AU - Yang, E. William AU - Marvel, A. Francoise AU - Levin, Eleanor AU - Maron, J. David AU - Gordon, F. Neil AU - Martin, S. Seth PY - 2021/2/8 TI - Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review JO - J Med Internet Res SP - e18773 VL - 23 IS - 2 KW - cardiac rehabilitation KW - telemedicine KW - digital technologies KW - mHealth KW - mobile phone N2 - Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective: The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods: Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results: Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions: Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions. UR - https://www.jmir.org/2021/2/e18773 UR - http://dx.doi.org/10.2196/18773 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555259 ID - info:doi/10.2196/18773 ER - TY - JOUR AU - Lokker, Cynthia AU - Jezrawi, Rita AU - Gabizon, Itzhak AU - Varughese, Jobin AU - Brown, Michael AU - Trottier, Dan AU - Alvarez, Elizabeth AU - Schwalm, Jon-David AU - McGillion, Michael AU - Ma, Jinhui AU - Bhagirath, Vinai PY - 2021/2/1 TI - Feasibility of a Web-Based Platform (Trial My App) to Efficiently Conduct Randomized Controlled Trials of mHealth Apps For Patients With Cardiovascular Risk Factors: Protocol For Evaluating an mHealth App for Hypertension JO - JMIR Res Protoc SP - e26155 VL - 10 IS - 2 KW - mHealth KW - mobile health KW - hypertension KW - app KW - patient-oriented KW - feasibility KW - cardiovascular disease KW - internet-administered KW - randomized controlled trial N2 - Background: Mobile health (mHealth) interventions can improve health by improving cardiovascular risk factors, but their adoption in care by physicians and patients is untapped. Few mHealth apps have been evaluated in clinical trials, and due to the fast pace of technological development, those previously evaluated are often outdated by the time trial results are available. Given the rapid pace of change in this field, it is not feasible to rigorously evaluate mHealth apps with current methodologies. Objective: The overall aim of this pilot study was to test the feasibility of using a web research platform called Trial My App to conduct efficient and rigorous web-based randomized controlled trials (RCTs) of mHealth apps relevant to patients with cardiovascular risk factors by evaluating an app that targets hypertension. Methods: For this study, 200 participants with suboptimally controlled hypertension will be recruited through advertisements in newsletters, media, and the internet, as well as through referrals from their health care providers. Screening, consent, randomization, and collection of patient-important health confidence and self-management ability outcomes will be conducted online through the Trial My App research platform. Participants will be randomized into 2 groups: 100 that will use an mHealth app for tracking hypertension and 100 that will be considered as an educational control. All participants will complete questionnaires at 0, 1, 3 and 6 months after enrolment. A substudy to validate the method of blood pressure readings and the consistency of data entered through Trial My App will be conducted with 40 participants. Results: The development of the Trial My App web platform has been completed. The creation of survey instruments has been completed in collaboration with our patient partners and advisory board. Recruitment is expected to begin in the first quarter of 2021; data collection and analysis are expected to be completed approximately 1 year after study commencement. Results will be disseminated through conferences and publications. The primary outcomes of this study include the feasibility of conducting an RCT using the Trial My App platform by reporting recruitment, retention, and completion statistics. We will validate app-entered data with a standard 7-day home blood pressure measurement method. Lastly, the pilot, nonblinded RCT will assess the effectiveness of the mHealth app in improving the control of hypertension compared with the control of hypertension in the educational control group. Conclusions: This study will determine if it is feasible to use the Trial My App web-based platform to evaluate the effectiveness of mHealth apps for patients with cardiovascular risk factors. As more mHealth apps are evaluated in RCTs, patients will be able to select apps that meet their needs and physicians will be able to make evidence-based recommendations to their patients for apps aimed at improving cardiovascular health. Trial Registration: ClinicalTrials.gov NCT04528654; https://clinicaltrials.gov/ct2/show/NCT04528654 International Registered Report Identifier (IRRID): PRR1-10.2196/26155 UR - https://www.researchprotocols.org/2021/2/e26155 UR - http://dx.doi.org/10.2196/26155 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522978 ID - info:doi/10.2196/26155 ER - TY - JOUR AU - Markert, Carl AU - Sasangohar, Farzan AU - Mortazavi, J. Bobak AU - Fields, Sherecce PY - 2021/1/29 TI - The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review JO - JMIR Hum Factors SP - e23796 VL - 8 IS - 1 KW - telemedicine KW - remote sensing technology KW - health coaching KW - decision support systems KW - clinical KW - older adults N2 - Background: Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. Objective: This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). Methods: A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. Results: Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. Conclusions: Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching. UR - http://humanfactors.jmir.org/2021/1/e23796/ UR - http://dx.doi.org/10.2196/23796 UR - http://www.ncbi.nlm.nih.gov/pubmed/33512322 ID - info:doi/10.2196/23796 ER - TY - JOUR AU - Diao, Xiaolin AU - Huo, Yanni AU - Yan, Zhanzheng AU - Wang, Haibin AU - Yuan, Jing AU - Wang, Yuxin AU - Cai, Jun AU - Zhao, Wei PY - 2021/1/25 TI - An Application of Machine Learning to Etiological Diagnosis of Secondary Hypertension: Retrospective Study Using Electronic Medical Records JO - JMIR Med Inform SP - e19739 VL - 9 IS - 1 KW - secondary hypertension KW - etiological diagnosis KW - machine learning KW - prediction model N2 - Background: Secondary hypertension is a kind of hypertension with a definite etiology and may be cured. Patients with suspected secondary hypertension can benefit from timely detection and treatment and, conversely, will have a higher risk of morbidity and mortality than those with primary hypertension. Objective: The aim of this study was to develop and validate machine learning (ML) prediction models of common etiologies in patients with suspected secondary hypertension. Methods: The analyzed data set was retrospectively extracted from electronic medical records of patients discharged from Fuwai Hospital between January 1, 2016, and June 30, 2019. A total of 7532 unique patients were included and divided into 2 data sets by time: 6302 patients in 2016-2018 as the training data set for model building and 1230 patients in 2019 as the validation data set for further evaluation. Extreme Gradient Boosting (XGBoost) was adopted to develop 5 models to predict 4 etiologies of secondary hypertension and occurrence of any of them (named as composite outcome), including renovascular hypertension (RVH), primary aldosteronism (PA), thyroid dysfunction, and aortic stenosis. Both univariate logistic analysis and Gini Impurity were used for feature selection. Grid search and 10-fold cross-validation were used to select the optimal hyperparameters for each model. Results: Validation of the composite outcome prediction model showed good performance with an area under the receiver-operating characteristic curve (AUC) of 0.924 in the validation data set, while the 4 prediction models of RVH, PA, thyroid dysfunction, and aortic stenosis achieved AUC of 0.938, 0.965, 0.959, and 0.946, respectively, in the validation data set. A total of 79 clinical indicators were identified in all and finally used in our prediction models. The result of subgroup analysis on the composite outcome prediction model demonstrated high discrimination with AUCs all higher than 0.890 among all age groups of adults. Conclusions: The ML prediction models in this study showed good performance in detecting 4 etiologies of patients with suspected secondary hypertension; thus, they may potentially facilitate clinical diagnosis decision making of secondary hypertension in an intelligent way. UR - http://medinform.jmir.org/2021/1/e19739/ UR - http://dx.doi.org/10.2196/19739 UR - http://www.ncbi.nlm.nih.gov/pubmed/33492233 ID - info:doi/10.2196/19739 ER - TY - JOUR AU - Lakshminarayan, Kamakshi AU - Murray, A. Thomas AU - Westberg, M. Sarah AU - Connett, John AU - Overton, Val AU - Nyman, A. John AU - Culhane-Pera, A. Kathleen AU - Pergament, L. Shannon AU - Drawz, Paul AU - Vollbrecht, Emily AU - Xiong, Txia AU - Everson-Rose, A. Susan PY - 2021/1/25 TI - Mobile Health Intervention to Close the Guidelines-To-Practice Gap in Hypertension Treatment: Protocol for the mGlide Randomized Controlled Trial JO - JMIR Res Protoc SP - e25424 VL - 10 IS - 1 KW - hypertension KW - mobile health technology KW - health disparities KW - randomized controlled trial N2 - Background: Suboptimal treatment of hypertension remains a widespread problem, particularly among minorities and socioeconomically disadvantaged groups. We present a health system?based intervention with diverse patient populations using readily available smartphone technology. This intervention is designed to empower patients and create partnerships between patients and their provider team to promote hypertension control. Objective: The mGlide randomized controlled trial is a National Institutes of Health?funded study, evaluating whether a mobile health (mHealth)-based intervention that is an active partnership between interprofessional health care teams and patients results in better hypertension control rates than a state-of-clinical care comparison. Methods: We are recruiting 450 participants including stroke survivors and primary care patients with elevated cardiovascular disease risk from diverse health systems. These systems include an acute stroke service (n=100), an academic medical center (n=150), and community medical centers including Federally Qualified Health Centers serving low-income and minority (Latino, Hmong, African American, Somali) patients (n=200). The primary aim tests the clinical effectiveness of the 6-month mHealth intervention versus standard of care. Secondary aims evaluate sustained hypertension control rates at 12 months; describe provider experiences of system usability and satisfaction; examine patient experiences, including medication adherence and medication use self-efficacy, self-rated health and quality of life, and adverse event rates; and complete a cost-effectiveness analysis. Results: To date, we have randomized 107 participants (54 intervention, 53 control). Conclusions: This study will provide evidence for whether a readily available mHealth care model is better than state-of-clinical care for bridging the guideline-to-practice gap in hypertension treatment in health systems serving diverse patient populations. Trial Registration: Clinicaltrials.gov NCT03612271; https://clinicaltrials.gov/ct2/show/NCT03612271 International Registered Report Identifier (IRRID): DERR1-10.2196/25424 UR - http://www.researchprotocols.org/2021/1/e25424/ UR - http://dx.doi.org/10.2196/25424 UR - http://www.ncbi.nlm.nih.gov/pubmed/33492231 ID - info:doi/10.2196/25424 ER - TY - JOUR AU - Boutilier, J. Justin AU - Chan, Y. Timothy C. AU - Ranjan, Manish AU - Deo, Sarang PY - 2021/1/21 TI - Risk Stratification for Early Detection of Diabetes and Hypertension in Resource-Limited Settings: Machine Learning Analysis JO - J Med Internet Res SP - e20123 VL - 23 IS - 1 KW - machine learning KW - diabetes KW - hypertension KW - screening KW - global health N2 - Background: The impending scale up of noncommunicable disease screening programs in low- and middle-income countries coupled with limited health resources require that such programs be as accurate as possible at identifying patients at high risk. Objective: The aim of this study was to develop machine learning?based risk stratification algorithms for diabetes and hypertension that are tailored for the at-risk population served by community-based screening programs in low-resource settings. Methods: We trained and tested our models by using data from 2278 patients collected by community health workers through door-to-door and camp-based screenings in the urban slums of Hyderabad, India between July 14, 2015 and April 21, 2018. We determined the best models for predicting short-term (2-month) risk of diabetes and hypertension (a model for diabetes and a model for hypertension) and compared these models to previously developed risk scores from the United States and the United Kingdom by using prediction accuracy as characterized by the area under the receiver operating characteristic curve (AUC) and the number of false negatives. Results: We found that models based on random forest had the highest prediction accuracy for both diseases and were able to outperform the US and UK risk scores in terms of AUC by 35.5% for diabetes (improvement of 0.239 from 0.671 to 0.910) and 13.5% for hypertension (improvement of 0.094 from 0.698 to 0.792). For a fixed screening specificity of 0.9, the random forest model was able to reduce the expected number of false negatives by 620 patients per 1000 screenings for diabetes and 220 patients per 1000 screenings for hypertension. This improvement reduces the cost of incorrect risk stratification by US $1.99 (or 35%) per screening for diabetes and US $1.60 (or 21%) per screening for hypertension. Conclusions: In the next decade, health systems in many countries are planning to spend significant resources on noncommunicable disease screening programs and our study demonstrates that machine learning models can be leveraged by these programs to effectively utilize limited resources by improving risk stratification. UR - http://www.jmir.org/2021/1/e20123/ UR - http://dx.doi.org/10.2196/20123 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475518 ID - info:doi/10.2196/20123 ER - TY - JOUR AU - Marcolino, Soriano Milena AU - Oliveira, Queiroz João Antonio AU - Cimini, Rodrigues Christiane Corrêa AU - Maia, Xavier Junia AU - Pinto, Almeida Vânia Soares Oliveira AU - Sá, Vivas Thábata Queiroz AU - Amancio, Kaique AU - Coelho, Lissandra AU - Ribeiro, Bonisson Leonardo AU - Cardoso, Silva Clareci AU - Ribeiro, Luiz Antonio PY - 2021/1/11 TI - Development and Implementation of a Decision Support System to Improve Control of Hypertension and Diabetes in a Resource-Constrained Area in Brazil: Mixed Methods Study JO - J Med Internet Res SP - e18872 VL - 23 IS - 1 KW - clinical decision support systems KW - primary health care KW - hypertension KW - diabetes mellitus KW - evidence-based practice KW - telemedicine KW - patient care management N2 - Background: The low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care. Objective: The aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction. Methods: This mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals? satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed. Results: A total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach ? of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application?s database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were consistent to affirm they were very satisfied with the CDSS. Conclusions: The CDSS was applicable in the context of primary health care settings in low-income regions, with good user satisfaction and potential to improve adherence to evidence-based practices. UR - http://www.jmir.org/2021/1/e18872/ UR - http://dx.doi.org/10.2196/18872 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427686 ID - info:doi/10.2196/18872 ER - TY - JOUR AU - Steinberg, M. Dori AU - Kay, C. Melissa AU - Svetkey, P. Laura AU - Askew, Sandy AU - Christy, Jacob AU - Burroughs, Jasmine AU - Ahmed, Hira AU - Bennett, G. Gary PY - 2020/12/7 TI - Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial JO - JMIR Mhealth Uhealth SP - e17536 VL - 8 IS - 12 KW - hypertension KW - DASH dietary pattern KW - digital health KW - nutrition KW - women?s health KW - mHealth N2 - Background: Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective: This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods: We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results: The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: ?2.8 mmHg, 95% CI ?1.8 to 7.4; P=.23) and diastolic (mean difference: ?3.6 mmHg, 95% CI ?0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions: A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration: ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472 UR - https://mhealth.jmir.org/2020/12/e17536 UR - http://dx.doi.org/10.2196/17536 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284116 ID - info:doi/10.2196/17536 ER - TY - JOUR AU - Jahan, Yasmin AU - Rahman, Moshiur Md AU - Faruque, G. Abu S. AU - Chisti, Jobayer Mohammod AU - Kazawa, Kana AU - Matsuyama, Ryota AU - Moriyama, Michiko PY - 2020/12/7 TI - Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial JO - J Med Internet Res SP - e19137 VL - 22 IS - 12 KW - mobile health KW - hypertension KW - behavior changes KW - awareness development KW - lifestyle KW - Bangladesh N2 - Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. Objective: The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging). Methods: A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL). Results: During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001). Conclusions: Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage ?low-salt culture? and educate family members. Trial Registration: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo International Registered Report Identifier (IRRID): RR2-10.2196/15523 UR - https://www.jmir.org/2020/12/e19137 UR - http://dx.doi.org/10.2196/19137 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284129 ID - info:doi/10.2196/19137 ER - TY - JOUR AU - Davoudi, Anahita AU - Lee, S. Natalie AU - Chivers, Corey AU - Delaney, Timothy AU - Asch, L. Elizabeth AU - Reitz, Catherine AU - Mehta, J. Shivan AU - Chaiyachati, H. Krisda AU - Mowery, L. Danielle PY - 2020/12/3 TI - Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study JO - J Med Internet Res SP - e22493 VL - 22 IS - 12 KW - text messaging KW - hypertension KW - telemedicine KW - cluster analysis N2 - Background: Automated texting platforms have emerged as a tool to facilitate communication between patients and health care providers with variable effects on achieving target blood pressure (BP). Understanding differences in the way patients interact with these communication platforms can inform their use and design for hypertension management. Objective: Our primary aim was to explore the unique phenotypes of patient interactions with an automated text messaging platform for BP monitoring. Our secondary aim was to estimate associations between interaction phenotypes and BP control. Methods: This study was a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension. A total of 201 patients with established primary care were assigned to the automated texting platform; messages exchanged throughout the 4-month program were analyzed. We used the k-means clustering algorithm to characterize two different interaction phenotypes: program conformity and engagement style. First, we identified unique clusters signifying differences in program conformity based on the frequency over time of error alerts, which were generated to patients when they deviated from the requested text message format (eg, ###/## for BP). Second, we explored overall engagement styles, defined by error alerts and responsiveness to text prompts, unprompted messages, and word count averages. Finally, we applied the chi-square test to identify associations between each interaction phenotype and achieving the target BP. Results: We observed 3 categories of program conformity based on their frequency of error alerts: those who immediately and consistently submitted texts without system errors (perfect users, 51/201), those who did so after an initial learning period (adaptive users, 66/201), and those who consistently submitted messages generating errors to the platform (nonadaptive users, 38/201). Next, we observed 3 categories of engagement style: the enthusiast, who tended to submit unprompted messages with high word counts (17/155); the student, who inconsistently engaged (35/155); and the minimalist, who engaged only when prompted (103/155). Of all 6 phenotypes, we observed a statistically significant association between patients demonstrating the minimalist communication style (high adherence, few unprompted messages, limited information sharing) and achieving target BP (P<.001). Conclusions: We identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control. UR - https://www.jmir.org/2020/12/e22493 UR - http://dx.doi.org/10.2196/22493 UR - http://www.ncbi.nlm.nih.gov/pubmed/33270032 ID - info:doi/10.2196/22493 ER - TY - JOUR AU - Heisey-Grove, M. Dawn AU - McClelland, E. Laura AU - Rathert, Cheryl AU - Tartaglia, Alexander AU - Jackson, Kevin AU - DeShazo, P. Jonathan PY - 2020/10/29 TI - Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study JO - J Med Internet Res SP - e19477 VL - 22 IS - 10 KW - health information technology KW - electronic messaging KW - patient physician communication KW - diabetes KW - hypertension N2 - Background: The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. Objective: To examine associations between patients? and clinicians? message content and changes in patients? health outcomes. Methods: We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff?generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. Results: Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (?=?.30; 95% CI ?0.56 to ?0.04), as were staffs? action responses (?=?30; 95% CI ?0.58 to ?0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients? complaints (?=?4.03; 95% CI ?7.94 to ?0.12). Deferred information sharing by clinic staff was associated with increased SBP (?=1.29; 95% CI 0.4 to 2.19). Conclusions: This is the first research to find associations between message content and patients? health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes. UR - http://www.jmir.org/2020/10/e19477/ UR - http://dx.doi.org/10.2196/19477 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118938 ID - info:doi/10.2196/19477 ER - TY - JOUR AU - McBride, M. Ciara AU - Morrissey, C. Eimear AU - Molloy, J. Gerard PY - 2020/10/28 TI - Patients? Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study JO - JMIR Mhealth Uhealth SP - e17470 VL - 8 IS - 10 KW - hypertension KW - self-management KW - mobile applications KW - feasibility KW - usability KW - medication adherence KW - qualitative research KW - digital technology KW - mobile phone N2 - Background: Worldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support. Objective: The aim of this study is to explore patients? experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension. Methods: A qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data. Results: Participants? age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients? experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence. Conclusions: The study?s findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study?s findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients. UR - http://mhealth.jmir.org/2020/10/e17470/ UR - http://dx.doi.org/10.2196/17470 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112251 ID - info:doi/10.2196/17470 ER - TY - JOUR AU - Xu, Hongxuan AU - Long, Huanyu PY - 2020/10/19 TI - The Effect of Smartphone App?Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e21759 VL - 8 IS - 10 KW - hypertension KW - smartphone KW - blood pressure KW - mobile KW - lifestyle KW - adherence KW - smartphone app KW - medication adherence N2 - Background: Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective: The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results: Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference ?2.28, 95% CI ?3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I2=0%). No difference between groups was demonstrated with respect to physical activity. Conclusions: A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction. UR - http://mhealth.jmir.org/2020/10/e21759/ UR - http://dx.doi.org/10.2196/21759 UR - http://www.ncbi.nlm.nih.gov/pubmed/33074161 ID - info:doi/10.2196/21759 ER - TY - JOUR AU - Cho, Jemma So Mi AU - Lee, Hyun Jung AU - Shim, Jee-Seon AU - Yeom, Hyungseon AU - Lee, Jin Su AU - Jeon, Woo Yong AU - Kim, Chang Hyeon PY - 2020/10/9 TI - Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial JO - J Med Internet Res SP - e17435 VL - 22 IS - 10 KW - metabolic health KW - health behavior KW - lifestyle modification KW - mobile health N2 - Background: Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. Objective: We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. Methods: In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. Results: Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean ?10.95, SD 2.09 mmHg; app only: mean ?7.29, SD 1.83 mmHg; app with personalized coaching: mean ?7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean ?0.12, SD 0.30 kg; app only: mean ?0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean ?0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean ?0.13, SD 0.34 kg; app only: mean ?0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean ?0.79, SD 0.38 kg; P=.08). Conclusions: Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. Trial Registration: ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271 UR - https://www.jmir.org/2020/10/e17435 UR - http://dx.doi.org/10.2196/17435 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034564 ID - info:doi/10.2196/17435 ER - TY - JOUR AU - Gordon, Kayleigh AU - Dainty, N. Katie AU - Steele Gray, Carolyn AU - DeLacy, Jane AU - Shah, Amika AU - Resnick, Myles AU - Seto, Emily PY - 2020/9/29 TI - Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study JO - JMIR Nursing SP - e22118 VL - 3 IS - 1 KW - telemonitoring KW - adherence KW - patient experience KW - complex patients KW - normalization process theory KW - implementation KW - mobile phone N2 - Background: Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs. Objective: This study aims to evaluate the feasibility and patients? perceived usefulness of a multi-condition TM platform in a nurse-led model of care. Methods: A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor. Results: In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs. Conclusions: Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team. UR - https://nursing.jmir.org/2020/1/e22118/ UR - http://dx.doi.org/10.2196/22118 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406972 ID - info:doi/10.2196/22118 ER - TY - JOUR AU - Schoenthaler, Antoinette AU - Leon, Michelle AU - Butler, Mark AU - Steinhaeuser, Karsten AU - Wardzinski, William PY - 2020/9/23 TI - Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial JO - JMIR Mhealth Uhealth SP - e17135 VL - 8 IS - 9 KW - mHealth KW - medication adherence KW - hypertension KW - type 2 diabetes KW - African Americans N2 - Background: Research has underscored the need to develop socioculturally tailored interventions to improve adherence behaviors in minority patients with hypertension (HTN) and type 2 diabetes (T2D). Novel mobile health (mHealth) approaches are potential methods for delivering tailored interventions to minority patients with increased cardiovascular risk. Objective: This study aims to develop and evaluate the acceptability and preliminary efficacy of a tailored mHealth adherence intervention versus attention control (AC) on medication adherence, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemoglobin A1c (HbA1c) at 3 months in 42 Black patients with uncontrolled HTN and/or T2D who were initially nonadherent to their medications. Methods: This was a two-phase pilot study consisting of a formative phase and a clinical efficacy phase. The formative phase consisted of qualitative interviews with 10 members of the target patient population (7/10, 70% female; mean age 65.8 years, SD 5.6) to tailor the intervention based on the Information-Motivation-Behavioral skills model of adherence. The clinical efficacy phase consisted of a 3-month pilot randomized controlled trial to evaluate the tailored mHealth intervention versus an AC. The tablet-delivered intervention included a tailoring survey, an individualized adherence profile, and a personalized list of interactive adherence-promoting modules, whereas AC included the tailoring survey and health education videos delivered on the tablet. Acceptability was assessed through semistructured exit interviews. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale, whereas blood pressure and HbA1c were assessed using automated devices. Results: In phase 1, thematic analysis of the semistructured interviews revealed the following 5 major barriers to adherence: disruptions in daily routine, forgetfulness, concerns about adverse effects, preference for natural remedies, and burdens of medication taking. Patients recommended the inclusion of modules that address improving patient-provider communication, peer vignettes, and stress reduction strategies to facilitate adherence. A total of 42 Black patients (23/42, 55% male; mean age 57.6 years, SD 11.1) participated in the clinical efficacy pilot trial. At 3 months, both groups showed significant improvements in adherence (mean 1.35, SD 1.60; P<.001) and SBP (?4.76 mm Hg; P=.04) with no between-group differences (P=.50 and P=.10). The decreases in DBP and HbA1c over time were nonsignificant (?1.97 mm Hg; P=.20; and ?0.2%; P=.45, respectively). Patients reported high acceptability of the intervention for improving their adherence. Conclusions: This pilot study demonstrated preliminary evidence on the acceptability of a tailored mHealth adherence intervention among a sample of Black patients with uncontrolled HTN and T2D who were initially nonadherent to their medications. Future research should explore whether repeated opportunities to use the mHealth intervention would result in improvements in behavioral and clinical outcomes over time. Modifications to the intervention as a result of the pilot study should guide future efforts. Trial Registration: ClinicalTrials.gov NCT01643473; http://clinicaltrials.gov/ct2/show/ NCT01643473 UR - http://mhealth.jmir.org/2020/9/e17135/ UR - http://dx.doi.org/10.2196/17135 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965230 ID - info:doi/10.2196/17135 ER - TY - JOUR AU - Chaniaud, Noémie AU - Métayer, Natacha AU - Megalakaki, Olga AU - Loup-Escande, Emilie PY - 2020/9/21 TI - Effect of Prior Health Knowledge on the Usability of Two Home Medical Devices: Usability Study JO - JMIR Mhealth Uhealth SP - e17983 VL - 8 IS - 9 KW - usability KW - prior health knowledge KW - mHealth KW - home medical devices KW - blood pressure monitor KW - pulse oximeter N2 - Background: Studies on the usability of health care devices are becoming more common, although usability standards are not necessarily specified and followed. Yet, there is little knowledge about the impact of the context of use on the usability outcome. It is specified in the usability standard (ISO 9241-11, 2018) of a device that it may be affected by its context of use and especially by the characteristics of its users. Among these, prior health knowledge (ie, knowledge about human body functioning) is crucial. However, no study has shown that prior health knowledge influences the usability of medical devices.  Objective: Our study aimed to fill this gap by analyzing the relationship between the usability of two home medical devices (soon to be used in the context of ambulatory surgery) and prior health knowledge through an experimental approach. Methods: For assessing the usability of two home medical devices (blood pressure monitor and pulse oximeter), user tests were conducted among 149 students. A mixed-methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). Participants completed a questionnaire to show the extent of their previous health knowledge and then operated both devices randomly. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (system usability scale [SUS]). The qualitative observational data were coded using inductive analysis by two independent researchers specialized in cognitive psychology and cognitive ergonomics. Correlational analyses and clusters were performed to test how usability relates to sociodemographic characteristics and prior health knowledge. Results: The results indicated a lack of usability for both devices. Regarding the blood pressure monitor (137 participants), users made approximately 0.77 errors (SD 1.49), and the mean SUS score was 72.4 (SD 21.07), which is considered ?satisfactory.? The pulse oximeter (147 participants) appeared easier to use, but participants made more errors (mean 0.99, SD 0.92), and the mean SUS score was 71.52 (SD 17.29), which is considered ?satisfactory.? The results showed a low negative and significant correlation only between the effectiveness of the two devices and previous knowledge (blood pressure monitor: r=?0.191, P=.03; pulse oximeter: r=?0.263, P=.001). More subtly, we experimentally identified the existence of a threshold level (?²2,146=10.9, P=.004) for health knowledge to correctly use the pulse oximeter, but this was missing for the blood pressure monitor. Conclusions: This study has the following two contributions: (1) a theoretical interest highlighting the importance of user characteristics including prior health knowledge on usability outcomes and (2) an applied interest to provide recommendations to designers and medical staff. UR - http://mhealth.jmir.org/2020/9/e17983/ UR - http://dx.doi.org/10.2196/17983 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955454 ID - info:doi/10.2196/17983 ER - TY - JOUR AU - McCarthy, Stephen AU - O'Raghallaigh, Paidi AU - Woodworth, Simon AU - Lim, Yin Yoke AU - Kenny, C. Louise AU - Adam, Frédéric PY - 2020/9/17 TI - Embedding the Pillars of Quality in Health Information Technology Solutions Using ?Integrated Patient Journey Mapping? (IPJM): Case Study JO - JMIR Hum Factors SP - e17416 VL - 7 IS - 3 KW - health information technology KW - health care quality KW - data analytics KW - multidisciplinary research KW - mobile phone N2 - Background: Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the health care sector. However, to deliver robust health care service improvements, it is essential that HIT solutions be designed by parallelly considering the 3 core pillars of health care quality: clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to design interventions that both adhere to medical protocols and achieve the tripartite goals of effectiveness, safety, and experience. Objective: In this paper, we present a design tool called Integrated Patient Journey Mapping (IPJM) that was developed to assist multidisciplinary teams in designing effective HIT solutions to address the 3 core pillars of health care quality. IPJM is intended to support the analysis of requirements as well as to promote empathy and the emergence of shared commitment and understanding among multidisciplinary teams. Methods: A 6-month, in-depth case study was conducted to derive findings on the use of IPJM during Learning to Evaluate Blood Pressure at Home (LEANBH), a connected health project that developed an HIT solution for the perinatal health context. Data were collected from over 700 hours of participant observations and 10 semistructured interviews. Results: The findings indicate that IPJM offered a constructive tool for multidisciplinary teams to work together in designing an HIT solution, through mapping the physical and emotional journey of patients for both the current service and the proposed connected health service. This allowed team members to consider the goals, tasks, constraints, and actors involved in the delivery of this journey and to capture requirements for the digital touchpoints of the connected health service. Conclusions: Overall, IPJM facilitates the design and implementation of complex HITs that require multidisciplinary participation. UR - http://humanfactors.jmir.org/2020/3/e17416/ UR - http://dx.doi.org/10.2196/17416 UR - http://www.ncbi.nlm.nih.gov/pubmed/32940610 ID - info:doi/10.2196/17416 ER - TY - JOUR AU - Vasti, Elena AU - Pletcher, J. Mark PY - 2020/8/25 TI - Recruiting Student Health Coaches to Improve Digital Blood Pressure Management: Randomized Controlled Pilot Study JO - JMIR Form Res SP - e13637 VL - 4 IS - 8 KW - mobile health KW - hypertension KW - coaching KW - health-related behavior KW - mobile phone N2 - Background: Hypertension is a significant problem in the United States, affecting 1 in 3 adults aged above 18 years and is associated with a higher risk for cardiovascular disease and stroke. The prevalence of hypertension has increased in medically underserved areas (MUAs). Mobile health technologies, such as digital self-monitoring devices, have been shown to improve the management of chronic health conditions. However, patients from MUAs have reduced access to these devices because of limited resources and low health literacy. Health coaches and peer training programs are a potentially cost-effective solution for the shortage of physicians available to manage hypertension in MUAs. Activating young people as student health coaches (SHCs) is a promising strategy to improve community health. Objective: This pilot study aims to assess (1) the feasibility of training high school students as health technology coaches in MUAs and (2) whether the addition of SHCs to digital home monitoring improves the frequency of self-monitoring and overall blood pressure (BP) control. Methods: In total, 15 high school students completed 3-day health coach training. Patients who had a documented diagnosis of hypertension were randomly assigned to 1 of the 3 intervention arms. The QardioArm alone (Q) group was provided a QardioArm cuff only for convenience. The SHC alone (S) group was instructed to meet with a health coach for 30 min once a week for 5 weeks to create action plans for reducing BP. The student+QardioArm (S+Q) group received both interventions. Results: Participants (n=27) were randomly assigned to 3 groups in a ratio of 9:9:9. All 15 students completed training, of which 40% (6/15) of students completed all the 5 meetings with their assigned patient. Barriers to feasibility included transportation and patient response drop-off at the end of the study. Overall, 92% (11/12) of the students rated their experience as very good or higher and 69% (9/13) reported that this experience made them more likely to go into the medical field. There was a statistically significant difference in the frequency of cuff use (S+Q vs Q groups: 37 vs 17; P<.001). Participants in the S+Q group reported better BP control after the intervention compared with the other groups. The average BP at the end of the intervention was 145/84 (SD 9/18) mm Hg, 150/85 (SD 18/12) mm Hg, and 128/69 (SD 20/14) mm Hg in the Q, S, and S+Q groups, respectively. Conclusions: This pilot study demonstrates the feasibility of pairing technology with young student coaches, although challenges existed. The S+Q group used their cuff more than the Q group. Patients were more engaged in the S+Q group, reporting higher satisfaction with their SHC and better control of their BP. UR - https://formative.jmir.org/2020/8/e13637 UR - http://dx.doi.org/10.2196/13637 UR - http://www.ncbi.nlm.nih.gov/pubmed/32840489 ID - info:doi/10.2196/13637 ER - TY - JOUR AU - Buis, R. Lorraine AU - Roberson, N. Dana AU - Kadri, Reema AU - Rockey, G. Nicole AU - Plegue, A. Melissa AU - Danak, U. Shivang AU - Guetterman, C. Timothy AU - Johnson, G. Melanie AU - Choe, Mi Hae AU - Richardson, R. Caroline PY - 2020/8/11 TI - Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study JO - J Med Internet Res SP - e19882 VL - 22 IS - 8 KW - cell phone KW - mobile phone KW - hypertension KW - blood pressure KW - medication adherence KW - telemedicine KW - pharmacists N2 - Background: Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective: We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods: We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results: A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions: Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration: ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8059 UR - https://www.jmir.org/2020/8/e19882 UR - http://dx.doi.org/10.2196/19882 UR - http://www.ncbi.nlm.nih.gov/pubmed/32780026 ID - info:doi/10.2196/19882 ER - TY - JOUR AU - Dorsch, P. Michael AU - Cornellier, L. Maria AU - Poggi, D. Armella AU - Bilgen, Feriha AU - Chen, Peiyu AU - Wu, Cindy AU - An, C. Lawrence AU - Hummel, L. Scott PY - 2020/8/10 TI - Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e16696 VL - 8 IS - 8 KW - hypertension KW - sodium intake KW - geofencing KW - mHealth N2 - Background: High dietary sodium intake is a significant public health problem in the United States. High sodium consumption is associated with high blood pressure and high risk of cardiovascular disease. Objective: The aim of this study was to evaluate the effect of a just-in-time adaptive mobile app intervention, namely, LowSalt4Life, on reducing sodium intake in adults with hypertension. Methods: In this study, 50 participants aged ?18 years who were under treatment for hypertension were randomized (1:1, stratified by gender) into 2 groups, namely, the App group (LowSalt4Life intervention) and the No App group (usual dietary advice) in a single-center, prospective, open-label randomized controlled trial for 8 weeks. The primary endpoint was the change in the 24-hour urinary sodium excretion estimated from spot urine by using the Kawasaki equation, which was analyzed using unpaired two-sided t tests. Secondary outcomes included the change in the sodium intake measured by the food frequency questionnaire (FFQ), the 24-hour urinary sodium excretion, blood pressure levels, and the self-reported confidence in following a low-sodium diet. Results: From baseline to week 8, there was a significant reduction in the Kawasaki-estimated 24-hour urinary sodium excretion calculated from spot urine in the App group compared to that in the No App group (?462 [SD 1220] mg vs 381 [SD 1460] mg, respectively; P=.03). The change in the 24-hour urinary sodium excretion was ?637 (SD 1524) mg in the App group and ?322 (SD 1485) mg in the No App group (P=.47). The changes in the estimated sodium intake as measured by 24-hour dietary recall and by FFQ in the App group were ?1537 (SD 2693) mg and ?1553 (SD 1764) mg while those in the No App group were ?233 (SD 2150) mg and ?515 (SD 1081) mg, respectively (P=.07 and P=.01, respectively). The systolic blood pressure change from baseline to week 8 in the App group was ?7.5 mmHg while that in the No App group was ?0.7 mmHg (P=.12), but the self-confidence in following a low-sodium diet was not significantly different between the 2 groups. Conclusions: This study shows that a contextual just-in-time mobile app intervention resulted in a greater reduction in the dietary sodium intake in adults with hypertension than that in the control group over a 8-week period, as measured by the estimated 24-hour urinary sodium excretion from spot urine and FFQ. The intervention group did not show a significant difference from the control group in the self-confidence in following a low sodium diet and in the 24-hour urinary sodium excretion or dietary intake of sodium as measured by the 24-hour dietary recall. A larger clinical trial is warranted to further elucidate the effects of the LowSalt4Life intervention on sodium intake and blood pressure levels in adults with hypertension. Trial Registration: ClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343 International Registered Report Identifier (IRRID): RR2-10.2196/11282 UR - http://mhealth.jmir.org/2020/8/e16696/ UR - http://dx.doi.org/10.2196/16696 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663139 ID - info:doi/10.2196/16696 ER - TY - JOUR AU - Jongsma, Rolanda Karin AU - van den Heuvel, M. Josephus F. AU - Rake, Jasmijn AU - Bredenoord, L. Annelien AU - Bekker, N. Mireille PY - 2020/8/4 TI - User Experiences With and Recommendations for Mobile Health Technology for Hypertensive Disorders of Pregnancy: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e17271 VL - 8 IS - 8 KW - mobile health KW - hypertension KW - telemonitoring KW - ethics KW - high-risk pregnancy KW - preeclampsia KW - digital health N2 - Background: Hypertensive disorders of pregnancy (HDP) are a primary cause of adverse maternal and neonatal outcomes worldwide. For women at risk of hypertensive complications, guidelines recommend frequent surveillance of blood pressure and signs of preeclampsia. Clinic visits range from every 2 weeks to several times a week. Given the wide ubiquity of smartphones and computers in most countries and a growing attention for self-management, digital technologies, including mobile health (mHealth), constitute a promising component of monitoring (self-measured) blood pressure during pregnancy. Currently, little is known about the experiences of women using such platforms and how mHealth can be aligned with their needs and preferences. Objective: The objectives were twofold: (1) to explore the experiences of Dutch women who had an increased risk of HDP with a blended care approach (mHealth combined with face-to-face care) for remote self-monitoring of blood pressure and preeclampsia symptoms and (2) to formulate recommendations for the use and integration of mHealth in clinical care. Methods: Alongside a prospective blended care study (SAFE@home study) that monitors pregnant women at increased risk of HPD with mHealth technology, a mixed methods study was conducted, including questionnaires (n=52) and interviews (n=11). Results were analyzed thematically. Results: Of the 4 themes, 2 themes were related to the technologies themselves (expectations, usability), and 2 themes were related to the interaction and use of mHealth (autonomy and responsibilities of patients, responsibilities of health care professionals). First, the digital platform met the expectations of patients, which contributed to user satisfaction. Second, the platform was considered user-friendly, and patients favored different moments and frequencies for measuring their blood pressure. Third, patient autonomy was mentioned in terms of increased insight about their own condition and being able to influence clinical decision making. Fourth, clinical expertise of health care professionals was considered essential to interpret the data, which translates to subsequent responsibilities for clinical management. Data from the questionnaires and interviews corresponded. Conclusions: Blended care using an mHealth tool to monitor blood pressure in pregnancy was positively evaluated by its users. Insights from participants led to 7 recommendations for designing and implementing similar interventions and to enhance future, morally sound use of digital technologies in clinical care. UR - https://mhealth.jmir.org/2020/8/e17271 UR - http://dx.doi.org/10.2196/17271 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749225 ID - info:doi/10.2196/17271 ER - TY - JOUR AU - Hernandez, Rosalba AU - Cohn, Michael AU - Hernandez, Alison AU - Daviglus, Martha AU - Martinez, Lizet AU - Martinez, Angela AU - Martinez, Itzel AU - Durazo-Arvizu, Ramon AU - Moskowitz, Judith PY - 2020/8/4 TI - A Web-Based Positive Psychological Intervention to Improve Blood Pressure Control in Spanish-Speaking Hispanic/Latino Adults With Uncontrolled Hypertension: Protocol and Design for the ¡Alégrate! Randomized Controlled Trial JO - JMIR Res Protoc SP - e17721 VL - 9 IS - 8 KW - positive psychology KW - hypertension KW - blood pressure KW - emotions KW - telemedicine KW - happiness KW - culture KW - Hispanic Americans N2 - Background: Growing evidence links psychological well-being and resilience with superior cardiac health, but there remains a critical scientific gap about whether (or how) interventions that aim to cultivate psychological well-being reduce cardiac risk. Hispanic/Latino people in the United States have high cardiovascular disease risk and poorly controlled blood pressure (BP) compared with their peers of European ancestry, and they represent a population in need of new and innovative therapeutic approaches. As such, a focused intervention to boost psychological well-being holds promise as a novel therapeutic target for hypertension in Hispanic/Latino adults; to date, however, no research has explored whether a causal link is evident. Objective: The aim of this paper is to detail the protocol for the ¡Alégrate! (Be Happy!) intervention, a Phase II randomized controlled trial testing initial efficacy in improving BP of a web-based positive psychological intervention designed to boost psychological well-being in Spanish-speaking Hispanic/Latino people with hypertension. Methods: A total of 70 Hispanic/Latino people aged ?18 years, fluent in Spanish, and with elevated BP (?140/90 mm Hg) will be recruited in person from a single Federally Qualified Health Center in Chicago. Enrollees will be randomly assigned to 1 of 2 trial arms: (1) web-based positive psychological intervention or (2) an active control condition (eg, 3 times weekly emotion reporting). Our 5-week Spanish-language ¡Alégrate! intervention is web-based and delivers curricular content via didactic instruction, journaling, and assigned at-home practice?all accessed via our website using investigator-purchased tablet computers, with a unique username and password assigned to each enrollee. Targeted skills include noting daily positive events, positive reappraisal of stressful events, effective expression of gratitude, performing acts of kindness, and regular practice of mindfulness and meditation. The primary outcome is improvement in BP, both sitting values and 24-hour ambulatory readings, as measured at baseline and 5 and 12 weeks from baseline. Secondary outcomes include psychological well-being, engagement in healthy behaviors, and circulating levels of inflammatory markers. The outcomes of interest are collected by trained research staff through in-person interviews using the REDCap software. Results: Activities of the ¡Alégrate! intervention were funded in August 2017, and data collection is ongoing. We expect to submit trial results for peer-reviewed publications in 2021, soon after recruitment has been concluded and statistical analyses are finalized. Conclusions: Findings will provide evidence on whether interventions to boost psychological well-being and resilience have downstream effects on BP control and cardiovascular health, particularly as they are deployed in the Spanish language with cultural tailoring and via a web-based platform. If effective, we will have an easily disseminatable application that can positively impact well-being profiles and BP control in Hispanic/Latino people, with the possibility of addressing health disparities of this US racial/ethnic minority group. Trial Registration: ClinicalTrials.gov NCT03892057; https://clinicaltrials.gov/ct2/show/NCT03892057 International Registered Report Identifier (IRRID): PRR1-10.2196/17721 UR - https://www.researchprotocols.org/2020/8/e17721 UR - http://dx.doi.org/10.2196/17721 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749224 ID - info:doi/10.2196/17721 ER - TY - JOUR AU - Kan, Wei-Chih AU - Kuo, Shu-Chun AU - Chien, Tsair-Wei AU - Lin, John Jui-Chung AU - Yeh, Yu-Tsen AU - Chou, Willy AU - Chou, Po-Hsin PY - 2020/7/27 TI - Therapeutic Duplication in Taiwan Hospitals for Patients With High Blood Pressure, Sugar, and Lipids: Evaluation With a Mobile Health Mapping Tool JO - JMIR Med Inform SP - e11627 VL - 8 IS - 7 KW - duplicate medication KW - mHealth KW - hypertension KW - high blood sugar KW - high blood lipid N2 - Background: Cardiovascular disease causes approximately half of all deaths in patients with type 2 diabetes. Duplicative prescriptions of medication in patients with high blood pressure (hypertension), high blood sugar (hyperglycemia), and high blood lipids (hyperlipidemia) have attracted substantial attention regarding the abuse of health care resources and to implement preventive measures for such abuse. Duplicative prescriptions may occur by patients receiving redundant medications for the same condition from two or more sources such as doctors, hospitals, and multiple providers, or as a result of the patient?s wandering among hospitals. Objective: We evaluated the degree of duplicative prescriptions in Taiwanese hospitals for outpatients with three types of medications (antihypertension, antihyperglycemia, and antihyperlipidemia), and then used an online dashboard based on mobile health (mHealth) on a map to determine whether the situation has improved in the recent 25 fiscal quarters. Methods: Data on duplicate prescription rates of drugs for the three conditions were downloaded from the website of Taiwan?s National Health Insurance Administration (TNHIA) from the third quarter of 2010 to the third quarter of 2016. Complete data on antihypertension, antihyperglycemia, and antihyperlipidemia prescriptions were obtained from 408, 414, and 359 hospitals, respectively. We used scale quality indicators to assess the attributes of the study data, created a dashboard that can be traced using mHealth, and selected the hospital type with the best performance regarding improvement on duplicate prescriptions for the three types of drugs using the weighted scores on an online dashboard. Kendall coefficient of concordance (W) was used to evaluate whether the performance rankings were unanimous. Results: The data quality was found to be acceptable and showed good reliability and construct validity. The online dashboard using mHealth on Google Maps allowed for easy and clear interpretation of duplicative prescriptions regarding hospital performance using multidisciplinary functionalities, and showed significant improvement in the reduction of duplicative prescriptions among all types of hospitals. Medical centers and regional hospitals showed better performance with improvement in the three types of duplicative prescriptions compared with the district hospitals. Kendall W was 0.78, indicating that the performance rankings were not unanimous (Chi square2=4.67, P=.10). Conclusions: This demonstration of a dashboard using mHealth on a map can inspire using the 42 other quality indicators of the TNHIA by hospitals in the future. UR - https://medinform.jmir.org/2020/7/e11627 UR - http://dx.doi.org/10.2196/11627 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716306 ID - info:doi/10.2196/11627 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - Martínez-Jiménez, María Eva AU - Calvo-Lobo, César AU - Romero-Morales, Carlos AU - López-López, Daniel AU - Palomo-López, Patricia PY - 2020/7/24 TI - QardioArm Blood Pressure Monitoring in a Population With Type 2 Diabetes: Validation Study JO - J Med Internet Res SP - e19781 VL - 22 IS - 7 KW - blood pressure KW - hypertension KW - type 2 diabetes KW - mobile applications KW - software validation N2 - Background: Home blood pressure monitoring has many benefits, even more so, in populations prone to high blood pressure, such as persons with diabetes. Objective: The purpose of this research was to validate the QardioArm mobile device in a sample of individuals with noninsulin-dependent type 2 diabetes in accordance with the guidelines of the second International Protocol of the European Society of Hypertension. Methods: The sample consisted of 33 patients with type 2 diabetes. To evaluate the validity of QardioArm by comparing its data with that obtained with a digital sphygmomanometer (Omron M3 Intellisense), two nurses collected diastolic blood pressure, systolic blood pressure, and heart rate with both devices. Results: The analysis indicated that the test device QardioArm met all the validation requirements using a sample population with type 2 diabetes. Conclusions: This paper reports the first validation of QardioArm in a population of individuals with noninsulin-dependent type 2 diabetes. QardioArm for home monitoring of blood pressure and heart rate met the requirements of the second International Protocol of the European Society of Hypertension. UR - http://www.jmir.org/2020/7/e19781/ UR - http://dx.doi.org/10.2196/19781 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706672 ID - info:doi/10.2196/19781 ER - TY - JOUR AU - Mena, J. Luis AU - Félix, G. Vanessa AU - Ostos, Rodolfo AU - González, J. Armando AU - Martínez-Peláez, Rafael AU - Melgarejo, D. Jesus AU - Maestre, E. Gladys PY - 2020/7/20 TI - Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e18012 VL - 8 IS - 7 KW - mHealth KW - photoplethysmography KW - blood pressure monitoring KW - hypertension N2 - Background: Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective: This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations. UR - https://mhealth.jmir.org/2020/7/e18012 UR - http://dx.doi.org/10.2196/18012 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459642 ID - info:doi/10.2196/18012 ER - TY - JOUR AU - Indraratna, Praveen AU - Tardo, Daniel AU - Yu, Jennifer AU - Delbaere, Kim AU - Brodie, Matthew AU - Lovell, Nigel AU - Ooi, Sze-Yuan PY - 2020/7/6 TI - Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e16695 VL - 8 IS - 7 KW - mobile phone KW - text messaging KW - telemedicine KW - myocardial ischemia KW - heart failure KW - hypertension N2 - Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective: A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods: Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results: A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI ?7.8 to ?0.78 mm Hg; n=2023; P=.02). Conclusions: The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD. UR - https://mhealth.jmir.org/2020/7/e16695 UR - http://dx.doi.org/10.2196/16695 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628615 ID - info:doi/10.2196/16695 ER - TY - JOUR AU - Radha, Mustafa AU - den Boer, Niels AU - Willemsen, C. Martijn AU - Paardekooper, Thom AU - IJsselsteijn, A. Wijnand AU - Sartor, Francesco PY - 2020/6/29 TI - Assisting Home-Based Resistance Training for Normotensive and Prehypertensive Individuals Using Ambient Lighting and Sonification Feedback: Sensor-Based System Evaluation JO - JMIR Cardio SP - e16354 VL - 4 IS - 1 KW - hypertension KW - sonification KW - respiratory guidance KW - intrinsic motivation KW - physical exertion N2 - Background: Physical exercise is an effective lifestyle intervention to improve blood pressure. Although aerobic sports can be performed anywhere, resistance exercises are traditionally performed at the gym; extending the latter to the home setting may promote an increase in the number of practitioners. Objective: This study aims to evaluate a sensor-based system that guides resistance exercises through ambient lighting and sonification (A/S) feedback in a home setting in 34 study participants who were normotensive and prehypertensive. Methods: Participants took part in a 1.5-hour exercise session in which they experienced the A/S feedback (ie, experimental condition) as well as a control condition (ie, no feedback) and a reference condition (ie, verbal feedback through a human remote coach). The system was evaluated for improving exercise form (range of motion, timing, and breathing patterns) as well as psychophysiological experience (perceived exertion, attentional focus, competence, and motivation). Results: A/S feedback was significantly better than the control for concentric (mean 2.48, SD 0.75 seconds; P<.001) and eccentric (mean 2.92, SD 1.05 seconds; P<.001) contraction times, concentric range of motion consistency (mean 15.64, SD 8.31 cm vs mean 17.94, SD 9.75 cm; P<.001), and perceived exertion (mean 3.37, SD 0.78 vs mean 3.64, SD 0.76; P<.001). However, A/S feedback did not outperform verbal feedback on any of these measures. The breathing technique was best in the control condition (ie, without any feedback). Participants did not show more positive changes in perceived competence with A/S feedback or verbal feedback. Conclusions: The system seemed to improve resistance exercise execution and perception in comparison with the control, but did not outperform a human tele-coach. Further research is warranted to improve the breathing technique. UR - https://cardio.jmir.org/2020/1/e16354 UR - http://dx.doi.org/10.2196/16354 UR - http://www.ncbi.nlm.nih.gov/pubmed/32597789 ID - info:doi/10.2196/16354 ER - TY - JOUR AU - Hasan, Tafsir S. M. AU - Ahmed, Imran Syed AU - Khan, Alfazal Md AU - Sarker, Alam Shafiqul AU - Ahmed, Tahmeed PY - 2020/6/15 TI - Achieving Optimal Gestational Weight Gain, Birth Weight, and Perinatal Outcomes Among Pregnant Women at Risk of Hypertension: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e16676 VL - 9 IS - 6 KW - hypertensive disorder KW - hypertension KW - pregnancy KW - preeclampsia KW - gestational weight gain KW - continuous blood pressure monitor KW - wearable device KW - Health Gauge KW - birth weight KW - perinatal outcome N2 - Background: Hypertensive disorders, including preeclampsia, complicate 10% of all pregnancies, causing maternal and fetal morbidity and mortality. In Bangladesh, 24% of all maternal deaths are directly attributed to hypertensive disorders. Conventional antenatal care practices often delay or miss detecting hypertensive disorders in pregnancy, which may allow some women to become vulnerable to the adverse consequences of the hypertensive disorders. Regular self-monitoring of blood pressure and weight gain may improve maternal and fetal outcomes among pregnant women at risk of developing hypertensive disorders during pregnancy through early diagnosis, prompt referral, and timely clinical management; however, to undertake a randomized controlled trial of an intervention to reduce adverse consequences of hypertensive disorders in pregnancy, its feasibility must first be determined. Objective: The objectives of this study are to evaluate the accuracy of a wearable blood pressure monitoring device (Health Gauge) in order to test the design and methods of a future definitive randomized controlled trial, and to examine the feasibility, acceptability, and fidelity of an intervention focusing on regular monitoring of weight gain and self-monitoring of blood pressure for pregnant women at risk of developing hypertensive disorders and their associated complications. Methods: The study is located in Matlab, Bangladesh will be conducted in two phases. First, a wearable blood pressure device (Health Gauge) will be validated in accordance with the European Society of Hypertension International Protocol (revision 2010). Second, a prospective, two-arm, parallel, and nonblinded randomized controlled external pilot trial will be conducted. In the pilot trial, 70 eligible participants will be individually randomized to the intervention arm, in which pregnant women will self-monitor their blood pressure daily using a wearable device (Health Gauge) and be evaluated monthly by trained health workers for weight gain from 20 weeks of gestation until delivery, or the control arm, in which pregnant women will be assessed for weight gain every two months from 20 weeks of gestation until delivery (1:1 intervention to control allocation ratio using a permuted block randomization method with concealment). All women will receive standard antenatal care. Results: A validation study of the wearable blood pressure device has successfully been conducted among the general adult population in Matlab, Bangladesh. As of September 2019, the pilot trial has completed enrollment of women who are pregnant (N=70; intervention: n=35; control: n=35) and follow-up of the participants is ongoing. Data analysis is expected to be completed by June 2020, and results are expected to be submitted for publication in August 2020. Conclusions: The findings of this study will help us to design a comprehensive, full-scale randomized controlled trial to test the efficacy of regular self-monitoring of blood pressure and weight gain during pregnancy, a simple and inexpensive intervention to help to achieve optimal maternal and fetal outcomes in pregnant women at risk of developing hypertensive disorders and their associated complications during pregnancy. Trial Registration: ClinicalTrials.gov NCT03858595; https://clinicaltrials.gov/ct2/show/NCT03858595 International Registered Report Identifier (IRRID): DERR1-10.2196/16676 UR - http://www.researchprotocols.org/2020/6/e16676/ UR - http://dx.doi.org/10.2196/16676 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459639 ID - info:doi/10.2196/16676 ER - TY - JOUR AU - Luo, Aijing AU - Xin, Zirui AU - Yuan, Yifeng AU - Wen, Tingxiao AU - Xie, Wenzhao AU - Zhong, Zhuqing AU - Peng, Xiaoqing AU - Ouyang, Wei AU - Hu, Chao AU - Liu, Fei AU - Chen, Yang AU - He, Haiyan PY - 2020/5/29 TI - Multidimensional Feature Classification of the Health Information Needs of Patients With Hypertension in an Online Health Community Through Analysis of 1000 Patient Question Records: Observational Study JO - J Med Internet Res SP - e17349 VL - 22 IS - 5 KW - online health community KW - health information needs KW - patients with hypertension KW - physician-patient communication N2 - Background: With the rapid development of online health communities, increasing numbers of patients and families are seeking health information on the internet. Objective: This study aimed to discuss how to fully reveal the health information needs expressed by patients with hypertension in their questions in a web-based environment and how to use the internet to help patients with hypertension receive personalized health education. Methods: This study randomly selected 1000 text records from the question data of patients with hypertension from 2008 to 2018 collected from Good Doctor Online and constructed a classification system through literature research and content analysis. This paper identified the background characteristics and questioning intention of each patient with hypertension based on the patient?s question and used co-occurrence network analysis and the k-means clustering method to explore the features of the health information needs of patients with hypertension. Results: The classification system for the health information needs of patients with hypertension included the following nine dimensions: drugs (355 names), symptoms and signs (395 names), tests and examinations (545 names), demographic data (526 kinds), diseases (80 names), risk factors (37 names), emotions (43 kinds), lifestyles (6 kinds), and questions (49 kinds). There were several characteristics of the explored web-based health information needs of patients with hypertension. First, more than 49% of patients described features, such as drugs, symptoms and signs, tests and examinations, demographic data, and diseases. Second, patients with hypertension were most concerned about treatment (778/1000, 77.80%), followed by diagnosis (323/1000, 32.30%). Third, 65.80% (658/1000) of patients asked physicians several questions at the same time. Moreover, 28.30% (283/1000) of patients were very concerned about how to adjust the medication, and they asked other treatment-related questions at the same time, including drug side effects, whether to take the drugs, how to treat the disease, etc. Furthermore, 17.60% (176/1000) of patients consulted physicians about the causes of clinical findings, including the relationship between the clinical findings and a disease, the treatment of a disease, and medications and examinations. Fourth, by k-means clustering, the questioning intentions of patients with hypertension were classified into the following seven categories: ?how to adjust medication,? ?what to do,? ?how to treat,? ?phenomenon explanation,? ?test and examination,? ?disease diagnosis,? and ?disease prognosis.? Conclusions: In a web-based environment, the health information needs expressed by Chinese patients with hypertension to physicians are common and distinct, that is, patients with different background features ask relatively common questions to physicians. The classification system constructed in this study can provide guidance to health information service providers for the construction of web-based health resources, as well as guidance for patient education, which could help solve the problem of information asymmetry in communication between physicians and patients. UR - http://www.jmir.org/2020/5/e17349/ UR - http://dx.doi.org/10.2196/17349 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469318 ID - info:doi/10.2196/17349 ER - TY - JOUR AU - Zhai, Panpan AU - Hayat, Khezar AU - Ji, Wenjing AU - Li, Qian AU - Shi, Li AU - Atif, Naveel AU - Xu, Sen AU - Li, Pengchao AU - Du, Qianqian AU - Fang, Yu PY - 2020/5/20 TI - Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial JO - J Med Internet Res SP - e16019 VL - 22 IS - 5 KW - medication adherence KW - text messaging KW - hypertension KW - consultation KW - pharmacy students N2 - Background: Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student?led consultations have the potential to help patients manage their blood pressure (BP). Objective: The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. Methods: We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi?an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). Results: We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; P=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; P=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; P=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; P=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (P=.08). Conclusions: The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717. UR - https://www.jmir.org/2020/5/e16019 UR - http://dx.doi.org/10.2196/16019 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432556 ID - info:doi/10.2196/16019 ER - TY - JOUR AU - Kassavou, Aikaterini AU - Mirzaei, Venus AU - Brimicombe, James AU - Edwards, Simon AU - Massou, Efthalia AU - Prevost, Toby A. AU - Griffin, Simon AU - Sutton, Stephen PY - 2020/5/19 TI - A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness JO - J Med Internet Res SP - e16629 VL - 22 IS - 5 KW - medication adherence KW - hypertension KW - type 2 diabetes KW - text messaging KW - interactive voice response N2 - Background: The efficacy of a highly tailored digital intervention to support medication adherence and feasibility to support clinical effectiveness as an adjunct to the primary care setting has not been evaluated. Objective: This trial aimed to assess the behavioral efficacy of a highly tailored digital intervention to support medication adherence and to evaluate the feasibility of its clinical effectiveness, in patients with either or both hypertension and type 2 diabetes. We also examined quality of life and mechanisms of behavior change. Intervention fidelity, engagement, and satisfaction were also explored. Methods: This was a multicenter, individually randomized controlled trial of 2 parallel groups: an intervention group that received a highly tailored text message and interactive voice response intervention for 12 weeks, and a control group that received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of a repeat prescription. Systolic blood pressure and glucose levels were assessed by nurses blinded to group allocation during practice visits at 3 months follow-up. Questionnaires obtained data to assess intervention mechanisms of action and satisfaction and digital log files captured data to evaluate fidelity and engagement. Results: A total of 135 nonadherent patients (62/135, 46% female; 122/135, 90.3%; aged above 50 years) were randomly allocated in the intervention (n=79) or in the control group (n=56); of whom 13% (18/135) were lost at follow-up. Medication adherence was significantly improved in the intervention group compared with the control group (t116=2.27; P=.02, 2-tailed). Systolic blood pressure was 0.6 mmHg (95% CI ?7.423 to 6.301), and hemoglobin A1c was 4.5 mmol/mol (95% CI ?13.099 to 4.710) lower in the intervention group compared with the control group. Changes in intentional nonadherence and nonintentional nonadherence explained the improvements in medication adherence in the intervention group (beta=.074, SE=0.464; P=.04), but not in the control group (beta=.00, SE 1.35; P=.37). The intervention had 100% fidelity, a median of 12 days of engagement, and 76% overall satisfaction. Conclusions: Our trial is the first that has been conducted in the United Kingdom and showed that among nonadherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was effective at improving treatment adherence and feasible to obtain clinically meaningful outcomes. Changes in intentional and nonintentional nonadherence predicted the improvements in medication adherence. The intervention had high fidelity, engagement, and satisfaction. Future research using a rigorous design is needed to evaluate the clinical effectiveness and cost-effectiveness of the intervention in primary care. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149. UR - http://www.jmir.org/2020/5/e16629/ UR - http://dx.doi.org/10.2196/16629 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427113 ID - info:doi/10.2196/16629 ER - TY - JOUR AU - Park, Yong-Seok AU - Kim, Sung-Hoon AU - Lee, Se Yoon AU - Choi, Seung-Ho AU - Ku, Seung-Woo AU - Hwang, Gyu-Sam PY - 2020/5/15 TI - Real-Time Monitoring of Blood Pressure Using Digitalized Pulse Arrival Time Calculation Technology for Prompt Detection of Sudden Hypertensive Episodes During Laryngeal Microsurgery: Retrospective Observational Study JO - J Med Internet Res SP - e13156 VL - 22 IS - 5 KW - larynx KW - blood pressure KW - photoplethysmography KW - pulse N2 - Background: Laryngeal microsurgery (LMS) is often accompanied by a sudden increase in blood pressure (BP) during surgery because of stimulation around the larynx. This sudden change in the hemodynamic status is not immediately reflected in a casual cuff-type measurement that takes intermittent readings every 3 to 5 min. Objective: This study aimed to investigate the potential of pulse arrival time (PAT) as a marker for a BP surge, which usually occurs in patients undergoing LMS. Methods: Intermittent measurements of BP and electrocardiogram (ECG) and photoplethysmogram (PPG) signals were recorded during LMS. PAT was defined as the interval between the R-peak on the ECG and the maximum slope on the PPG. Mean PAT values before and after BP increase were compared. PPG-related parameters and the correlations between changes in these variables were calculated. Results: BP surged because of laryngoscopic manipulation (mean systolic BP [SBP] from 115.3, SD 21.4 mmHg, to 159.9, SD 25.2 mmHg; P<.001), whereas PAT decreased significantly (from mean 460.6, SD 51.9 ms, to 405.8, SD 50.1 ms; P<.001) in most of the cases. The change in SBP showed a significant correlation with the inverse of the PAT (r=0.582; P<.001). Receiver-operating characteristic curve analysis indicated that an increase of 11.5% in the inverse of the PAT could detect a 40% increase in SBP, and the area under the curve was 0.814. Conclusions: During LMS, where invasive arterial catheterization is not always possible, PAT shows good correlation with SBP and may, therefore, have the potential to identify abrupt BP surges during laryngoscopic manipulations in a noninvasive manner. UR - https://www.jmir.org/2020/5/e13156 UR - http://dx.doi.org/10.2196/13156 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412413 ID - info:doi/10.2196/13156 ER - TY - JOUR AU - Weerahandi, Himali AU - Paul, Soaptarshi AU - Quintiliani, M. Lisa AU - Chokshi, Sara AU - Mann, M. Devin PY - 2020/5/7 TI - A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study JO - JMIR Form Res SP - e13989 VL - 4 IS - 5 KW - eHealth KW - mobile KW - telemedicine N2 - Background: The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective: This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods: We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results: A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions: In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes. UR - http://formative.jmir.org/2020/5/e13989/ UR - http://dx.doi.org/10.2196/13989 UR - http://www.ncbi.nlm.nih.gov/pubmed/32379049 ID - info:doi/10.2196/13989 ER - TY - JOUR AU - Steinman, Lesley AU - Heang, Hen AU - van Pelt, Maurits AU - Ide, Nicole AU - Cui, Haixia AU - Rao, Mayuree AU - LoGerfo, James AU - Fitzpatrick, Annette PY - 2020/4/24 TI - Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study JO - JMIR Mhealth Uhealth SP - e13536 VL - 8 IS - 4 KW - diabetes mellitus KW - hypertension KW - chronic disease KW - noncommunicable diseases KW - health educators KW - mHealth KW - qualitative KW - disease management KW - developing countries N2 - Background: In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo?s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective: This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods: We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results: We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor?s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions: These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management. UR - http://mhealth.jmir.org/2020/4/e13536/ UR - http://dx.doi.org/10.2196/13536 UR - http://www.ncbi.nlm.nih.gov/pubmed/32329737 ID - info:doi/10.2196/13536 ER - TY - JOUR AU - Bernabe-Ortiz, Antonio AU - Pauschardt, Julia AU - Diez-Canseco, Francisco AU - Miranda, Jaime J. PY - 2020/4/21 TI - Sustainability of mHealth Effects on Cardiometabolic Risk Factors: Five-Year Results of a Randomized Clinical Trial JO - J Med Internet Res SP - e14595 VL - 22 IS - 4 KW - mHealth KW - low- and middle-income countries KW - blood pressure KW - body weight N2 - Background: The long-term effects of mobile health (mHealth) interventions have not been documented, especially in resource-constrained settings. Objective: This study aimed to assess the effects of a 1-year mHealth intervention on blood pressure levels and body weight in low-resource urban settings in Peru, 4 years after the completion of the original study. Methods: Four years after the original Grupo de Investigación en Salud Móvil en America Latina (GISMAL) study, we attempted to contact the 212 individuals originally enrolled in the study in Peru. The primary outcomes were systolic and diastolic blood pressure levels and hypertension incidence. Secondary outcome measures were body weight, BMI, and self-reported target behaviors. The study personnel collecting the data were masked to the group assignment. Linear mixed models were used to evaluate the effects of the intervention on primary and secondary outcomes in an intention-to-treat analysis. Results: Data from 164 (77.4%) of the 212 originally enrolled participants were available and analyzed (80 in the intervention group and 84 in the control group). The intervention did not result in changes in systolic (?2.54 mm Hg, 95% CI ?8.23 to 3.15) or diastolic (3.41 mm Hg, 95% CI ?0.75 to 7.57) blood pressure compared with the control group. The intervention reduced the risk of developing hypertension, but the result was not significant (risk ratio (RR) 0.76, 95% CI 0.45-1.28). However, those who received the intervention had lower body weight (?5.42 kg, 95% CI ?10.4 to ?0.48) and BMI (?2.56 kg/m2, 95% CI ?4.46 to ?0.66). In addition, compared to the control participants, those who received ?50% of the scheduled calls during the intervention had greater reductions in body weight (?6.23 kg, 95% CI ?11.47 to ?0.99) and BMI (?2.81 kg/m2, 95% CI ?4.77 to ?0.85). Conclusions: An mHealth intervention comprising motivational interview calls and SMS text messaging appears to have effects on health 4 years after intervention completion. Although there were no effects on blood pressure levels, important reductions in body weight and BMI were seen 5 years after randomization. Thus, mHealth appears to be a promising preventive strategy for noncommunicable diseases in resource-constrained settings. Trial Registration: Clinicaltrials.gov NCT01295216; https://clinicaltrials.gov/ct2/show/NCT01295216 UR - http://www.jmir.org/2020/4/e14595/ UR - http://dx.doi.org/10.2196/14595 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314970 ID - info:doi/10.2196/14595 ER - TY - JOUR AU - Ramirez, Magaly AU - Chen, Kimberly AU - Follett, W. Robert AU - Mangione, M. Carol AU - Moreno, Gerardo AU - Bell, S. Douglas PY - 2020/4/17 TI - Impact of a ?Chart Closure? Hard Stop Alert on Prescribing for Elevated Blood Pressures Among Patients With Diabetes: Quasi-Experimental Study JO - JMIR Med Inform SP - e16421 VL - 8 IS - 4 KW - decision support systems, clinical KW - diabetes mellitus KW - hypertension KW - drug prescriptions N2 - Background: University of California at Los Angeles Health implemented a Best Practice Advisory (BPA) alert for the initiation of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) for individuals with diabetes. The BPA alert was configured with a ?chart closure? hard stop, which demanded a response before closing the chart. Objective: The aim of the study was to evaluate whether the implementation of the BPA was associated with changes in ACEI and ARB prescribing during primary care encounters for patients with diabetes. Methods: We defined ACEI and ARB prescribing opportunities as primary care encounters in which the patient had a diabetes diagnosis, elevated blood pressure in recent encounters, no active ACEI or ARB prescription, and no contraindications. We used a multivariate logistic regression model to compare the change in the probability of an ACEI or ARB prescription during opportunity encounters before and after BPA implementation in primary care sites that did (n=30) and did not (n=31) implement the BPA. In an additional subgroup analysis, we compared ACEI and ARB prescribing in BPA implementation sites that had also implemented a pharmacist-led medication management program. Results: We identified a total of 2438 opportunity encounters across 61 primary care sites. The predicted probability of an ACEI or ARB prescription increased significantly from 11.46% to 22.17% during opportunity encounters in BPA implementation sites after BPA implementation. However, in the subgroup analysis, we only observed a significant improvement in ACEI and ARB prescribing in BPA implementation sites that had also implemented the pharmacist-led program. Overall, the change in the predicted probability of an ACEI or ARB prescription from before to after BPA implementation was significantly greater in BPA implementation sites compared with nonimplementation sites (difference-in-differences of 11.82; P<.001). Conclusions: A BPA with a ?chart closure? hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers. UR - http://medinform.jmir.org/2020/4/e16421/ UR - http://dx.doi.org/10.2196/16421 UR - http://www.ncbi.nlm.nih.gov/pubmed/32301741 ID - info:doi/10.2196/16421 ER - TY - JOUR AU - Lisón, Francisco Juan AU - Palomar, Gonzalo AU - Mensorio, S. Marinna AU - Baños, M. Rosa AU - Cebolla-Martí, Ausiàs AU - Botella, Cristina AU - Benavent-Caballer, Vicent AU - Rodilla, Enrique PY - 2020/4/14 TI - Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial JO - J Med Internet Res SP - e14196 VL - 22 IS - 4 KW - web KW - internet KW - overweight KW - obesity KW - hypertension N2 - Background: Internet-based interventions are a promising strategy for promoting healthy lifestyle behaviors. These have a tremendous potential for delivering electronic health interventions in scalable and cost-effective ways. There is strong evidence that the use of these programs can lead to weight loss and can lower patients? average blood pressure (BP) levels. So far, few studies have investigated the effects of internet-based programs on patients who are obese with hypertension (HTN). Objective: The aim of this study is to investigate the short- and long-term efficacy, in terms of body composition and BP parameters, of a self-administered internet-based intervention involving different modules and learning techniques aimed at promoting lifestyle changes (both physical activity and healthy eating) in patients who are obese with HTN. Methods: A randomized wait-list controlled trial design was used. We recruited 105 adults with HTN who were overweight or obese and randomly assigned them to either a 3-month internet-based intervention group (n=55) or the wait-list control group (n=50). We assessed BMI (primary outcome), body fat mass (BFM), systolic (S)BP and diastolic (D)BP, blood glucose and insulin levels, physical activity levels, and functional capacity for aerobic exercise at Time 0 (preintervention) and Time 1 (postintervention). All the patients in the wait-list control group subsequently received the intervention, and a secondary within-group analysis, which also included these participants, was conducted at Time 2 (12-month follow-up). Results: A 2-way mixed analysis of covariance showed a significant decrease in BMI, BFM, and blood glucose at 3 months in the internet-based intervention group; the effect size for the BMI and BFM parameters was moderate to large, and there was also a borderline significant trend for DBP and insulin. These results were either maintained or improved upon at Time 2 and showed significant changes for BMI (mean difference ?0.4, 95% CI ?0.1 to ?0.6; P=.005), BFM (mean difference ?2.4, 95% CI ?1.1 to ?3.6; P<.001), DBP (mean difference ?1.8, 95% CI ?0.2 to ?3.3; P=.03), and blood glucose (mean difference ?2, 95% CI 0 to ?4; P=.04). Conclusions: Implementation of our self-administered internet-based intervention, which involved different learning techniques aimed to promote lifestyle changes, resulted in positive short- and long-term health benefits in patients who are obese with HTN. Trial Registration: ClinicalTrials.gov NCT03396302; https://clinicaltrials.gov/ct2/show/NCT03396302 UR - http://www.jmir.org/2020/4/e14196/ UR - http://dx.doi.org/10.2196/14196 UR - http://www.ncbi.nlm.nih.gov/pubmed/32286232 ID - info:doi/10.2196/14196 ER - TY - JOUR AU - Etminani, Kobra AU - Tao Engström, Arianna AU - Göransson, Carina AU - Sant?Anna, Anita AU - Nowaczyk, S?awomir PY - 2020/4/9 TI - How Behavior Change Strategies are Used to Design Digital Interventions to Improve Medication Adherence and Blood Pressure Among Patients With Hypertension: Systematic Review JO - J Med Internet Res SP - e17201 VL - 22 IS - 4 KW - digital intervention KW - hypertension KW - medication adherence KW - behavior change KW - intervention mapping KW - matrix of change objective. N2 - Background: Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. Objective: Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. Methods: We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. Results: The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. Conclusions: This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement. UR - https://www.jmir.org/2020/4/e17201 UR - http://dx.doi.org/10.2196/17201 UR - http://www.ncbi.nlm.nih.gov/pubmed/32271148 ID - info:doi/10.2196/17201 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - López-López, Daniel AU - Calvo-Lobo, César AU - Rodríguez-Sanz, David AU - Martínez-Jiménez, María Eva AU - Palomo-López, Patricia PY - 2020/4/2 TI - An Automated Blood Pressure Display for Self-Measurement in Patients With Chronic Kidney Disease (iHealth Track): Device Validation Study JO - JMIR Mhealth Uhealth SP - e14702 VL - 8 IS - 4 KW - iHealth Track KW - validation KW - blood pressure KW - heart rate KW - International Protocol N2 - Background: Hypertension is a global public health issue and is closely related to chronic kidney disorder (CKD). In people with CKD, strict monitoring of blood pressure is an important part of therapy. Objective: The aim of this research was to validate the iHealth Track blood pressure monitoring device for patients with CKD according to the European Society of Hypertension International Protocol 2010 (ESH-IP2). Methods: In total, 33 patients who received hemodialysis in Plasencia participated in the study. There were 9 successive measurements made, which conformed to the ESH-IP2. We calculated the differences between the standard reference device (Omron M3 Intellisense) and the test device (iHealth Track) for blood pressure and heart rate values. For 99 total comparisons of paired measurements, we classified differences into various categories (?5 mmHg, ?10 mmHg, and ?15 mmHg for blood pressure; ?3, ?5, and ?8 beats per minute for heart rate). Results: In 90 of 99 systolic blood pressure and 89 of 99 diastolic blood pressure comparisons between the devices, measurement differences were within 5 mmHg. In 81 of 99 heart rate comparisons between the devices, measurement differences were within 3 beats per minute. The mean differences between the test and reference standard measurements were 3.27 (SD 2.99) mmHg for systolic blood pressure, 3.59 (SD 4.55) mmHg for diastolic blood pressure, and 2.18 (SD 2.75) beats per minute for heart rate.We also observed that for both systolic and diastolic blood pressure, 31 of 33 participants had at least two of three comparisons between the devices with measurement differences less than 5 mmHg. For heart rate, 28 of 33 patients had at least two of three comparisons between the devices with measurement differences less than 3 beats per minute. Conclusions: To our knowledge, this is the first study to show that iHealth Track meets the requirements of the ESH-IP2 in patients with CKD. Therefore, the iHealth Track is suitable for use in renal patients. UR - https://mhealth.jmir.org/2020/4/e14702 UR - http://dx.doi.org/10.2196/14702 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238337 ID - info:doi/10.2196/14702 ER - TY - JOUR AU - Li, Ran AU - Liang, Ning AU - Bu, Fanlong AU - Hesketh, Therese PY - 2020/3/27 TI - The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e17776 VL - 8 IS - 3 KW - hypertension KW - self-management KW - mHealth KW - medication adherence KW - mobile phone KW - health behavior N2 - Background: Effective treatment of hypertension requires careful self-management. With the ongoing development of mobile technologies and the scarcity of health care resources, mobile health (mHealth)?based self-management has become a useful treatment for hypertension, and its effectiveness has been assessed in many trials. However, there is a paucity of comprehensive summaries of the studies using both qualitative and quantitative methods. Objective: This systematic review aimed to measure the effectiveness of mHealth in improving the self-management of hypertension for adults. The outcome measures were blood pressure (BP), BP control, medication adherence, self-management behavior, and costs. Methods: A systematic search was conducted using 5 electronic databases. The snowballing method was used to scan the reference lists of relevant studies. Only peer-reviewed randomized controlled trials (RCTs) published between January 2010 and September 2019 were included. Data extraction and quality assessment were performed by 3 researchers independently, adhering to the validation guideline and checklist. Both a meta-analysis and a narrative synthesis were carried out. Results: A total of 24 studies with 8933 participants were included. Of these, 23 studies reported the clinical outcome of BP, 12 of these provided systolic blood pressure (SBP) and diastolic blood pressure (DBP) data, and 16 articles focused on change in self-management behavior and medication adherence. All 24 studies were included in the narrative synthesis. According to the meta-analysis, a greater reduction in both SBP and DBP was observed in the mHealth intervention groups compared with control groups, ?3.78 mm Hg (P<.001; 95% CI ?4.67 to ?2.89) and ?1.57 mm Hg (P<.001; 95% CI ?2.28 to ?0.86), respectively. Subgroup analyses showed consistent reductions in SBP and DBP across different frequencies of reminders, interactive patterns, intervention functions, and study duration subgroups. A total of 16 studies reported better medication adherence and behavioral change in the intervention groups, while 8 showed no significant change. Six studies included an economic evaluation, which drew inconsistent conclusions. However, potentially long-term financial benefits were mentioned in all economic evaluations. All studies were assessed to be at high risk of bias. Conclusions: This review found that mHealth self-management interventions were effective in BP control. The outcomes of this review showed improvements in self-management behavior and medication adherence. The most successful mHealth intervention combined the feature of tailored messages, interactive communication, and multifaceted functions. Further research with longer duration and cultural adaptation is necessary. With increasing disease burden from hypertension globally, mHealth offers a potentially effective method for self-management and control of BP. mHealth can be easily integrated into existing health care systems. Trial Registration: PROSPERO CRD42019152062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=152062 UR - http://mhealth.jmir.org/2020/3/e17776/ UR - http://dx.doi.org/10.2196/17776 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217503 ID - info:doi/10.2196/17776 ER - TY - JOUR AU - Timpel, Patrick AU - Oswald, Sarah AU - Schwarz, H. Peter E. AU - Harst, Lorenz PY - 2020/3/18 TI - Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses JO - J Med Internet Res SP - e16791 VL - 22 IS - 3 KW - telemedicine KW - diabetes mellitus KW - hypertension KW - dyslipidemia KW - review KW - GRADE approach KW - treatment outcome N2 - Background: Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective: The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods: We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results: Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ??0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions: The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations. UR - http://www.jmir.org/2020/3/e16791/ UR - http://dx.doi.org/10.2196/16791 UR - http://www.ncbi.nlm.nih.gov/pubmed/32186516 ID - info:doi/10.2196/16791 ER - TY - JOUR AU - Ni, Zhao AU - Atluri, Namratha AU - Shaw, J. Ryan AU - Tan, Jingru AU - Khan, Kinza AU - Merk, Helena AU - Ge, Yunfan AU - Shrestha, Shrinkhala AU - Shrestha, Abha AU - Vasudevan, Lavanya AU - Karmacharya, Biraj AU - Yan, L. Lijing PY - 2020/3/9 TI - Evaluating the Feasibility and Acceptability of a Mobile Health?Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e15419 VL - 8 IS - 3 KW - hypertension KW - female community health volunteers KW - mHealth N2 - Background: Hypertension is a major modifiable risk factor for cardiovascular disease, the world?s leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal?s Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. Objective: The goal of this study was to assess if a mobile health?based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. Methods: In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. Results: All 17 female community health volunteers successfully measured 1113 rural Nepalis? blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. Conclusions: Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal. UR - http://mhealth.jmir.org/2020/3/e15419/ UR - http://dx.doi.org/10.2196/15419 UR - http://www.ncbi.nlm.nih.gov/pubmed/32149712 ID - info:doi/10.2196/15419 ER - TY - JOUR AU - McDonough, W. Caitrin AU - Smith, M. Steven AU - Cooper-DeHoff, M. Rhonda AU - Hogan, R. William PY - 2020/2/27 TI - Optimizing Antihypertensive Medication Classification in Electronic Health Record-Based Data: Classification System Development and Methodological Comparison JO - JMIR Med Inform SP - e14777 VL - 8 IS - 2 KW - antihypertensive agents KW - electronic health records KW - classification KW - RxNorm KW - phenotype N2 - Background: Computable phenotypes have the ability to utilize data within the electronic health record (EHR) to identify patients with certain characteristics. Many computable phenotypes rely on multiple types of data within the EHR including prescription drug information. Hypertension (HTN)-related computable phenotypes are particularly dependent on the correct classification of antihypertensive prescription drug information, as well as corresponding diagnoses and blood pressure information. Objective: This study aimed to create an antihypertensive drug classification system to be utilized with EHR-based data as part of HTN-related computable phenotypes. Methods: We compared 4 different antihypertensive drug classification systems based off of 4 different methodologies and terminologies, including 3 RxNorm Concept Unique Identifier (RxCUI)?based classifications and 1 medication name?based classification. The RxCUI-based classifications utilized data from (1) the Drug Ontology, (2) the new Medication Reference Terminology, and (3) the Anatomical Therapeutic Chemical Classification System and DrugBank, whereas the medication name?based classification relied on antihypertensive drug names. Each classification system was applied to EHR-based prescription drug data from hypertensive patients in the OneFlorida Data Trust. Results: There were 13,627 unique RxCUIs and 8025 unique medication names from the 13,879,046 prescriptions. We observed a broad overlap between the 4 methods, with 84.1% (691/822) to 95.3% (695/729) of terms overlapping pairwise between the different classification methods. Key differences arose from drug products with multiple dosage forms, drug products with an indication of benign prostatic hyperplasia, drug products that contain more than 1 ingredient (combination products), and terms within the classification systems corresponding to retired or obsolete RxCUIs. Conclusions: In total, 2 antihypertensive drug classifications were constructed, one based on RxCUIs and one based on medication name, that can be used in future computable phenotypes that require antihypertensive drug classifications. UR - http://medinform.jmir.org/2020/2/e14777/ UR - http://dx.doi.org/10.2196/14777 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130152 ID - info:doi/10.2196/14777 ER - TY - JOUR AU - Duan, Huilong AU - Wang, Zheyu AU - Ji, Yumeng AU - Ma, Li AU - Liu, Fang AU - Chi, Mingwei AU - Deng, Ning AU - An, Jiye PY - 2020/2/25 TI - Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment JO - JMIR Mhealth Uhealth SP - e14466 VL - 8 IS - 2 KW - goal-directed design KW - smartphone KW - mobile health KW - patients KW - hypertension self-management KW - mobile phone N2 - Background: Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective: The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods: The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results: In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions: This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management. UR - http://mhealth.jmir.org/2020/2/e14466/ UR - http://dx.doi.org/10.2196/14466 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130161 ID - info:doi/10.2196/14466 ER - TY - JOUR AU - Barsky, Jordan AU - Hunter, Rebekah AU - McAllister, Colin AU - Yeates, Karen AU - Campbell, Norm AU - Liu, Peter AU - Perkins, Nancy AU - Hua-Stewart, Diane AU - Maar, A. Marion AU - Tobe, W. Sheldon PY - 2019/12/9 TI - Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e12639 VL - 7 IS - 12 KW - blood pressure KW - hypertension KW - mHealth KW - population groups KW - short message service N2 - Background: DREAM-GLOBAL (Diagnosing hypertension?Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging?based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness. Objective: The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership. Methods: The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant?s own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership. Results: In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension. Conclusions: In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership. Trial Registration: Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226. UR - https://mhealth.jmir.org/2019/12/e12639 UR - http://dx.doi.org/10.2196/12639 UR - http://www.ncbi.nlm.nih.gov/pubmed/31815678 ID - info:doi/10.2196/12639 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - López-López, Daniel AU - Rodríguez-Sanz, David AU - Casado-Hernández, Israel AU - Calvo-Lobo, Cesar AU - Palomo-López, Patricia PY - 2019/12/2 TI - QardioArm Upper Arm Blood Pressure Monitor Against Omron M3 Upper Arm Blood Pressure Monitor in Patients With Chronic Kidney Disease: A Validation Study According to the European Society of Hypertension International Protocol Revision 2010 JO - J Med Internet Res SP - e14686 VL - 21 IS - 12 KW - blood pressure KW - hypertension KW - kidney disease KW - mobile apps KW - software validation N2 - Background: Hypertension is considered as a main risk factor for chronic kidney disease development and progression. Thus, the control and evaluation of this disease with new software and devices are especially important in patients who suffer from chronic kidney disease. Objective: This study aimed to validate the QardioArm mobile device, which is used for blood pressure (BP) self-measurement in patients who suffer from chronic kidney disease, by following the European Society of Hypertension International Protocol 2 (ESH-IP2) guidelines. Methods: A validation study was carried out by following the ESH-IP2 guidelines. A sample of 33 patients with chronic kidney disease self-measured their BP by using the QardioArm and Omron M3 Intellisense devices. Heart rate (HR), diastolic BP, and systolic BP were measured. Results: The QardioArm fulfilled the ESH-IP2 validation criteria in patients who suffered from chronic kidney disease. Conclusions: Thus, this study is considered as the first validation using a wireless upper arm oscillometric device connected to an app to measure BP and HR meeting the ESH-IP2 requirements in patients who suffer from chronic kidney disease. New validation studies following the ESH-IP2 guidelines should be carried out using different BP devices in patients with specific diseases. UR - https://www.jmir.org/2019/12/e14686 UR - http://dx.doi.org/10.2196/14686 UR - http://www.ncbi.nlm.nih.gov/pubmed/31789600 ID - info:doi/10.2196/14686 ER - TY - JOUR AU - Wang, Guangyu AU - Zhou, Silu AU - Rezaei, Shahbaz AU - Liu, Xin AU - Huang, Anpeng PY - 2019/10/30 TI - An Ambulatory Blood Pressure Monitor Mobile Health System for Early Warning for Stroke Risk: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e14926 VL - 7 IS - 10 KW - ambulatory blood pressure monitor KW - mHealth KW - stroke-risk early warning KW - abnormal blood pressure data analyzing KW - longitudinal observational study N2 - Background: Stroke, as a leading cause of death around the globe, has become a heavy burden on our society. Studies show that stroke can be predicted and prevented if a person?s blood pressure (BP) status is appropriately monitored via an ambulatory blood pressure monitor (ABPM) system. However, currently there exists no efficient and user-friendly ABPM system to provide early warning for stroke risk in real-time. Moreover, most existing ABPM devices measure BP during the deflation of the cuff, which fails to reflect blood pressure accurately. Objective: In this study, we sought to develop a new ABPM mobile health (mHealth) system that was capable of monitoring blood pressure during inflation and could detect early stroke-risk signals in real-time. Methods: We designed an ABPM mHealth system that is based on mobile network infrastructure and mobile apps. The proposed system contains two major parts: a new ABPM device in which an inflation-type BP measurement algorithm is embedded, and an abnormal blood pressure data analysis algorithm for stroke-risk prediction services at our health data service center. For evaluation, the ABPM device was first tested using simulated signals and compared with the gold standard of a mercury sphygmomanometer. Then, the performance of our proposed mHealth system was evaluated in an observational study. Results: The results are presented in two main parts: the device test and the longitudinal observational studies of the presented system. The average measurement error of the new ABPM device with the inflation-type algorithm was less than 0.55 mmHg compared to a reference device using simulated signals. Moreover, the results of correlation coefficients and agreement analyses show that there is a strong linear correlation between our device and the standard mercury sphygmomanometer. In the case of the system observational study, we collected a data set with 88 features, including real-time data, user information, and user records. Our abnormal blood pressure data analysis algorithm achieved the best performance, with an area under the curve of 0.904 for the low risk level, 0.756 for the caution risk level, and 0.912 for the high-risk level. Our system enables a patient to be aware of their risk in real-time, which improves medication adherence with risk self-management. Conclusions: To our knowledge, this device is the first ABPM device that measures blood pressure during the inflation process and has obtained a government medical license. Device tests and longitudinal observational studies were conducted in Peking University hospitals, and they showed the device?s high accuracy for BP measurements, its efficiency in detecting early signs of stroke, and its efficiency at providing an early warning for stroke risk. UR - http://mhealth.jmir.org/2019/10/e14926/ UR - http://dx.doi.org/10.2196/14926 UR - http://www.ncbi.nlm.nih.gov/pubmed/31670694 ID - info:doi/10.2196/14926 ER - TY - JOUR AU - Islam, Shariful Sheikh Mohammed AU - Cartledge, Susie AU - Karmakar, Chandan AU - Rawstorn, Charles Jonathan AU - Fraser, F. Steve AU - Chow, Clara AU - Maddison, Ralph PY - 2019/9/14 TI - Validation and Acceptability of a Cuffless Wrist-Worn Wearable Blood Pressure Monitoring Device Among Users and Health Care Professionals: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e14706 VL - 7 IS - 10 KW - hypertension KW - cardiovascular disease KW - wearable device KW - blood pressure KW - ambulatory blood pressure monitoring N2 - Background: Blood pressure (BP) is an important modifiable cardiovascular risk factor, yet its long-term monitoring remains problematic. Wearable cuffless devices enable the capture of multiple BP measures during everyday activities and could improve BP monitoring, but little is known about their validity or acceptability. Objective: This study aimed to validate a wrist-worn cuffless wearable BP device (Model T2; TMART Technologies Limited) and assess its acceptability among users and health care professionals. Methods: A mixed methods study was conducted to examine the validity and comparability of a wearable cuffless BP device against ambulatory and home devices. BP was measured simultaneously over 24 hours using wearable and ambulatory devices and over 7 days using wearable and home devices. Pearson correlation coefficients compared the degree of association between the measures, and limits of agreement (LOA; Bland-Altman plots) were generated to assess measurement bias. Semistructured interviews were conducted with users and 10 health care professionals to assess acceptability, facilitators, and barriers to using the wearable device. Interviews were audio recorded, transcribed, and analyzed. Results: A total of 9090 BP measurements were collected from 20 healthy volunteers (mean 20.3 years, SD 5.4; N=10 females). Mean (SD) systolic BP (SBP)/diastolic BP (DBP) measured using the ambulatory (24 hours), home (7 days), and wearable (7 days) devices were 126 (SD 10)/75 (SD 6) mm Hg, 112 (SD 10)/71 (SD 9) mm Hg and 125 (SD 4)/77 (SD 3) mm Hg, respectively. Mean (LOA) biases and precision between the wearable and ambulatory devices over 24 hours were 0.5 (?10.1 to 11.1) mm Hg for SBP and 2.24 (?17.6 to 13.1) mm Hg for DBP. The mean biases (LOA) and precision between the wearable and home device over 7 days were ?12.7 (?28.7 to 3.4) mm Hg for SBP and ?5.6 (?20.5 to 9.2) mm Hg for DBP. The wearable BP device was well accepted by participants who found the device easy to wear and use. Both participants and health care providers agreed that the wearable cuffless devices were easy to use and that they could be used to improve BP monitoring. Conclusions: Wearable BP measures compared well against a gold-standard ambulatory device, indicating potential for this user-friendly method to augment BP management, particularly by enabling long-term monitoring that could improve treatment titration and increase understanding of users? BP response during daily activity and stressors. UR - https://mhealth.jmir.org/2019/10/e14706 UR - http://dx.doi.org/10.2196/14706 UR - http://www.ncbi.nlm.nih.gov/pubmed/31628788 ID - info:doi/10.2196/14706 ER - TY - JOUR AU - Nordyke, J. Robert AU - Appelbaum, Kevin AU - Berman, A. Mark PY - 2019/10/9 TI - Estimating the Impact of Novel Digital Therapeutics in Type 2 Diabetes and Hypertension: Health Economic Analysis JO - J Med Internet Res SP - e15814 VL - 21 IS - 10 KW - digital therapeutics KW - behavioral intervention KW - economic evaluation KW - diabetes KW - hypertension N2 - Background: Behavioral interventions can meaningfully improve cardiometabolic conditions. Digital therapeutics (DTxs) delivering these interventions may provide benefits comparable to pharmacologic therapies, displacing medications for some patients. Objective: Our objective was to estimate the economic impact of a digital behavioral intervention in type 2 diabetes mellitus (T2DM) and hypertension (HTN) and estimate the impact of clinical inertia on deprescribing medications. Methods: Decision analytic models estimated health resource savings and cost effectiveness from a US commercial payer perspective. A 3-year time horizon was most relevant to the intervention and payer. Effectiveness of the DTx in improving clinical outcomes was based on cohort studies and published literature. Health resource utilization (HRU), health state utilities, and costs were drawn from the literature with costs adjusted to 2018 dollars. Future costs and quality-adjusted life years (QALYs) were discounted at 3%. Sensitivity analyses assessed uncertainty. Results: Average HRU savings ranged from $97 to $145 per patient per month, with higher potential benefits in T2DM. Cost-effectiveness acceptability analyses using a willingness-to-pay of $50,000/QALY indicated that the intervention would be cost effective at total 3-year program costs of $6468 and $6620 for T2DM and HTN, respectively. Sensitivity analyses showed that reduced medication costs are a primary driver of potential HRU savings, and the results were robust within values tested. A resistance to deprescribe medications when a patient?s clinical outcomes improve can substantially reduce the estimated economic benefits. Our models rely on estimates of clinical effectiveness drawn from limited cohort studies with DTxs and cannot account for other disease management programs that may be implemented. Performance of DTxs in real-world settings is required to further validate their economic benefits. Conclusions: The DTxs studied may provide substantial cost savings, in part by reducing the use of conventional medications. Clinical inertia may limit the full cost savings of DTxs. UR - https://www.jmir.org/2019/10/e15814 UR - http://dx.doi.org/10.2196/15814 UR - http://www.ncbi.nlm.nih.gov/pubmed/31599740 ID - info:doi/10.2196/15814 ER - TY - JOUR AU - McGillicuddy, John AU - Chandler, Jessica AU - Sox, Luke AU - Mueller, Martina AU - Nemeth, Lynne AU - Baliga, Prabhakar AU - Treiber, Frank PY - 2019/06/21 TI - ?Smartphone Medication Adherence Saves Kidneys? for Kidney Transplantation Recipients: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e13351 VL - 8 IS - 6 KW - mHealth KW - kidney transplant KW - medication adherence KW - digital health N2 - Background: Kidney transplant recipients? poor medication adherence and poor control of comorbidities, particularly hypertension, are risk factors for graft rejection, graft loss, and death. Few randomized controlled trials (RCTs) have been successful in improving sustained medication adherence and blood pressure control among kidney transplantation recipients. We provide rationale for an RCT evaluating a mobile health medical self-management system for kidney transplantation recipients called Smartphone Medication Adherence Saves Kidneys (SMASK). Objective: Our objective is to determine whether SMASK is efficacious in improving medication adherence and sustaining blood pressure control among kidney transplantation recipients with uncontrolled hypertension and poor medication adherence compared to an enhanced standard care. Methods: This two-arm, 6-month, phase II single-site efficacy RCT will involve 80 kidney transplantation recipients. Participants will be randomly assigned to the SMASK intervention arm or control arm. SMASK includes multilevel components: automated reminders from an electronic medication tray; tailored text messages and motivational feedback, guided by the self-determination theory; and automated summary reports for providers. Evaluations will be conducted preintervention, at 3 and 6 months, and posttrial at 12 months. Specific aims are to test the hypotheses that compared to standard care, the SMASK cohort will demonstrate significantly improved changes at 3, 6, and 12 months in the primary outcome variables medication adherence (proportion with electronic monitor-derived score >0.90) and blood pressure control (proportion meeting and sustaining adherence to the Kidney Disease Improving Global Outcomes [KDIGO] guidelines for blood pressure control); the secondary outcome variables provider adherence to KDIGO guidelines, measured by timing of medication changes and changes in self-determination theory constructs; and the exploratory outcome variables estimated glomerular filtration rate, variability in calcineurin inhibitor trough levels, and proportion of patients meeting and sustaining the 24-hour ambulatory blood pressure below 130/80 mm Hg. After the 6-month evaluation, interviews with a random sample of SMASK subjects (n=20) and health care providers (n=3-5) will assess user reactions including acceptability, usability, and aids/barriers to sustainability. Data from the RCT and interviews will be triangulated to further refine and optimize SMASK and prepare for a multisite effectiveness RCT. Results: The SMASK project received funding from National Institute of Diabetes and Digestive and Kidney Diseases in June 2016, obtained institutional review board approval in April 2016, and began data collection in July 2016. As of July 2018, we completed enrollment with a total of 80 participants. Conclusions: This study will provide data regarding the efficacy of SMASK to improve medication adherence and blood pressure control in a cohort of hypertensive kidney transplant recipients. An efficacious SMASK intervention will pave the way for a larger, multicenter, effectiveness RCT powered sufficiently to evaluate clinical events in a real-world setting and with the potential to demonstrate improved outcomes at lower cost than standard care. International Registered Report Identifier (IRRID): DERR1-10.2196/13351 UR - http://www.researchprotocols.org/2019/6/e13351/ UR - http://dx.doi.org/10.2196/13351 UR - http://www.ncbi.nlm.nih.gov/pubmed/31228175 ID - info:doi/10.2196/13351 ER - TY - JOUR AU - Ogink, AM Paula AU - de Jong, M. Jelske AU - Koeneman, Mats AU - Weenk, Mariska AU - Engelen, JLPG Lucien AU - van Goor, Harry AU - van de Belt, H. Tom AU - Bredie, JH Sebastian PY - 2019/06/19 TI - Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study JO - J Med Internet Res SP - e11164 VL - 21 IS - 6 KW - ambulatory blood pressure monitoring KW - home blood pressure monitoring KW - cuffless blood pressure device KW - hypertension N2 - Background: Frequent home blood pressure (BP) measurements result in a better estimation of the true BP. However, traditional cuff-based BP measurements are troublesome for patients. Objective: This study aimed to evaluate the feasibility of a cuffless device for ambulatory systolic blood pressure (SBP) measurement. Methods: This was a mixed method feasibility study in patients with hypertension. Performance of ambulatory SBPs with the device was analyzed quantitatively by intrauser reproducibility and comparability to a classic home BP monitor. Correct use by the patients was checked with video, and user-friendliness was assessed using a validated questionnaire, the System Usability Scale (SUS). Patient experiences were assessed using qualitative interviews. Results: A total of 1020 SBP measurements were performed using the Checkme monitor in 11 patients with hypertension. Duplicate SBPs showed a high intrauser correlation (R=0.86, P<.001). SBPs measured by the Checkme monitor did not correlate well with those of the different home monitors (R=0.47, P=.007). However, the mean SBPs measured by the Checkme and home monitors over the 3-week follow-up were strongly correlated (R=0.75, P=.008). In addition, 36.4% (n=4) of the participants performed the Checkme measurements without any mistakes. The mean SUS score was 86.4 (SD 8.3). The most important facilitator was the ease of using the Checkme monitor. Most important barriers included the absence of diastolic BP and the incidental difficulties in obtaining an SBP result. Conclusions: Given the good intrauser reproducibility, user-friendliness, and patient experience, all of which facilitate patients to perform frequent measurements, cuffless BP monitoring may change the way patients measure their BP at home in the context of ambulant hypertension management. UR - http://www.jmir.org/2019/6/e11164/ UR - http://dx.doi.org/10.2196/11164 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219050 ID - info:doi/10.2196/11164 ER - TY - JOUR AU - Brandt, R. Lena AU - Hidalgo, Liliana AU - Diez-Canseco, Francisco AU - Araya, Ricardo AU - Mohr, C. David AU - Menezes, R. Paulo AU - Miranda, Jaime J. PY - 2019/06/18 TI - Addressing Depression Comorbid With Diabetes or Hypertension in Resource-Poor Settings: A Qualitative Study About User Perception of a Nurse-Supported Smartphone App in Peru JO - JMIR Ment Health SP - e11701 VL - 6 IS - 6 KW - mental health KW - depression KW - noncommunicable diseases KW - mHealth KW - smartphone KW - developing countries N2 - Background: Smartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries. Objective: The aim of this paper was to explore the patients? perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psychoeducational, and nurse-supported intervention delivered via a smartphone app aimed at reducing depressive symptoms in people with diabetes, hypertension or both who attend public health care centers, as well as the nurses? feedback about their role and its feasibility to be scaled up. Methods: This study combines data from 2 pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes, hypertension or both with comorbid depressive symptoms who used CONEMO and 6 staff nurses who accompanied the intervention. Using a content analysis approach, interview notes from patient interviews were transferred to a digital format, coded, and categorized into 6 main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, nurse?s support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into 4 domains: general feedback, evaluation of training, evaluation of study activities, and feasibility of implementing this intervention within the existing structures of health system. Results: Patients perceived improvement in their emotional health because of CONEMO, whereas some also reported better physical health. Many encountered some difficulties with using CONEMO, but resolved them with time and practice. However, the interactive elements of the app, such as short message service, android notifications, and pop-up messages were mostly perceived as challenging. Satisfaction with CONEMO was high, as was the self-reported adherence. Overall, patients evaluated the nurse accompaniment positively, but they suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties in completing their tasks and explained that the CONEMO intervention activities competed with their everyday work routine. Conclusions: Using a nurse-supported smartphone app to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but it requires context-specific adaptations regarding the implementation of a task shifting approach within the public health care system. These results provide valuable information about user feedback for those building mobile health interventions for depression. UR - https://mental.jmir.org/2019/6/e11701/ UR - http://dx.doi.org/10.2196/11701 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215511 ID - info:doi/10.2196/11701 ER - TY - JOUR AU - Hui, Yan Chi AU - Creamer, Emily AU - Pinnock, Hilary AU - McKinstry, Brian PY - 2019/06/03 TI - Apps to Support Self-Management for People With Hypertension: Content Analysis JO - JMIR Mhealth Uhealth SP - e13257 VL - 7 IS - 6 KW - hypertension KW - self-management KW - telehealth KW - telemedicine KW - mobile app N2 - Background: Home blood pressure monitoring (HBPM) is one component of effective supported self-management, which may potentially be mediated by mobile apps. Objective: The aim of this study was to identify the self-management features (HBPM and broader support strategies) offered by currently available apps and to determine the features associated with download frequency and user ratings. Methods: We searched Google Play store, Apple App store, National Health Services Apps Library and myhealthapps.net (first search on February 1, 2018; updated August 18, 2018). We included high blood pressure apps available in the United Kingdom and extracted their features, number of downloads, and the average users? rating from the app stores. We mapped the features to the holistic Practical Reviews In Self-Management Support (PRISMS) taxonomy of self-management support. We employed a regression analysis to determine if any features were associated with download frequency or user rating. Results: We included 151 apps. The 3 most common features were as follows: monitoring blood pressure (BP) and charting logs; lifestyle (exercise or dietary) advice; and providing information about hypertension. The other 11 components of the PRISMS taxonomy were rarely featured. There was little evidence to support associations between specific features and the download statistics and rating scores, with only 2 uncommon features achieving borderline significant associations. The presence of social support features, such as a forum, was weakly but significantly (R2=.04, P=.02) correlated with the number of downloads. Apps designed specifically for particular BP monitors/smart watches were weakly associated with a higher rating score (R2=.05, P<.001). Apps with more ratings were associated with more downloads (R2=.91, P<.001). Conclusions: The functionality of currently available apps is limited to logging BP, offering lifestyle advice, and providing information about hypertension. Future app development should consider broadening the remit to produce a system that can respond flexibly to the diversity of support that enables people to self-manage their hypertension. UR - https://mhealth.jmir.org/2019/6/e13257/ UR - http://dx.doi.org/10.2196/13257 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162124 ID - info:doi/10.2196/13257 ER - TY - JOUR AU - Su, Min AU - Haldane, Victoria AU - Upshur, Ross AU - Sullivan, Frank AU - Légaré, France AU - Greiver, Michelle AU - Wei, Xiaolin PY - 2019/05/31 TI - The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018 JO - JMIR Res Protoc SP - e13571 VL - 8 IS - 5 KW - treatment adherence KW - cardiovascular disease KW - primary care N2 - Background: Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective: This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods: We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization?s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results: The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions: The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. International Registered Report Identifier (IRRID): DERR1-10.2196/13571 UR - http://www.researchprotocols.org/2019/5/e13571/ UR - http://dx.doi.org/10.2196/13571 UR - http://www.ncbi.nlm.nih.gov/pubmed/31152529 ID - info:doi/10.2196/13571 ER - TY - JOUR AU - Moon, Whan Eui AU - Tan, Chuan Ngiap AU - Allen, Carson John AU - Jafar, Hasan Tazeen PY - 2019/05/28 TI - The Use of Wireless, Smartphone App?Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e13153 VL - 7 IS - 5 KW - mHealth KW - smartphone KW - hypertension KW - home blood pressure monitoring KW - self blood pressure monitoring KW - health informatics KW - data collection methods KW - personal health records N2 - Background: Reliable home blood pressure monitoring (HBPM) is essential to effective hypertension management; however, manual recording is subject to underreporting and inaccuracies. Mobile health technologies hold great potential as HBPM tools, but the fidelity of a smartphone app in HBPM has not been adequately assessed. Objective: The primary aim of the trial was to compare the fidelity of a smartphone app to that of a handwritten logbook in making HBPM data available to clinicians at follow-up visits. Fidelity was defined as the percentage of scheduled blood pressure (BP) recordings over a 3-week period that were properly recorded and reported to the clinic. The secondary aims were to investigate patient factors associated with HBPM fidelity and to explore the effect of time on the fidelity. Methods: A 2-arm, parallel, unblinded, randomized controlled pilot trial was conducted in a government polyclinic in Singapore. Hypertensive adults, aged 40 to 70 years, who were on antihypertensive medication and owned a smartphone were recruited and randomized by a computer-generated randomization schedule to 3 weeks of either semiautomated HBPM utilizing a Bluetooth-enabled BP monitor and a smartphone app or a fully manual process utilizing a conventional handwritten logbook. The primary outcome was home BP recording fidelity. Results: Of the 80 patients randomized, 79 (smartphone app: 38 and logbook: 41) were included in the final analysis. Although fidelity was higher among the app users, it did not differ significantly between study arms (smartphone app: 66.7% and logbook: 52.4%; P=.21). Chinese and Indian ethnicities were associated with higher fidelity (absolute percent and 95% CI) by 35.6% (4.27 to 66.9) and 45.0% (8.69 to 81.3), respectively, in comparison with other ethnicities (P=.03); longer smartphone ownership increased fidelity on an average of 10.5% (0.83 to 20.2) per year (P=.03); the number of apps on the smartphone decreased fidelity at a rate of ?0.32% (?0.58 to ?0.05) per app (P=.02); years of hypertension morbidity increased fidelity at a rate of 1.56% (0.03 to 3.09) per year (P=.046); and the number of people working in the household decreased fidelity at a rate of ?8.18% (?16.3 to ?0.08) per additional working person (P=.048). The fidelity of the app was significantly higher in the first week (64.4%) than the second (55.1%, P=.001) and third (58.2%, P=.03) weeks of monitoring. Conclusions: Amid the increasing integration of health technologies into clinical practice, our study demonstrates the feasibility of smartphone app?assisted HBPM in hypertensive adults of Singapore. Our pilot study found no statistically significant difference in mean BP recording fidelity between a smartphone app and conventional handwritten logbook. However, the small sample size precludes definitive conclusions and highlights the need for a larger, adequately powered trial. Trial Registration: ClinicalTrials.gov NCT03209024; https://clinicaltrials.gov/ct2/show/NCT03209024 (Archived by WebCite at http://www.webcitation.org/78EVWBg0T) UR - http://mhealth.jmir.org/2019/5/e13153/ UR - http://dx.doi.org/10.2196/13153 UR - http://www.ncbi.nlm.nih.gov/pubmed/30905872 ID - info:doi/10.2196/13153 ER - TY - JOUR AU - Alessa, Tourkiah AU - Hawley, S. Mark AU - Hock, S. Emma AU - de Witte, Luc PY - 2019/05/28 TI - Smartphone Apps to Support Self-Management of Hypertension: Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e13645 VL - 7 IS - 5 KW - smartphone apps KW - mobile apps KW - self-management KW - hypertension KW - blood pressure KW - mobile applications N2 - Background: Hypertension is a widespread chronic disease, and its effective treatment requires self-management by patients. Health-related apps provide an effective way of supporting hypertension self-management. However, the increasing range and variety of hypertension apps available on the market, owing to the global growth in apps, creates the need for patients and health care professionals to be informed about the effectiveness of these apps and the levels of privacy and security that they provide. Objective: This study aimed to describe and assess all available apps supporting hypertension self-management in the most popular app stores and investigate their functionalities. Methods: In January 2018, the UK Apple and Google Play stores were scanned for all free and paid apps supporting hypertension self-management. Apps were included if they were in English, had functionality supporting hypertension self-management, and targeted adult users with hypertension. The included apps were downloaded and their functionalities were investigated. Behavior change techniques (BCTs) linked with the theoretical domain framework (TDF) underpinning potentially effective apps were independently coded by two reviewers. The data privacy and security of the apps were also independently assessed. Results: A total of 186 hypertension apps that met the inclusion criteria were included in this review. The majority of these apps had only one functionality (n=108), while the remainder offered different combinations of functionalities. A small number of apps had comprehensive functionalities (n=30) that are likely to be more effective in supporting hypertension self-management. Most apps lacked a clear theoretical basis, and 24 BCTs identified in these 30 apps were mapped to 10 TDF mechanisms of actions. On an average, 18.4 BCTs were mapped to 6 TDF mechanisms of actions that may support hypertension self-management behaviors. There was a concerning absence of evidence related to the effectiveness and usability of all 186 apps, and involvement of health care professionals in the app development process was minimal. Most apps did not meet the current standards of data security and privacy. Conclusions: Despite the widespread accessibility and availability of smartphone apps with a range of combinations of functionalities that can support the self-management of hypertension, only a small number of apps are likely to be effective. Many apps lack security measures as well as a clear theoretical basis and do not provide any evidence concerning their effectiveness and usability. This raises a serious issue, as health professionals and those with hypertension have insufficient information to make decisions on which apps are safe and effective. UR - http://mhealth.jmir.org/2019/5/e13645/ UR - http://dx.doi.org/10.2196/13645 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140434 ID - info:doi/10.2196/13645 ER - TY - JOUR AU - Rodriguez, Sarah AU - Hwang, Kevin AU - Wang, Jing PY - 2019/05/23 TI - Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers JO - JMIR Form Res SP - e10388 VL - 3 IS - 2 KW - patient-generated health data KW - connected health KW - remote monitoring KW - electronic health record KW - hypertension KW - patient reported outcome KW - self-measured blood pressure KW - self-monitoring of blood pressure N2 - Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider?s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. UR - http://formative.jmir.org/2019/2/e10388/ UR - http://dx.doi.org/10.2196/10388 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124468 ID - info:doi/10.2196/10388 ER - TY - JOUR AU - Geerse, Carlijn AU - van Slobbe, Cher AU - van Triet, Edda AU - Simonse, Lianne PY - 2019/05/03 TI - Design of a Care Pathway for Preventive Blood Pressure Monitoring: Qualitative Study JO - JMIR Cardio SP - e13048 VL - 3 IS - 1 KW - eHealth KW - blood pressure monitoring KW - at-risk patients KW - secondary preventive care KW - care pathway KW - design N2 - Background: Electronic health (eHealth) services could provide a solution for monitoring the blood pressure of at-risk patients while also decreasing expensive doctor visits. However, a major barrier to their implementation is the lack of integration into organizations. Objective: Our aim was to design a Care Pathway for monitoring the blood pressure of at-risk patients, in order to increase eHealth implementation in secondary preventive care. Methods: A qualitative design study was used in this research. Data were collected by conducting visual mapping sessions including semistructured interviews with hypertension patients and doctors. The data were transcribed and coded and thereafter mapped into a Care Pathway. Results: Four themes emerged from the results: (1) the current approach to blood pressure measuring has disadvantages, (2) risk and lifestyle factors of blood pressure measuring need to be considered, (3) there are certain influences of the at-home context on measuring blood pressure, and (4) new touchpoints between patients and health professionals need to be designed. These in-depth insights combined with the visualization of the current blood pressure process resulted in our Care Pathway design for monitoring the blood pressure of at-risk patients as secondary preventive care. Conclusions: The Care Pathway guides the implementation of eHealth devices for blood pressure self-measurement. It showcases the pathway of at-risk patients and increases their involvement in managing their blood pressure. It serves as a basis for a new service using eHealth. UR - http://cardio.jmir.org/2019/1/e13048/ UR - http://dx.doi.org/10.2196/13048 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758790 ID - info:doi/10.2196/13048 ER - TY - JOUR AU - Menezes, Paulo AU - Quayle, Julieta AU - Garcia Claro, Heloísa AU - da Silva, Simone AU - Brandt, R. Lena AU - Diez-Canseco, Francisco AU - Miranda, Jaime J. AU - Price, N. LeShawndra AU - Mohr, C. David AU - Araya, Ricardo PY - 2019/04/26 TI - Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru JO - JMIR Ment Health SP - e11698 VL - 6 IS - 4 KW - depression KW - mHealth KW - pilot study KW - feasibility study KW - PHQ-9 N2 - Background: Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. Objective: This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). Methods: Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. Results: The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. Conclusions: The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants? depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings. UR - http://mental.jmir.org/2019/4/e11698/ UR - http://dx.doi.org/10.2196/11698 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025949 ID - info:doi/10.2196/11698 ER - TY - JOUR AU - Hao, Yiming AU - Cheng, Feng AU - Pham, Minh AU - Rein, Hayley AU - Patel, Devashru AU - Fang, Yuchen AU - Feng, Yiyi AU - Yan, Jin AU - Song, Xueyang AU - Yan, Haixia AU - Wang, Yiqin PY - 2019/04/23 TI - A Noninvasive, Economical, and Instant-Result Method to Diagnose and Monitor Type 2 Diabetes Using Pulse Wave: Case-Control Study JO - JMIR Mhealth Uhealth SP - e11959 VL - 7 IS - 4 KW - type 2 diabetes KW - hypertension KW - hyperlipidemia KW - pulse wave analysis KW - diagnosis N2 - Background: We should pay more attention to the long-term monitoring and early warning of type 2 diabetes and its complications. The traditional blood glucose tests are traumatic and cannot effectively monitor the development of diabetic complications. The development of mobile health is changing rapidly. Therefore, we are interested in developing a new noninvasive, economical, and instant-result method to accurately diagnose and monitor type 2 diabetes and its complications. Objective: We aimed to determine whether type 2 diabetes and its complications, including hypertension and hyperlipidemia, could be diagnosed and monitored by using pulse wave. Methods: We collected the pulse wave parameters from 50 healthy people, 139 diabetic patients without hypertension and hyperlipidemia, 133 diabetic patients with hypertension, 70 diabetic patients with hyperlipidemia, and 75 diabetic patients with hypertension and hyperlipidemia. The pulse wave parameters showing significant differences among these groups were identified. Various machine learning models such as linear discriminant analysis, support vector machines (SVMs), and random forests were applied to classify the control group, diabetic patients, and diabetic patients with complications. Results: There were significant differences in several pulse wave parameters among the 5 groups. The parameters height of tidal wave (h3), time distance between the start point of pulse wave and dominant wave (t1), and width of percussion wave in its one-third height position (W) increase and the height of dicrotic wave (h5) decreases when people develop diabetes. The parameters height of dominant wave (h1), h3, and height of dicrotic notch (h4) are found to be higher in diabetic patients with hypertension, whereas h5 is lower in diabetic patients with hyperlipidemia. For detecting diabetes, the method with the highest out-of-sample prediction accuracy is SVM with polynomial kernel. The algorithm can detect diabetes with 96.35% accuracy. However, all the algorithms have a low accuracy when predicting diabetic patients with hypertension and hyperlipidemia (below 70%). Conclusions: The results demonstrated that the noninvasive and convenient pulse-taking diagnosis described in this paper has the potential to become a low-cost and accurate method to monitor the development of diabetes. We are collecting more data to improve the accuracy for detecting hypertension and hyperlipidemia among diabetic patients. Mobile devices such as sport bands, smart watches, and other diagnostic tools are being developed based on the pulse wave method to improve the diagnosis and monitoring of diabetes, hypertension, and hyperlipidemia. UR - http://mhealth.jmir.org/2019/4/e11959/ UR - http://dx.doi.org/10.2196/11959 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012863 ID - info:doi/10.2196/11959 ER - TY - JOUR AU - Wetterholm, Madeleine AU - Bonn, Erika Stephanie AU - Alexandrou, Christina AU - Löf, Marie AU - Trolle Lagerros, Ylva PY - 2019/04/17 TI - Validation of Two Automatic Blood Pressure Monitors With the Ability to Transfer Data via Bluetooth JO - J Med Internet Res SP - e12772 VL - 21 IS - 4 KW - blood pressure monitors KW - diabetes mellitus, type 2 KW - hypertension KW - methods KW - mHealth KW - self-care KW - self-management N2 - Background: Patients with chronic diseases are in need of regular health controls. Diabetes mellitus type 2 is currently the most prevalent chronic metabolic disease. A majority of diabetic patients have at least one comorbid chronic disease, where hypertension is the most common. The standard for blood pressure (BP) measurement is manual BP monitoring at health care clinics. Nevertheless, several advantages of self-measured BP have been documented. With BP data transfer from an automatic BP monitor via Bluetooth to software, for example, a smartphone app, home measurement could effectively be integrated into regular care. Objective: The aim of this study was to validate two commercially available automatic BP monitors with the ability to transfer BP data via Bluetooth (Beurer BM 85 and Andersson Lifesense BDR 2.0), against manual BP monitoring in patients with type 2 diabetes. Methods: A total of 181 participants with type 2 diabetes were recruited from 6 primary care centers in Stockholm, Sweden. BP was first measured using a manual BP monitor and then measured using the two automatic BP monitors. The mean differences between the automatic and manual measurements were calculated by subtracting the manual BP monitor measurement from the automatic monitor measurement. Validity of the two automatic BP monitors was further assessed using Spearman rank correlation coefficients and the Bland-Altman method. Results: In total, 180 participants, 119 men and 61 women, were included. The mean age was 60.1 (SD 11.4) years and the mean body mass index was 30.4 (SD 5.4) kg/m2. The mean difference between the Beurer BM 85 and the manual BP monitor was 11.1 (SD 11.2) mmHg for systolic blood pressure (SBP) and 8.0 (SD 8.1) mmHg for diastolic blood pressure (DBP). The mean difference between the Andersson Lifesense BDR 2.0 and the manual BP monitor was 3.2 (SD 10.8) mmHg for SBP and 4.2 (SD 7.2) mmHg for DBP. The automatic BP measurements were significantly correlated (P<.001) with the manual BP measurement values (Andersson Lifesense BDR 2.0: r=0.78 for SBP and r=0.71 for DBP; Beurer BM 85: r=0.78 for SBP and r=0.69 for DBP). Conclusions: The two automatic BP monitors validated measure sufficiently accurate on a group level, with the Andersson Lifesense BDR 2.0 more often falling within the ranges for what is acceptable in clinical practice compared with the Beurer BM 85. UR - https://www.jmir.org/2019/4/e12772/ UR - http://dx.doi.org/10.2196/12772 UR - http://www.ncbi.nlm.nih.gov/pubmed/30994459 ID - info:doi/10.2196/12772 ER - TY - JOUR AU - Lanssens, Dorien AU - Vandenberk, Thijs AU - Lodewijckx, Joy AU - Peeters, Tessa AU - Storms, Valerie AU - Thijs, M. Inge AU - Grieten, Lars AU - Gyselaers, Wilfried PY - 2019/04/15 TI - Midwives?, Obstetricians?, and Recently Delivered Mothers? Perceptions of Remote Monitoring for Prenatal Care: Retrospective Survey JO - J Med Internet Res SP - e10887 VL - 21 IS - 4 KW - remote monitoring KW - gestational hypertensive diseases KW - questionnaires KW - monitoring, ambulatory KW - hypertension, pregnancy-induced KW - surveys and questionnaires N2 - Background: The Pregnancy Remote Monitoring (PREMOM) study enrolled pregnant women at increased risk of developing hypertensive disorders of pregnancy and investigated the effect of remote monitoring in addition to their prenatal follow-up. Objective: The objective of this study was to investigate the perceptions and experiences of remote monitoring among mothers, midwives, and obstetricians who participated in the PREMOM study. Methods: We developed specific questionnaires for the mothers, midwives, and obstetricians addressing 5 domains: (1) prior knowledge and experience of remote monitoring, (2) reactions to abnormal values, (3) privacy, (4) quality and patient safety, and (5) financial aspects. We also questioned the health care providers about which issues they considered important when implementing remote monitoring. We used a 5-point Likert scale to provide objective scores. It was possible to add free-text feedback at every question. Results: A total of 91 participants completed the questionnaires. The mothers, midwives, and obstetricians reported positive experiences and perceptions of remote monitoring, although most of them had no or little prior experience with this technology. They supported a further rollout of remote monitoring in Belgium. Nearly three-quarters of the mothers (34/47, 72%) did not report any problems with taking the measurements at the required times. Almost half of the mothers (19/47, 40%) wanted to be contacted within 3 to 12 hours after abnormal measurement values, preferably by telephone. Conclusions: Although most of midwives and obstetricians had no or very little experience with remote monitoring before enrolling in the PREMOM study, they reported, based on their one-year experience, that remote monitoring was an important component in the follow-up of high-risk pregnancies and would recommend it to their colleagues and pregnant patients. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/ct2/show/NCT03246737 (Archived by WebCite at http://www.webcitation.org/76KVnHSYY) UR - https://www.jmir.org/2019/4/e10887/ UR - http://dx.doi.org/10.2196/10887 UR - http://www.ncbi.nlm.nih.gov/pubmed/30985286 ID - info:doi/10.2196/10887 ER - TY - JOUR AU - Leong, Y. Amanda AU - Makowsky, J. Mark PY - 2019/04/12 TI - Quality of Blood Pressure Tracking Apps for the iPhone: Content Analysis and Evaluation of Adherence With Home Blood Pressure Measurement Best Practices JO - JMIR Mhealth Uhealth SP - e10809 VL - 7 IS - 4 KW - hypertension KW - mobile apps KW - self-management KW - blood pressure monitoring, ambulatory KW - cross-sectional studies N2 - Background: Blood pressure (BP) tracking apps may aid in hypertension (HTN) self-management, but app quality may be problematic. Objective: This study aimed to develop a content-dependent rating system for BP tracking apps and systematically evaluate BP tracking features, content-independent quality, functional characteristics, and educational comprehensiveness of English language iPhone apps developed with the primary purpose of tracking a consumer?s BP measurements. Methods: We created a 28-item checklist reflecting overall app quality and a simplified 2-item checklist to assess adherence with home BP monitoring best practices. Apps with educational information were evaluated for comprehensiveness on a 7-point scale and for consistency with evidence-based guidelines. Higher scores represent better quality and comprehensiveness. We searched the Canadian App Store on June 28, 2016, using the keywords hypertension and blood pressure. A total of 2 reviewers independently assessed apps according to the standardized template. We determined if paid apps, educational apps, or those rated ?4 stars were of higher quality. Results: Of the 948 apps screened, 62 met the inclusion criteria. The mean overall quality score was 12.2 (SD 4.6, out of 28) and 6 apps (10%, 6/62) met the home BP monitoring best practice criteria. In all, 12 apps contained educational content (mean comprehensiveness 2.4, SD 1.6 out of 14), most commonly, background information on HTN. Apps with educational content (mean 15.1, SD 3.8 vs 11.8, SD 4.8; P=.03) or a ?4 star rating (median 19, interquartile range [IQR] 15-20, vs 12, IQR 9-15; P=.02) had higher overall quality. Conclusions: The BP tracking apps reviewed had variable quality and few met the home BP monitoring best practice criteria. When deciding to recommend a specific BP tracking app, we suggest clinicians should evaluate whether the app allows input of duplicate BP readings in the morning and evening for at least seven days and presents the mean BP value for user-specified dates. Greater attention to home BP measurement best practices is required during app development. UR - https://mhealth.jmir.org/2019/4/e10809/ UR - http://dx.doi.org/10.2196/10809 UR - http://www.ncbi.nlm.nih.gov/pubmed/30977739 ID - info:doi/10.2196/10809 ER - TY - JOUR AU - Lewinski, A. Allison AU - Patel, D. Uptal AU - Diamantidis, J. Clarissa AU - Oakes, Megan AU - Baloch, Khaula AU - Crowley, J. Matthew AU - Wilson, Jonathan AU - Pendergast, Jane AU - Biola, Holly AU - Boulware, Ebony L. AU - Bosworth, B. Hayden PY - 2019/04/09 TI - Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention JO - J Med Internet Res SP - e12541 VL - 21 IS - 4 KW - telemedicine KW - cardiovascular diseases KW - diabetes mellitus type 2 KW - vulnerable populations KW - renal insufficiency KW - professional-patient relations KW - hypertension N2 - Background: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. Objective: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. Methods: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ?140 mm Hg and/or diastolic blood pressure [DBP] ?90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. Results: Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. Conclusion: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. Trial Registration: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU) UR - https://www.jmir.org/2019/4/e12541/ UR - http://dx.doi.org/10.2196/12541 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964439 ID - info:doi/10.2196/12541 ER - TY - JOUR AU - Schroeder, B. Emily AU - Moore, Kelly AU - Manson, M. Spero AU - Baldwin, A. Megan AU - Goodrich, K. Glenn AU - Malone, S. Allen AU - Pieper, E. Lisa AU - Xu, Stanley AU - Fort, M. Meredith AU - Johnson, David AU - Son-Stone, Linda AU - Steiner, F. John PY - 2019/04/02 TI - An Interactive Voice Response and Text Message Intervention to Improve Blood Pressure Control Among Individuals With Hypertension Receiving Care at an Urban Indian Health Organization: Protocol and Baseline Characteristics of a Pragmatic Randomized Controlled Trial JO - JMIR Res Protoc SP - e11794 VL - 8 IS - 4 KW - Indians, North American KW - hypertension KW - urban health KW - pragmatic clinical trial KW - text messages N2 - Background: Efficient and effective strategies for treating chronic health conditions such as hypertension are particularly needed for under-resourced clinics such as Urban Indian Health Organizations (UIHOs). Objective: The objective of the Controlling Blood Pressure Trial is to assess the impact of an interactive voice response and text message (IVR-T) intervention compared with usual care among individuals with hypertension receiving care at a UIHO in Albuquerque, New Mexico. This manuscript presents the baseline characteristics of individuals enrolled in the trial and compares their characteristics with those in the hypertension registry who did not enroll in the trial. Methods: A hypertension registry developed from the clinic?s electronic health record was used for recruitment. Potentially eligible participants were contacted by letter and then by phone. Those who expressed interest completed an in-person baseline visit that included a baseline survey and blood pressure measurement using standardized procedures. Individuals randomized to the intervention group could opt to receive either automated text messages or automated phone calls in either English or Spanish. The messages include reminders of upcoming appointments at First Nations Community HealthSource, requests to reschedule recently missed appointments, monthly reminders to refill medications, and weekly motivational messages to encourage self-care, appointment keeping, and medication taking for hypertension. Individuals in the IVR-T arm could opt to nominate a care partner to also receive notices of upcoming and missed appointments. Individuals in the IVR-T arm were also offered a home blood pressure monitor. Follow-up visits will be conducted at 6 months and 12 months. Results: Over a 9.5-month period from April 2017 to January 2018, 295 participants were enrolled from a recruitment list of 1497 individuals. The enrolled cohort had a mean age of 53 years, was 25.1% (74/295) American Indian or Alaska Native and 51.9% (153/295) Hispanic, and 39.0% (115/295) had a baseline blood pressure greater than or equal to 140/90 mmHg. Overall, the differences between those enrolled in the trial and patients with hypertension who were ineligible, those who could not be reached, or those who chose not to enroll were minimal. Enrolled individuals had a slightly lower blood pressure (129/77 mmHg vs 132/79 mmHg; P=.04 for systolic blood pressure and P=.01 for diastolic blood pressure), were more likely to self-pay for their care (26% vs 10%; P<.001), and had a more recent primary care visit (164 days vs 231 days; P<.001). The enrolled cohort reported a high prevalence of poor health, low socioeconomic status, and high levels of basic material needs. Conclusions: The Controlling Blood Pressure Trial has successfully enrolled a representative sample of individuals receiving health care at a UIHO. Trial follow-up will conclude in February 2019. Trial Registration: ClinicalTrials.gov NCT03135405; http://clinicaltrials.gov/ct2/show/NCT03135405 (Archived by WebCite http://www.webcitation.org/76H2B4SO6) International Registered Report Identifier (IRRID): DERR1-10.2196/11794 UR - https://www.researchprotocols.org/2019/4/e11794/ UR - http://dx.doi.org/10.2196/11794 UR - http://www.ncbi.nlm.nih.gov/pubmed/30938688 ID - info:doi/10.2196/11794 ER - TY - JOUR AU - Pattin, Anthony AU - Panak, L. Rebekah AU - Hunold, Rebecca AU - Kirwen, Abagail AU - Minnich, R. Samantha AU - Chen, Tian PY - 2019/04/01 TI - A Medication Synchronization Program and Blood Pressure Levels in a Community Pharmacy: Protocol JO - JMIR Res Protoc SP - e12527 VL - 8 IS - 4 KW - pharmacy practice KW - medication synchronization KW - hypertension N2 - Background: The lack of adherence to prescribed antihypertensive medication occurs in 50% of patients and leads to poor health outcomes and increased medical costs. Consistent use of antihypertensive medications among patients with hypertension is essential to the reduction of short- and long-term cardiovascular complications. Strategies to improve medication adherence include syncing prescription medications in the pharmacy, which allow patients to retrieve chronically prescribed medications in one visit. The adoption of medication synchronization has been shown to improve adherence to medications; however, there is a lack of data showing if the intervention reduces blood pressure and improves long-term health outcomes. Objective: This study aims to determine the association between participation in an appointment-based medication synchronization service and blood pressure levels among patients on antihypertensive medications. Methods: This longitudinal prospective cohort study will observe changes in blood pressure among individuals in a medication synchronization program and those in a usual care group. Patients on at least two antihypertensive medications and four total medications have been recruited to participate in the study. All participants will be required to have at least a 6-month history of filling prescriptions at the pharmacy prior to enrollment in the study. Based on an estimated standard deviation of 14 mmHg, a sample size of 70 participants provides approximately 80% power with a two-sided .05 significance to detect a difference of 9 mmHg blood pressure between the two cohorts. Results: As of the publication of this paper, patients are completing final blood pressure visits at the pharmacy and medication data are being collected from the pharmacy. Once patients complete all blood pressure visits, data analysis will begin. Conclusions: This study will link medication synchronization and changes in blood pressure levels among individuals with hypertension. This study will provide preliminary data for a randomized clinical trial that will assess the impact of medication synchronization on blood pressure. International Registered Report Identifier (IRRID): DERR1-10.2196/12527 UR - https://www.researchprotocols.org/2019/4/e12527/ UR - http://dx.doi.org/10.2196/12527 UR - http://www.ncbi.nlm.nih.gov/pubmed/30932864 ID - info:doi/10.2196/12527 ER - TY - JOUR AU - Shaffer, Anne Victoria AU - Wegier, Pete AU - Valentine, KD AU - Belden, L. Jeffery AU - Canfield, M. Shannon AU - Patil, J. Sonal AU - Popescu, Mihail AU - Steege, M. Linsey AU - Jain, Akshay AU - Koopman, J. Richelle PY - 2019/03/26 TI - Patient Judgments About Hypertension Control: The Role of Variability, Trends, and Outliers in Visualized Blood Pressure Data JO - J Med Internet Res SP - e11366 VL - 21 IS - 3 KW - data visualization KW - hypertension KW - hypertension control KW - patients? judgment KW - primary care N2 - Background: Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. Objective: As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, we conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data. Methods: In 3 Web studies, participants (internet sample of patients with hypertension) reviewed a series of vignettes depicting patients with hypertension; each vignette included a graph of a patient?s BP. We examined how data visualizations that varied by BP mean and SD (Study 1), the pattern of change over time (Study 2), and the presence of extreme values (Study 3) affected patients? judgments about hypertension control and the need for a medication change. Results: Participants? judgments about hypertension control were significantly influenced by BP mean and SD (Study 1), data trends (whether BP was increasing or decreasing over time?Study 2), and extreme values (ie, outliers?Study 3). Conclusions: Patients? judgment about hypertension control is influenced both by factors that are important predictors of hypertension related-health outcomes (eg, BP mean) and factors that are not (eg, variability and outliers). This study highlights the importance of developing data visualizations that direct attention toward clinically meaningful information. UR - https://www.jmir.org/2019/3/e11366/ UR - http://dx.doi.org/10.2196/11366 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912759 ID - info:doi/10.2196/11366 ER - TY - JOUR AU - Palacholla, Sita Ramya AU - Fischer, Nils AU - Coleman, Amanda AU - Agboola, Stephen AU - Kirley, Katherine AU - Felsted, Jennifer AU - Katz, Chelsea AU - Lloyd, Stacy AU - Jethwani, Kamal PY - 2019/03/26 TI - Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review JO - JMIR Cardio SP - e11951 VL - 3 IS - 1 KW - medical informatics KW - culturally appropriate technology KW - hypertension N2 - Background: The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management. Objective: This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators. Methods: This review followed the methodological framework developed by Arskey and O?Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies. Results: A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients. Conclusions: Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness. UR - http://cardio.jmir.org/2019/1/e11951/ UR - http://dx.doi.org/10.2196/11951 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758771 ID - info:doi/10.2196/11951 ER - TY - JOUR AU - Silveira, Vitório Daniel AU - Marcolino, Soriano Milena AU - Machado, Leandro Elaine AU - Ferreira, Gonçalves Camila AU - Alkmim, Moreira Maria Beatriz AU - Resende, Santos Elmiro AU - Carvalho, Couto Bárbara AU - Antunes, Pires André AU - Ribeiro, Pinho Antonio Luiz PY - 2019/03/25 TI - Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care Setting in Brazil: Mixed-Methods Field Study on Usability, Feasibility, and Utility JO - JMIR Mhealth Uhealth SP - e9869 VL - 7 IS - 3 KW - telemedicine KW - clinical decision support system KW - cardiovascular disease KW - hypertension N2 - Background: Despite being an important cardiovascular risk factor, hypertension has low control levels worldwide. Computerized clinical decision support systems (CDSSs) might be effective in reducing blood pressure with a potential impact in reducing cardiovascular risk. Objective: The goal of the research was to evaluate the feasibility, usability, and utility of a CDSS, TeleHAS (tele?hipertensão arterial sistêmica, or arterial hypertension system), in the care of patients with hypertension in the context of a primary care setting in a middle-income country. Methods: The TeleHAS app consists of a platform integrating clinical and laboratory data on a particular patient, from which it performs cardiovascular risk calculation and provides evidence-based recommendations derived from Brazilian and international guidelines for the management of hypertension and cardiovascular risk. Ten family physicians from different primary care units in the city of Montes Claros, Brazil, were randomly selected to use the CDSS for the care of hypertensive patients for 6 months. After 3 and 6 months, the feasibility, usability, and utility of the CDSS in the routine care of the health team was evaluated through a standardized questionnaire and semistructured interviews. Results: Throughout the study, clinicians registered 535 patients with hypertension, at an average of 1.24 consultations per patient. Women accounted for 80% (8/10) of participant doctors, median age was 31.5 years (interquartile range 27 to 59 years). As for feasibility, 100% of medical users claimed it was possible to use the app in the primary care setting, and for 80% (8/10) of them it was easy to incorporate its use into the daily routine and home visits. Nevertheless, 70% (7/10) of physicians claimed that the time taken to fill out the CDSS causes significant delays in service. Clinicians evaluated TeleHAS as good (8/10, 80% of users), with easy completion and friendly interface (10/10, 100%) and the potential to improve patients? treatment (10/10, 100%). A total of 90% (9/10) of physicians had access to new knowledge about cardiovascular risk and hypertension through the app recommendations and found it useful to promote prevention and optimize treatment. Conclusions: In this study, a CDSS developed to assist the management of patients with hypertension was feasible in the context of a primary health care setting in a middle-income country, with good user satisfaction and the potential to improve adherence to evidence-based practices. UR - http://mhealth.jmir.org/2019/3/e9869/ UR - http://dx.doi.org/10.2196/mhealth.9869 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907740 ID - info:doi/10.2196/mhealth.9869 ER - TY - JOUR AU - Daugherty, L. Stacie AU - Vupputuri, Suma AU - Hanratty, Rebecca AU - Steiner, F. John AU - Maertens, A. Julie AU - Blair, V. Irene AU - Dickinson, Miriam L. AU - Helmkamp, Laura AU - Havranek, P. Edward PY - 2019/03/25 TI - Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial JO - JMIR Res Protoc SP - e12498 VL - 8 IS - 3 KW - hypertension KW - social values KW - African Americans KW - medication adherence KW - health care disparities N2 - Background: Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient?s ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies. Objective: The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat. Methods: The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients? adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients? prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes. Results: This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes. Conclusions: The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition?hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations. Trial Registration: ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB). International Registered Report Identifier (IRRID): DERR1-10.2196/12498 UR - http://www.researchprotocols.org/2019/3/e12498/ UR - http://dx.doi.org/10.2196/12498 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907744 ID - info:doi/10.2196/12498 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - López-López, Daniel AU - Palomo-López, Patricia AU - Rodríguez-Sanz, David AU - Calvo-Lobo, César PY - 2019/03/19 TI - Validation in the General Population of the iHealth Track Blood Pressure Monitor for Self-Measurement According to the European Society of Hypertension International Protocol Revision 2010: Descriptive Investigation JO - JMIR Mhealth Uhealth SP - e13137 VL - 7 IS - 3 KW - blood pressure determination KW - heart rate determination KW - validation studies KW - telemedicine N2 - Background: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. Objective: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. Methods: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (?5, ?10, and ?15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (?3, ?5, and ?8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. Results: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. Conclusions: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population. UR - http://mhealth.jmir.org/2019/3/e13137/ UR - http://dx.doi.org/10.2196/13137 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888331 ID - info:doi/10.2196/13137 ER - TY - JOUR AU - Fitzpatrick, L. Annette AU - van Pelt, Maurits AU - Heang, Hen AU - Steinman, Lesley AU - Ide, Nicole AU - Chhea, Chhorvann AU - LoGerfo, P. James PY - 2019/03/19 TI - Using Targeted mHealth Messages to Address Hypertension and Diabetes Self-Management in Cambodia: Protocol for a Clustered Randomized Controlled Trial JO - JMIR Res Protoc SP - e11614 VL - 8 IS - 3 KW - Cambodia KW - diabetes KW - hypertension KW - mHealth KW - mobile phone N2 - Background: Hypertension and diabetes represent the first and third highest contributors to global disability. While mobile health (mHealth) messaging programs have rapidly increased in low- and middle-income countries (LMIC), adaptations for specific patient health needs is a new approach to manage chronic conditions. Objective: The primary aim of this study is to develop and test an mHealth communication intervention using electronic data capture (by tablet) and voice messaging to improve hypertension and diabetes self-management in Cambodia. The secondary aim is to share results with the Cambodian Ministry of Health and development partners to inform health policy and develop strategies for hypertension and diabetes control. Methods: The study design is a cluster randomized controlled clinical trial randomizing each of 75 Community peer educators (PEs), trained and coordinated by MoPoTsyo Patient Information Center in Phnom Penh, into one of 3 groups of 25 (approximately 60 patients each) to receive either tablet+messages, tablet only, or no intervention (control). The total sample within each group includes 25 clusters and approximately 1500 patients located in 7 Operational Districts in rural regions or urban slums in Cambodia. The interventions (groups 1 and 2) were compared with usual PE monitoring without the tablet or mHealth messaging interventions. Focus groups and informant interviews were conducted to develop messages according to specific themes?medications adherence, laboratory testing, physician visits, obesity, smoking, and general lifestyle issues. Using the data received at monthly PE monitoring meetings, patients will receive specific messages based on their individual health challenges. Following the intervention completion, clinical and process outcomes will be compared with baseline metrics between groups. Results: PEs were randomized in July 2017, and the intervention was implemented in September 2017 through June 2018. Analyses are underway. Conclusions: This project is unique in its combination of electronic data transfer, which can be accessed immediately, with voice messages most relevant to individual patients? needs. Positive results will indicate the value of using targeted messaging in patient-specific, self-management issues to improve hypertension and diabetes control. International Registered Report Identifier (IRRID): DERR1-10.2196/11614 UR - http://www.researchprotocols.org/2019/3/e11614/ UR - http://dx.doi.org/10.2196/11614 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888330 ID - info:doi/10.2196/11614 ER - TY - JOUR AU - Guthrie, L. Nicole AU - Berman, A. Mark AU - Edwards, L. Katherine AU - Appelbaum, J. Kevin AU - Dey, Sourav AU - Carpenter, Jason AU - Eisenberg, M. David AU - Katz, L. David PY - 2019/03/12 TI - Achieving Rapid Blood Pressure Control With Digital Therapeutics: Retrospective Cohort and Machine Learning Study JO - JMIR Cardio SP - e13030 VL - 3 IS - 1 KW - hypertension KW - mobile health KW - mHealth KW - lifestyle medicine KW - digital therapeutics KW - digital medicine KW - machine learning, behavioral therapy N2 - Background: Behavioral therapies, such as electronic counseling and self-monitoring dispensed through mobile apps, have been shown to improve blood pressure, but the results vary and long-term engagement is a challenge. Machine learning is a rapidly advancing discipline that can be used to generate predictive and responsive models for the management and treatment of chronic conditions and shows potential for meaningfully improving outcomes. Objective: The objectives of this retrospective analysis were to examine the effect of a novel digital therapeutic on blood pressure in adults with hypertension and to explore the ability of machine learning to predict participant completion of the intervention. Methods: Participants with hypertension, who engaged with the digital intervention for at least 2 weeks and had paired blood pressure values, were identified from the intervention database. Participants were required to be ?18 years old, reside in the United States, and own a smartphone. The digital intervention offers personalized behavior therapy, including goal setting, skill building, and self-monitoring. Participants reported blood pressure values at will, and changes were calculated using averages of baseline and final values for each participant. Machine learning was used to generate a model of participants who would complete the intervention. Random forest models were trained at days 1, 3, and 7 of the intervention, and the generalizability of the models was assessed using leave-one-out cross-validation. Results: The primary cohort comprised 172 participants with hypertension, having paired blood pressure values, who were engaged with the intervention. Of the total, 86.1% participants were women, the mean age was 55.0 years (95% CI 53.7-56.2), baseline systolic blood pressure was 138.9 mmHg (95% CI 136.6-141.3), and diastolic was 86.2 mmHg (95% CI 84.8-87.7). Mean change was ?11.5 mmHg for systolic blood pressure and ?5.9 mmHg for diastolic blood pressure over a mean of 62.6 days (P<.001). Among participants with stage 2 hypertension, mean change was ?17.6 mmHg for systolic blood pressure and ?8.8 mmHg for diastolic blood pressure. Changes in blood pressure remained significant in a mixed-effects model accounting for the baseline systolic blood pressure, age, gender, and body mass index (P<.001). A total of 43% of the participants tracking their blood pressure at 12 weeks achieved the 2017 American College of Cardiology/American Heart Association definition of blood pressure control. The 7-day predictive model for intervention completion was trained on 427 participants, and the area under the receiver operating characteristic curve was .78. Conclusions: Reductions in blood pressure were observed in adults with hypertension who used the digital therapeutic. The degree of blood pressure reduction was clinically meaningful and achieved rapidly by a majority of the studied participants. Greater improvement was observed in participants with more severe hypertension at baseline. A successful proof of concept for using machine learning to predict intervention completion was presented. UR - http://cardio.jmir.org/2019/1/e13030/ UR - http://dx.doi.org/10.2196/13030 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758792 ID - info:doi/10.2196/13030 ER - TY - JOUR AU - Huang, Ching-Chang AU - Chen, Ying-Hsien AU - Hung, Chi-Sheng AU - Lee, Jen-Kuang AU - Hsu, Tse-Pin AU - Wu, Hui-Wen AU - Chuang, Pao-Yu AU - Chen, Ming-Fong AU - Ho, Yi-Lwun PY - 2019/03/04 TI - Assessment of the Relationship Between Ambient Temperature and Home Blood Pressure in Patients From a Web-Based Synchronous Telehealth Care Program: Retrospective Study JO - J Med Internet Res SP - e12369 VL - 21 IS - 3 KW - ambient temperature KW - home blood pressure KW - antihypertensive agents KW - retrospective studies N2 - Background: Decreased ambient temperature significantly increases office blood pressure, but few studies have evaluated the effect of ambient temperature on home blood pressure. Objective: We aimed to investigate the relationship between short-term ambient temperature exposure and home blood pressure. Methods: We recruited patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital. Blood pressure was measured at home by patients or their caregivers. We obtained hourly meteorological data for Taipei (temperature, relative humidity, and wind speed) for the same time period from the Central Weather Bureau, Taiwan. Results: From 2009 to 2013, we enrolled a total of 253 patients. Mean patient age was 70.28 (SD 13.79) years, and 66.0% (167/253) of patients were male. We collected a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. A 1°C decrease was associated with a 0.5492-mm Hg increase in mean blood pressure, a 0.6841-mm Hg increase in systolic blood pressure, and a 0.2709-mm Hg increase in diastolic blood pressure. This temperature effect on home blood pressure was less prominent in patients with diabetes or hypertension. Antihypertensive agents modified this negative effect of temperature on home blood pressure to some extent, and angiotensin receptor blockers had the most favorable results. Conclusions: Short-term exposure to low ambient temperature significantly increased home blood pressure in patients with chronic cardiovascular diseases. Antihypertensive agents may modify this effect. UR - http://www.jmir.org/2019/3/e12369/ UR - http://dx.doi.org/10.2196/12369 UR - http://www.ncbi.nlm.nih.gov/pubmed/30829574 ID - info:doi/10.2196/12369 ER - TY - JOUR AU - McManus, D. David AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Manders, S. Emily AU - Fusco, Kelsey AU - Jung, S. Lindsey AU - Spartano, L. Nicole AU - Kheterpal, Vik AU - Nowak, Christopher AU - Sardana, Mayank AU - Murabito, M. Joanne PY - 2019/03/01 TI - Design and Preliminary Findings From a New Electronic Cohort Embedded in the Framingham Heart Study JO - J Med Internet Res SP - e12143 VL - 21 IS - 3 KW - smartphone KW - tele-medicine KW - blood pressure monitoring KW - ambulatory KW - cohort studies N2 - Background: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary. Objective: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). Methods: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements, and to wear the smartwatch daily. Results: Up to July 2017, we enrolled 790 eFHS participants, representing 76% (790/1044) of potentially eligible FHS participants. eFHS participants were, on average, 53±8 years of age and 57% were women. A total of 85% (675/790) of eFHS participants completed all of the baseline survey and 59% (470/790) completed the 3-month survey. A total of 42% (241/573) and 76% (306/405) of eFHS participants adhered to weekly digital BP and heart rate (HR) uploads, respectively, over 12 weeks. Conclusions: We have designed an e-cohort focused on identifying novel cardiovascular disease risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable. UR - http://www.jmir.org/2019/3/e12143/ UR - http://dx.doi.org/10.2196/12143 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821691 ID - info:doi/10.2196/12143 ER - TY - JOUR AU - Park, Jaram AU - Kim, Jeong-Whun AU - Ryu, Borim AU - Heo, Eunyoung AU - Jung, Young Se AU - Yoo, Sooyoung PY - 2019/02/15 TI - Patient-Level Prediction of Cardio-Cerebrovascular Events in Hypertension Using Nationwide Claims Data JO - J Med Internet Res SP - e11757 VL - 21 IS - 2 KW - health risk appraisal KW - risk KW - hypertension KW - chronic disease KW - clustering and classification KW - decision support systems N2 - Background: Prevention and management of chronic diseases are the main goals of national health maintenance programs. Previously widely used screening tools, such as Health Risk Appraisal, are restricted in their achievement this goal due to their limitations, such as static characteristics, accessibility, and generalizability. Hypertension is one of the most important chronic diseases requiring management via the nationwide health maintenance program, and health care providers should inform patients about their risks of a complication caused by hypertension. Objective: Our goal was to develop and compare machine learning models predicting high-risk vascular diseases for hypertensive patients so that they can manage their blood pressure based on their risk level. Methods: We used a 12-year longitudinal dataset of the nationwide sample cohort, which contains the data of 514,866 patients and allows tracking of patients? medical history across all health care providers in Korea (N=51,920). To ensure the generalizability of our models, we conducted an external validation using another national sample cohort dataset, comprising one million different patients, published by the National Health Insurance Service. From each dataset, we obtained the data of 74,535 and 59,738 patients with essential hypertension and developed machine learning models for predicting cardiovascular and cerebrovascular events. Six machine learning models were developed and compared for evaluating performances based on validation metrics. Results: Machine learning algorithms enabled us to detect high-risk patients based on their medical history. The long short-term memory-based algorithm outperformed in the within test (F1-score=.772, external test F1-score=.613), and the random forest-based algorithm of risk prediction showed better performance over other machine learning algorithms concerning generalization (within test F1-score=.757, external test F1-score=.705). Concerning the number of features, in the within test, the long short-term memory-based algorithms outperformed regardless of the number of features. However, in the external test, the random forest-based algorithm was the best, irrespective of the number of features it encountered. Conclusions: We developed and compared machine learning models predicting high-risk vascular diseases in hypertensive patients so that they may manage their blood pressure based on their risk level. By relying on the prediction model, a government can predict high-risk patients at the nationwide level and establish health care policies in advance. UR - http://www.jmir.org/2019/2/e11757/ UR - http://dx.doi.org/10.2196/11757 UR - http://www.ncbi.nlm.nih.gov/pubmed/30767907 ID - info:doi/10.2196/11757 ER - TY - JOUR AU - Jin, Yinzi AU - Jing, Mingxia AU - Zhang, Luyu AU - Song, Suhang AU - Ma, Xiaochen PY - 2019/01/31 TI - Internet Access and Hypertension Management Among the Elderly Population: A Nationally Representative Cross-Sectional Survey in China JO - J Med Internet Res SP - e11280 VL - 21 IS - 1 KW - China KW - health disparity KW - hypertension KW - internet N2 - Background: Hypertension is a rapidly growing epidemic in China. Yet, it remains inadequately controlled, especially in rural areas. The internet has shown potential for better health management in different settings; however, few studies have investigated its role in hypertension management in China. Objective: This study aims to examine the association between internet access and hypertension awareness, treatment, and control among elderly Chinese adults and to investigate whether the association between internet access and hypertension management differed between those living in urban and rural areas. Methods: We obtained data from the nationally representative survey of the China Health and Retirement Longitudinal Study in 2011. Hypertension was defined as (1) average systolic blood pressure of ?140 mm Hg or average diastolic blood pressure of ?90 mm Hg or (2) currently taking antihypertensive medications. The outcome assessed included hypertension awareness, treatment, and control. The key independent variable was defined as whether one had internet access at home. We performed multivariate logistic regressions for each of the 3 outcomes. Results: Among 5135 hypertensive respondents (age 62.4 [SD 9.9] years; 2351/5135, 45.78% men), 12.89% (662/5135) had internet access at home. Compared with those who had no internet access, internet access was positively associated with hypertension awareness (odds ratio [OR] 1.36, 95% CI 1.07-1.73) and treatment (OR 1.38, 95% CI 1.09-1.75), but not with control (OR 1.19, 95% CI 0.90-1.58). Internet access reduced urban-rural disparity in hypertension awareness by 9.6% (P=.02), treatment by 8.3% (P=.05), but not in control. In addition, the moderating effect of internet access on urban-rural disparities in hypertension management was larger among females. The decreased urban-rural disparities were primarily driven by that internet access improved the management level in rural areas. Conclusions: Despite the low rate of internet access among the elderly population, the internet shows its potential as a platform for achieving better hypertension management in China. Strategies for reducing the disparities in hypertension management and overall disease burden of hypertension among the elderly population might consider the internet as a platform. UR - http://www.jmir.org/2019/1/e11280/ UR - http://dx.doi.org/10.2196/11280 UR - http://www.ncbi.nlm.nih.gov/pubmed/30702439 ID - info:doi/10.2196/11280 ER - TY - JOUR AU - Buis, R. Lorraine AU - Dawood, Katee AU - Kadri, Reema AU - Dawood, Rachelle AU - Richardson, R. Caroline AU - Djuric, Zora AU - Sen, Ananda AU - Plegue, Melissa AU - Hutton, David AU - Brody, Aaron AU - McNaughton, D. Candace AU - Brook, D. Robert AU - Levy, Phillip PY - 2019/01/25 TI - Improving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e12601 VL - 8 IS - 1 KW - hypertension KW - mHealth KW - blood pressure KW - smartphone KW - mobile phone N2 - Background: African Americans shoulder significant disparities related to hypertension (HTN), which is a serious public health problem in the city of Detroit, Michigan, where more than 80% of the population is African American. Connectivity through smartphones, use of home blood pressure (BP) monitoring, and newly developed mobile health (mHealth) interventions can facilitate behavioral changes and may improve long-term self-care for chronic conditions, but implementation of a combined approach utilizing these methods has not been tested among African American patients with uncontrolled HTN. Since African Americans are more likely than other racial or ethnic subgroups to utilize the emergency department (ED) for ambulatory care, this presents an opportunity to intervene on a population that is otherwise difficult to reach. Objective: The MI-BP app aims to reduce health disparities related to HTN in the community by employing a user-centered intervention focused on self-BP monitoring, physical activity, reduced sodium intake, and medication adherence. We seek to test the efficacy of MI-BP, an mHealth app for HTN self-management, on BP control (primary aim), physical activity, sodium intake, and medication adherence (secondary aim) in African Americans with HTN. This study also seeks to evaluate the cost-effectiveness of MI-BP when compared with usual care methods. Methods: This is a 1-year randomized controlled trial that will recruit individuals who have uncontrolled HTN from 2 EDs in the city of Detroit, with a planned sample size of 396 randomized participants. To be eligible for inclusion, potential participants must be African American, 25 to 70 years old, previously diagnosed with HTN, have a smartphone compatible with MI-BP, and have uncontrolled BP at triage and on repeat measurement at least 1-hour post triage vitals. Once a participant is deemed eligible, all study procedures and subsequent follow-up visits (8 in total) are conducted at the Wayne State University Clinical Research Service Center. We seek to determine the effect of MI-BP on BP for 1 year (using BP control and mean systolic BP as coprimary outcomes and physical activity, sodium intake, and medication adherence as secondary outcomes) compared with usual care controls. Results: Recruitment for this study began in January 2018. The study will continue through 2021. Conclusions: As the first of its kind conducted in an ED setting, MI-BP was designed to document the efficacy and acceptability of a multicomponent mHealth approach to help African Americans with uncontrolled BP modify their lifestyle to better manage their HTN. We expect to lay the foundation to sustainably reduce HTN-related health disparities through better integration of multiple behavior self-monitoring and improve outcomes for those who traditionally rely on the ED for chronic disease care. Trial Registration: ClinicalTrials.gov NCT02360293; http://clinicaltrials.gov/ct2/show/NCT02360293 International Registered Report Identifier (IRRID): RR1-10.2196/12601 UR - http://www.researchprotocols.org/2019/1/e12601/ UR - http://dx.doi.org/10.2196/12601 UR - http://www.ncbi.nlm.nih.gov/pubmed/30681965 ID - info:doi/10.2196/12601 ER - TY - JOUR AU - Langford, T. Aisha AU - Solid, A. Craig AU - Scott, Ebony AU - Lad, Meeki AU - Maayan, Eli AU - Williams, K. Stephen AU - Seixas, A. Azizi PY - 2019/01/14 TI - Mobile Phone Ownership, Health Apps, and Tablet Use in US Adults With a Self-Reported History of Hypertension: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e12228 VL - 7 IS - 1 KW - smartphone KW - text messaging KW - health communication KW - ownership KW - goals KW - cell phone KW - telemedicine KW - hypertension KW - tablets KW - chronic disease N2 - Background: Mobile phone and tablet ownership have increased in the United States over the last decade, contributing to the growing use of mobile health (mHealth) interventions to help patients manage chronic health conditions like diabetes. However, few studies have characterized mobile device ownership and the presence of health-related apps on mobile devices in people with a self-reported history of hypertension. Objective: This study aimed to describe the prevalence of smartphone, tablet, and basic mobile phone ownership and the presence of health apps by sociodemographic factors and self-reported hypertension status (ie, history) in a nationally representative sample of US adults, and to describe whether mobile devices are associated with health goal achievement, medical decision making, and patient-provider communication. Methods: Data from 3285 respondents from the 2017 Health Information National Trends Survey were analyzed. Participants were asked if they owned a smartphone, tablet, or basic mobile phone and if they had health apps on a smartphone or tablet. Participants were also asked if their smartphones or tablets helped them achieve a health-related goal like losing weight, make a decision about how to treat an illness, or talk with their health care providers. Chi-square analyses were conducted to test for differences in mobile device ownership, health app presence, and app helpfulness by patient characteristics. Results: Approximately 1460 (37.6% weighted prevalence) participants reported a history of hypertension. Tablet and smartphone ownership were lower in participants with a history of hypertension than in those without a history of hypertension (55% vs 66%, P=.001, and 86% vs 68%, P<.001, respectively). Participants with a history of hypertension were more likely to own a basic mobile phone only as compared to those without a history of hypertension (16% vs 9%, P<.001). Among those with a history of hypertension exclusively, basic mobile phone, smartphone, and tablet ownership were associated with age and education, but not race or sex. Older adults were more likely to report having a basic mobile phone only, whereas those with higher education were more likely to report owning a tablet or smartphone. Compared to those without a history of hypertension, participants with a history of hypertension were less likely to have health-related apps on their smartphones or tablets (45% vs 30%, P<.001) and report that mobile devices helped them achieve a health-related goal (72% vs 63%, P=.01). Conclusions: Despite the increasing use of smartphones, tablets, and health-related apps, these tools are used less among people with a self-reported history of hypertension. To reach the widest cross-section of patients, a mix of novel mHealth interventions and traditional health communication strategies (eg, print, web based, and in person) are needed to support the diverse needs of people with a history of hypertension. UR - http://mhealth.jmir.org/2019/1/e12228/ UR - http://dx.doi.org/10.2196/12228 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344667 ID - info:doi/10.2196/12228 ER - TY - JOUR AU - Sinnenberg, Lauren AU - Mancheno, Christina AU - Barg, K. Frances AU - Asch, A. David AU - Rivard, Lee Christy AU - Horst-Martz, Emma AU - Buttenheim, Alison AU - Ungar, Lyle AU - Merchant, Raina PY - 2018/12/21 TI - Content Analysis of Metaphors About Hypertension and Diabetes on Twitter: Exploratory Mixed-Methods Study JO - JMIR Diabetes SP - e11177 VL - 3 IS - 4 KW - cardiovascular diseases KW - language KW - metaphor KW - social media KW - hypertension KW - diabetes mellitus N2 - Background: Widespread metaphors contribute to the public?s understanding of health. Prior work has characterized the metaphors used to describe cancer and AIDS. Less is known about the metaphors characterizing cardiovascular disease. Objective: The objective of our study was to characterize the metaphors that Twitter users employ in discussing hypertension and diabetes. Methods: We filtered approximately 10 billion tweets for keywords related to diabetes and hypertension. We coded a random subset of 5000 tweets for the presence of metaphor and the type of metaphor employed. Results: Among the 5000 tweets, we identified 797 (15.9%) about hypertension or diabetes that employed metaphors. When discussing the development of heart disease, Twitter users described the disease as a journey (n=202), as transmittable (n=116), as an object (n=49), or as being person-like (n=15). In discussing the experience of these diseases, some Twitter users employed war metaphors (n=101). Other users described the challenge to control their disease (n=34), the disease as an agent (n=58), or their bodies as machines (n=205). Conclusions: Metaphors are used frequently by Twitter users in their discussion of hypertension and diabetes. These metaphors can help to guide communication between patients and providers to improve public health. UR - http://diabetes.jmir.org/2018/4/e11177/ UR - http://dx.doi.org/10.2196/11177 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578222 ID - info:doi/10.2196/11177 ER - TY - JOUR AU - Warner, E. Bronwen AU - Velardo, Carmelo AU - Salvi, Dario AU - Lafferty, Kathryn AU - Crosbie, Sarah AU - Herrington, G. William AU - Haynes, Richard PY - 2018/12/21 TI - Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study JO - JMIR Cardio SP - e11332 VL - 2 IS - 2 KW - chronic kidney disease KW - blood pressure KW - telemonitoring KW - mobile phone N2 - Background: Blood pressure (BP) is a key modifiable risk factor for patients with chronic kidney disease (CKD), with current guidelines recommending strict control to reduce the risk of progression of both CKD and cardiovascular disease. Trials involving BP lowering require multiple visits to achieve target BP, which increases the costs of such trials, and in routine care, BP measured in the clinic may not accurately reflect the usual BP. Objective: We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enabled BP machine that could transmit BP measurements to a tablet device installed with a bespoke app to guide the measurement of BP and collect questionnaire data) was acceptable to patients with CKD and whether patients would provide sufficient BP readings to assess variability and guide treatment. Methods: A total of 25 participants with CKD were trained to use the telemonitoring equipment and asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24-hour period. Participants were given questionnaires at the 1- and 3-month time points; the questionnaires were derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study. Results: Mean participant age was 58 (SD 11) years, and mean estimated glomerular filtration rate was 36 (SD 13) mL/min/1.73m2. 13/25 (52%) participants provided >90% of the expected data and 18/25 (72%) provided >80% of the expected data. The usability of the telemonitoring system was rated highly, with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation for the variability of systolic BP telemonitoring was 9.4% (95% CI 7.8-10.9) compared with 7.9% (95% CI 6.4-9.5) for the BPro device, P=.05 (and was 9.0% over 1 year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP was short term. Conclusions: Telemonitoring is acceptable for patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing BP among different targets) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN13725286; http://www.isrctn.com/ISRCTN13725286 (Archived by WebCite at http://www.webcitation.org/74PAX51Ji). UR - http://cardio.jmir.org/2018/2/e11332/ UR - http://dx.doi.org/10.2196/11332 UR - http://www.ncbi.nlm.nih.gov/pubmed/30596204 ID - info:doi/10.2196/11332 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Elena Marta AU - López-López, Daniel AU - Palomo-López, Patricia AU - Rodríguez-Sanz, David AU - Calvo-Lobo, César PY - 2018/10/25 TI - The QardioArm Blood Pressure App for Self-Measurement in an Obese Population: Validation Study Using the European Society of Hypertension International Protocol Revision 2010 JO - JMIR Mhealth Uhealth SP - e11632 VL - 6 IS - 10 KW - obesity KW - blood pressure determination N2 - Background: Obesity and high blood pressure (HBP) pose high cardiovascular risks, and they are frequent causes of cardiovascular disease. Objective: The aim of this study was to validate the mobile app QardioArm for high blood pressure monitoring in obese subjects (body mass index ?30 kg/m2) according to guidelines in the European Society of Hypertension-International Protocol 2 (ESH-IP2). Methods: We recruited 33 obese subjects and measured their blood pressure using QardioArm (test device) and Omron M3 Intellisense (Omron Healthcare, Kyoto, Japan; standard device). We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) according to the ESH-IP2. Results: A total of 95 of 99 differences for SBP and 91 of 99 for DBP displayed absolute differences within 10 mm Hg. A total of 98 of 99 differences for SBP and 98 of 99 for DBP exhibited absolute differences within 15 mm Hg. This result satisfied requirements for part 1 of the ESH-IP2. A total of 27 out of 33 individuals for SBP and 30 out of 33 individuals for DBP had a minimum of 2 of 3 comparisons within 5 mm Hg difference. None of the subjects had 3 differences outside 5 mm Hg for SBP and DBP, satisfying part 2 of the ESH-IP2. For HR measurements, a total of 90 of 99 differences had absolute differences within 3 beats per minute (bpm), and a total of 94 or 99 differences had absolute differences within 5 bpm. A total of 98 of 99 differences had absolute differences within 8 bpm. Therefore, the test device satisfied part 1 of ESH-IP2 criteria for HR. For part 2 of ESH-IP2, 31 of 33 individuals had a minimum of 2 of 3 comparisons within 3 bpm difference for HR. Only 1 of 33 subjects had 3 differences outside 3 bpm. Conclusions: To the best of our knowledge, this was the first study to show that an app that measures blood pressure and HR meets the requirements of the ESH-IP2 in an obese population. We believe the ESH-IP2 should publish explicit criteria for validation of blood pressure devices in specific populations. UR - http://mhealth.jmir.org/2018/10/e11632/ UR - http://dx.doi.org/10.2196/11632 UR - http://www.ncbi.nlm.nih.gov/pubmed/30361193 ID - info:doi/10.2196/11632 ER - TY - JOUR AU - Fuchs, C. Sandra AU - Harzheim, Erno AU - Iochpe, Cirano AU - David, de Caroline N. AU - Gonçalves, R. Marcelo AU - Sesin, P. Guilhermo AU - Costa, M. Cassio AU - Moreira, B. Leila AU - Fuchs, D. Flavio PY - 2018/08/07 TI - Technologies for Innovative Monitoring to Reduce Blood Pressure and Change Lifestyle Using Mobile Phones in Adult and Elderly Populations (TIM Study): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e169 VL - 7 IS - 8 KW - blood pressure KW - blood pressure monitoring KW - hypertension KW - weight KW - diet KW - sodium KW - physical activity KW - randomized controlled trial KW - text messages N2 - Background: Hypertension is a growing problem worldwide, markedly in low- and middle-income countries, where the rate of control slightly decreased. The overall prevalence of hypertension in Brazil is 28.7% among adult individuals and 68.9% in the population aged 60 years and older, and less than a third of patients have controlled blood pressure (BP). The use of technologies?mobile phones and the internet?to implement interventions to reduce blood pressure can minimize costs and diminish cardiovascular risk. Interventions through text messaging and electronic BP monitoring present divergent results. Objective: This trial evaluates the effectiveness of interventions?personalized messages and telemonitoring of BP?to reduce systolic BP and improve lifestyle compared to the usual care of patients with hypertension (control group). Methods: This factorial randomized controlled trial enrolls individuals aged 30 to 75 years who have a mobile phone and internet access with the diagnosis of hypertension under drug treatment with up to 2 medications and uncontrolled BP. Eligible participants should have both increased office BP and 24-hour BP with ambulatory BP monitoring. Participants with severe hypertension (systolic BP ?180 or diastolic BP ?110 mm Hg), life threatening conditions, low life expectancy, recent major cardiovascular event (last 6 months), other indications for the use of antihypertensive medication, diagnosis of secondary hypertension, pregnant or lactating women, or those unable to understand the interventions are excluded. Participants are randomly allocate to 1 of 4 experimental arms: (1) Telemonitoring of blood pressure (TELEM) group: receives an automatic oscillometric device to measure BP, (2) telemonitoring by text message (TELEMEV) group: receives personalized, standardized text messages to stimulate lifestyle changes and adhere with BP-lowering medication, (3) TELEM-TELEMEV group: receives both interventions, and (4) control group: receives usual clinical treatment (UCT). Data collection is performed in a clinical research center located in a referent hospital. The primary outcomes are reduction of systolic BP assessed by 24-hour ambulatory BP monitoring (primary outcome) and change of lifestyle (based on dietary approaches to stop hypertension (DASH)-type diet, sodium restriction, weight loss or control, increase of physical activity). Results: This study was funded by two Brazilian agencies: the National Council for Scientific and Technological Development and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul. Enrollment was completed at the end of 2017 (N=231), the follow-up is ongoing, and data analysis is expected to begin in early 2019. A reduction of 24-hour systolic BP of approximately 8.8 [SD 13.1] mm Hg for participants in the BP monitoring group versus 3.4 [SD 11.6] mm Hg in the UCT group is expected. A similar reduction in the text messaging group is expected. Conclusions: The use of mobile technologies connected to the internet through mobile phones promotes time optimization, cost reduction, and better use of public health resources. However, it has not been established whether simple interventions such as text messaging are superior to electronic BP monitoring and whether both outperform conventional counseling. Trial Registration: ClinicalTrials.gov NCT03005470; https://clinicaltrials.gov/ct2/show/NCT03005470 (Archived by WebCite at http://www.webcitation.org/70AoANESu). Plataforma Brasil CAAE 31423214.0.0000.5327. Registered Report Identifier: RR1-10.2196/9619 UR - http://www.researchprotocols.org/2018/8/e169/ UR - http://dx.doi.org/10.2196/resprot.9619 UR - http://www.ncbi.nlm.nih.gov/pubmed/30087093 ID - info:doi/10.2196/resprot.9619 ER - TY - JOUR AU - Albrecht, Lauren AU - Wood, W. Peter AU - Fradette, Miriam AU - McAlister, A. Finlay AU - Rabi, Doreen AU - Boulanger, Pierre AU - Padwal, Raj PY - 2018/07/24 TI - Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study JO - JMIR Aging SP - e10975 VL - 1 IS - 2 KW - blood pressure KW - telemonitoring KW - community-dwelling KW - qualitative N2 - Background: Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. Objective: The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. Methods: We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. Results: Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. Conclusions: Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population. UR - http://aging.jmir.org/2018/2/e10975/ UR - http://dx.doi.org/10.2196/10975 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518242 ID - info:doi/10.2196/10975 ER - TY - JOUR AU - Alessa, Tourkiah AU - Abdi, Sarah AU - Hawley, S. Mark AU - de Witte, Luc PY - 2018/07/23 TI - Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction JO - JMIR Mhealth Uhealth SP - e10723 VL - 6 IS - 7 KW - mobile phone KW - mobile application KW - mobile app KW - self-management KW - hypertension KW - blood pressure N2 - Background: Hypertension is a chronic disease that is considered to be a public health problem and requires efforts by patients to manage themselves. The global growth in the use of mobile phones and tablets has been accompanied by the increased use of health apps. Many of these apps support the self-management of hypertension and, therefore, they have the potential benefits of lowering blood pressure. Despite this, there is currently a lack of evidence for their effectiveness, usability, and patient satisfaction with their use. Objective: A systematic review was conducted to assess the effectiveness of apps in lowering blood pressure, as well as their usability and patients? satisfaction with their use. Methods: We conducted searches in the following databases: MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), IEEE Xplore ASSIAN, Google Scholar and the main Arabic databases Al Manhal, AskZad, and Mandumah. We looked for studies that used apps in the self-management of hypertension from 2008-2016. We also checked the reference lists of the review papers and all the primary studies for additional references. Results: A total of 21 studies with a total of 3112 participants were included in the review. Of the 14 studies that assessed the effectiveness of the apps in lowering blood pressure, 10 (71.4%) studies (6 RCTs and 4 nonrandomized studies) reported that using the apps led to significant decreases in blood pressure and seemed to be effective in the self-management of hypertension. Of these 10, only 2 (20%) RCTs and 3 (30%) nonrandomized studies had a low?moderate risk of bias. The results of this review are inconclusive regarding which combinations of functionalities would be most effective in lowering blood pressure because of variation in the studies? quality, but the data suggest that apps incorporating more comprehensive functionalities are likely to be more effective. In all the studies that assessed the usability of the apps and users? acceptance of them, all the apps seemed to be accepted and easy to use. Conclusions: Most of the studies reported that apps might be effective in lowering blood pressure and are accepted by users. However, these findings should be interpreted with caution, as most of the studies had a high risk of bias. More well-designed, large-scale studies are required to evaluate the real effect of using apps in lowering blood pressure and to identify the most effective functionality combinations for lowering blood pressure. UR - http://mhealth.jmir.org/2018/7/e10723/ UR - http://dx.doi.org/10.2196/10723 UR - http://www.ncbi.nlm.nih.gov/pubmed/30037787 ID - info:doi/10.2196/10723 ER - TY - JOUR AU - Rivera-Romero, Octavio AU - Olmo, Alberto AU - Muñoz, Rocío AU - Stiefel, Pablo AU - Miranda, Luisa María AU - Beltrán, M. Luis PY - 2018/05/30 TI - Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review JO - JMIR Mhealth Uhealth SP - e130 VL - 6 IS - 5 KW - pregnancy KW - hypertension KW - pre-eclampsia KW - blood pressure KW - telemedicine N2 - Background: Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective: The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods: A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results: The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions: mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC. UR - http://mhealth.jmir.org/2018/5/e130/ UR - http://dx.doi.org/10.2196/mhealth.9671 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/mhealth.9671 ER - TY - JOUR AU - Sak, Gabriele AU - Schulz, Johannes Peter PY - 2018/05/30 TI - Exploring Health Information-Seeking Preferences of Older Adults With Hypertension: Quasi-Experimental Design JO - JMIR Cardio SP - e12 VL - 2 IS - 1 KW - desire for health information KW - assisted computer-based information search KW - decision self-efficacy KW - medical decision making KW - senior hypertensive patients KW - quasi-experimental design KW - Switzerland N2 - Background: Patients? engagement in health care decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information, but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of desire for health information on seniors? perceived confidence in making an informed choice (ie, decision self-efficacy). Objective: The goal of this study was to investigate the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of an assisted computer-based information search. Additionally, the study allowed insights into the sources seniors with hypertension prefer to consult. Methods: A sample of 101 senior citizens (aged ?60 years) with high blood pressure in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of covariance were conducted to detect differences between and within who desired additional hypertension-related content (intervention group) and ?information avoiders? (control group). Results: Health care professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the internet (intervention group only). However, among the total sample, the internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred in seniors consulting additional information compared to information avoiders (F1,93=28.25, P<.001). Conclusions: Consulting health information on a computer screen, and assistance by a computer-savvy person, may be a helpful activity to increase perceived confidence in making treatment decisions in seniors with hypertension. UR - http://cardio.jmir.org/2018/1/e12/ UR - http://dx.doi.org/10.2196/cardio.8903 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758784 ID - info:doi/10.2196/cardio.8903 ER - TY - JOUR AU - Tanaka, Rika AU - Nolan, P. Robert PY - 2018/05/11 TI - Psychobehavioral Profiles to Assist Tailoring of Interventions for Patients With Hypertension: Latent Profile Analysis JO - J Med Internet Res SP - e149 VL - 20 IS - 5 KW - hypertension KW - depression KW - health behavior KW - lifestyle KW - counseling N2 - Background: Practice guidelines advocate combining pharmacotherapy with lifestyle counseling for patients with hypertension. To allow for appropriate tailoring of interventions to meet individual patient needs, a comprehensive understanding of baseline patient characteristics is essential. However, few studies have empirically assessed behavioral profiles of hypertensive patients in Web-based lifestyle counseling programs. Objective: The objectives of this study were to (1) specify baseline psychobehavioral profiles of patients with hypertension who were enrolled in a Web-based lifestyle counseling trial, and (2) examine mean differences among the identified profile groups in demographics, psychological distress, self-reported self-care behaviors, physiological outcomes, and program engagement to determine prognostic implications. Methods: Participants (N=264; mean age 57.5 years; 154/264, 58.3% female; 193/264, 73.1% white) were recruited into a longitudinal, double-blind, randomized controlled trial, designed to evaluate an online lifestyle intervention for hypertensive patients. A series of latent profile analyses identified psychobehavioral profiles, indicated by baseline measures of mood, motivation, and health behaviors. Mean differences between profile groups were then explored. Results: A 2-class solution provided the best model fit (the Bayesian information criterion (BIC) is 10,133.11; sample-size adjusted BIC is 10,006.54; Lo-Mendell-Rubin likelihood ratio test is 65.56, P=.001). The 2 profile groups were (1) adaptive adjustment, marked by low distress, high motivation, and somewhat satisfactory engagement in health behaviors and (2) affectively distressed, marked by clinically significant distress. At baseline, on average, affectively distressed patients had lower income, higher body mass index, and endorsed higher stress compared with their adaptive adjustment counterparts. At 12-months post intervention, treatment effects were sustained for systolic blood pressure and Framingham risk index in the adaptive adjustment group, and those in the adaptive adjustment group were 2.4 times more likely to complete the 12-month intervention study, compared with their affectively distressed counterparts. Conclusions: Interventions for patients who are adaptively adjusted may differ in focus from those designed for the affectively distressed patients. As such, this study underscores the importance of identifying psychobehavioral profiles, as they allow for evidence-based tailoring of lifestyle counseling programs for patients with hypertension. Trial Registration: ClinicalTrials.gov NCT01541540; https://clinicaltrials.gov/ct2/show/NCT01541540 (Archived by WebCite at http://www.webcitation.org/6yzZYZcWF) UR - http://www.jmir.org/2018/5/e149/ UR - http://dx.doi.org/10.2196/jmir.8757 UR - http://www.ncbi.nlm.nih.gov/pubmed/29752248 ID - info:doi/10.2196/jmir.8757 ER - TY - JOUR AU - Ye, Chengyin AU - Fu, Tianyun AU - Hao, Shiying AU - Zhang, Yan AU - Wang, Oliver AU - Jin, Bo AU - Xia, Minjie AU - Liu, Modi AU - Zhou, Xin AU - Wu, Qian AU - Guo, Yanting AU - Zhu, Chunqing AU - Li, Yu-Ming AU - Culver, S. Devore AU - Alfreds, T. Shaun AU - Stearns, Frank AU - Sylvester, G. Karl AU - Widen, Eric AU - McElhinney, Doff AU - Ling, Xuefeng PY - 2018/01/30 TI - Prediction of Incident Hypertension Within the Next Year: Prospective Study Using Statewide Electronic Health Records and Machine Learning JO - J Med Internet Res SP - e22 VL - 20 IS - 1 KW - hypertension KW - risk assessment KW - electronic health records KW - multiple chronic conditions KW - mental disorders KW - social determinants of health N2 - Background: As a high-prevalence health condition, hypertension is clinically costly, difficult to manage, and often leads to severe and life-threatening diseases such as cardiovascular disease (CVD) and stroke. Objective: The aim of this study was to develop and validate prospectively a risk prediction model of incident essential hypertension within the following year. Methods: Data from individual patient electronic health records (EHRs) were extracted from the Maine Health Information Exchange network. Retrospective (N=823,627, calendar year 2013) and prospective (N=680,810, calendar year 2014) cohorts were formed. A machine learning algorithm, XGBoost, was adopted in the process of feature selection and model building. It generated an ensemble of classification trees and assigned a final predictive risk score to each individual. Results: The 1-year incident hypertension risk model attained areas under the curve (AUCs) of 0.917 and 0.870 in the retrospective and prospective cohorts, respectively. Risk scores were calculated and stratified into five risk categories, with 4526 out of 381,544 patients (1.19%) in the lowest risk category (score 0-0.05) and 21,050 out of 41,329 patients (50.93%) in the highest risk category (score 0.4-1) receiving a diagnosis of incident hypertension in the following 1 year. Type 2 diabetes, lipid disorders, CVDs, mental illness, clinical utilization indicators, and socioeconomic determinants were recognized as driving or associated features of incident essential hypertension. The very high risk population mainly comprised elderly (age>50 years) individuals with multiple chronic conditions, especially those receiving medications for mental disorders. Disparities were also found in social determinants, including some community-level factors associated with higher risk and others that were protective against hypertension. Conclusions: With statewide EHR datasets, our study prospectively validated an accurate 1-year risk prediction model for incident essential hypertension. Our real-time predictive analytic model has been deployed in the state of Maine, providing implications in interventions for hypertension and related diseases and hopefully enhancing hypertension care. UR - http://www.jmir.org/2018/1/e22/ UR - http://dx.doi.org/10.2196/jmir.9268 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382633 ID - info:doi/10.2196/jmir.9268 ER - TY - JOUR AU - Marcolino, Soriano Milena AU - Oliveira, Queiroz João Antonio AU - D'Agostino, Marcelo AU - Ribeiro, Luiz Antonio AU - Alkmim, Moreira Maria Beatriz AU - Novillo-Ortiz, David PY - 2018/01/17 TI - The Impact of mHealth Interventions: Systematic Review of Systematic Reviews JO - JMIR Mhealth Uhealth SP - e23 VL - 6 IS - 1 KW - telemedicine KW - medical informatics KW - mobile phones N2 - Background: Mobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed. Objective: We performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery. Methods: We used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Results: The searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load. Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries. UR - http://mhealth.jmir.org/2018/1/e23/ UR - http://dx.doi.org/10.2196/mhealth.8873 UR - http://www.ncbi.nlm.nih.gov/pubmed/29343463 ID - info:doi/10.2196/mhealth.8873 ER - TY - JOUR AU - Dou, Kaili AU - Yu, Ping AU - Deng, Ning AU - Liu, Fang AU - Guan, YingPing AU - Li, Zhenye AU - Ji, Yumeng AU - Du, Ningkai AU - Lu, Xudong AU - Duan, Huilong PY - 2017/12/06 TI - Patients? Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test JO - JMIR Mhealth Uhealth SP - e177 VL - 5 IS - 12 KW - smartphone KW - mobile health KW - patients KW - hypertension KW - chronic disease KW - disease management N2 - Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients? acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients? acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients? acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients? actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results: The model accounted for .412 of the variance in patients? intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients? smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients? intentions to use the technology. Age and gender had no significant influence on patients? acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions: This study developed a theoretical model to predict patients? acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients? awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. UR - https://mhealth.jmir.org/2017/12/e177/ UR - http://dx.doi.org/10.2196/mhealth.7886 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212629 ID - info:doi/10.2196/mhealth.7886 ER - TY - JOUR AU - Mileski, Michael AU - Kruse, Scott Clemens AU - Catalani, Justin AU - Haderer, Tara PY - 2017/10/24 TI - Adopting Telemedicine for the Self-Management of Hypertension: Systematic Review JO - JMIR Med Inform SP - e41 VL - 5 IS - 4 KW - hypertension KW - telemedicine KW - eHealth KW - mHealth KW - disease management N2 - Background: Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. Objective: A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Methods: Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results: Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. Conclusions: This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of hypertension. UR - http://medinform.jmir.org/2017/4/e41/ UR - http://dx.doi.org/10.2196/medinform.6603 UR - http://www.ncbi.nlm.nih.gov/pubmed/29066424 ID - info:doi/10.2196/medinform.6603 ER - TY - JOUR AU - Usher-Smith, A. Juliet AU - Winther, R. Laura AU - Shefer, S. Guy AU - Silarova, Barbora AU - Payne, A. Rupert AU - Griffin, J. Simon PY - 2017/10/16 TI - Factors Associated With Engagement With a Web-Based Lifestyle Intervention Following Provision of Coronary Heart Disease Risk: Mixed Methods Study JO - J Med Internet Res SP - e351 VL - 19 IS - 10 KW - Web-based intervention KW - cardiovascular disease KW - engagement KW - risk KW - qualitative research N2 - Background: Web-based interventions provide the opportunity to combine the tailored approach of face-to-face interventions with the scalability and cost-effectiveness of public health interventions. This potential is often limited by low engagement. A number of studies have described the characteristics of individuals who engage more in Web-based interventions but few have explored the reasons for these variations. Objective: We aimed to explore individual-level factors associated with different degrees of engagement with a Web-based behavior change intervention following provision of coronary heart disease (CHD) risk information, and the barriers and facilitators to engagement. Methods: This study involved the secondary analysis of data from the Information and Risk Modification Trial, a randomized controlled trial of a Web-based lifestyle intervention alone, or alongside information on estimated CHD risk. The intervention consisted of three interactive sessions, each lasting up to 60 minutes, delivered at monthly intervals. Participants were characterized as high engagers if they completed all three sessions. Thematic analysis of qualitative data from interviews with 37 participants was combined with quantitative data on usage of the Web-based intervention using a mixed-methods matrix, and data on the views of the intervention itself were analyzed across all participants. Results: Thirteen participants were characterized as low engagers and 24 as high engagers. There was no difference in age (P=.75), gender (P=.95), or level of risk (P=.65) between the groups. Low engagement was more often associated with: (1) reporting a negative emotional reaction in response to the risk score (P=.029), (2) perceiving that the intervention did not provide any new lifestyle information (P=.011), and (3) being less likely to have reported feeling an obligation to complete the intervention as part of the study (P=.019). The mixed-methods matrix suggested that there was also an association between low engagement and less success with previous behavior change attempts, but the statistical evidence for this association was weak (P=.16). No associations were seen between engagement and barriers or facilitators to health behavior change, or comments about the design of the intervention itself. The most commonly cited barriers related to issues with access to the intervention itself: either difficulties remembering the link to the site or passwords, a perceived lack of flexibility within the website, or lack of time. Facilitators included the nonjudgmental presentation of lifestyle information, the use of simple language, and the personalized nature of the intervention. Conclusions: This study shows that the level of engagement with a Web-based intervention following provision of CHD risk information is not influenced by the level of risk but by the individual?s response to the risk information, their past experiences of behavior change, the extent to which they consider the lifestyle information helpful, and whether they felt obliged to complete the intervention as part of a research study. A number of facilitators and barriers to Web-based interventions were also identified, which should inform future interventions. UR - http://www.jmir.org/2017/10/e351/ UR - http://dx.doi.org/10.2196/jmir.7697 UR - http://www.ncbi.nlm.nih.gov/pubmed/29038095 ID - info:doi/10.2196/jmir.7697 ER - TY - JOUR AU - Buis, R. Lorraine AU - Roberson, N. Dana AU - Kadri, Reema AU - Rockey, G. Nicole AU - Plegue, A. Melissa AU - Choe, Mi Hae AU - Richardson, R. Caroline PY - 2017/10/10 TI - Utilizing Consumer Health Informatics to Support Management of Hypertension by Clinical Pharmacists in Primary Care: Study Protocol JO - JMIR Res Protoc SP - e193 VL - 6 IS - 10 KW - hypertension KW - medication adherence KW - cell phones KW - telemedicine N2 - Background: Hypertension (HTN) is a major public health concern in the United States given its wide prevalence, high cost, and poor rates of control. Multiple strategies to counter this growing epidemic have been studied, and home blood pressure (BP) monitoring, mobile health (mHealth) interventions, and referrals to clinical pharmacists for BP management have all shown potential to be effective intervention strategies. Objective: The purpose of this study is to establish feasibility and acceptability of BPTrack, a clinical pharmacist-led mHealth intervention that aims to improve BP control by supporting home BP monitoring and medication adherence among patients with uncontrolled HTN. BPTrack is an intervention that makes home-monitored BP data available to clinical pharmacists for use in HTN management. Secondarily, this study seeks to understand barriers to adoption of this intervention, as well as points of improvement among key stakeholders, so that larger scale dissemination of the intervention may be achieved and more rigorous research can be conducted. Methods: This study is recruiting up to 25 individuals who have poorly controlled HTN from a Family Medicine clinic affiliated with a large Midwestern academic medical center. Patient participants complete a baseline visit, including installation and instructions on how to use BPTrack. Patient participants are then asked to follow the BP monitoring protocol for a period of 12 weeks, and subsequently complete a follow-up visit at the conclusion of the study period. Results: The recruitment period for the pilot study began in November 2016, and data collection is expected to conclude in late-2017. Conclusions: This pilot study seeks to document the feasibility and acceptability of a clinical pharmacist-led mHealth approach to managing HTN within a primary care setting. Through our 12-week pilot study, we expect to lend support for this approach, and lay the foundation for translating this approach into wider-scale implementation. This mHealth intervention seeks to leverage the multidisciplinary care team already in place within primary care, and to improve health outcomes for patients with uncontrolled HTN. Trial Registration: Clinicaltrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 (Archived by WebCite® at http://www.webcitation.org/6u3wTGbe6) UR - http://www.researchprotocols.org/2017/10/e193/ UR - http://dx.doi.org/10.2196/resprot.8059 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017994 ID - info:doi/10.2196/resprot.8059 ER - TY - JOUR AU - Thies, Kathleen AU - Anderson, Daren AU - Cramer, Benjamin PY - 2017/10/03 TI - Lack of Adoption of a Mobile App to Support Patient Self-Management of Diabetes and Hypertension in a Federally Qualified Health Center: Interview Analysis of Staff and Patients in a Failed Randomized Trial JO - JMIR Hum Factors SP - e24 VL - 4 IS - 4 KW - telehealth KW - mobile health KW - mHealth KW - underserved patients KW - HIT KW - usability N2 - Background: Thousands of mobile health (mHealth) apps have been developed to support patients? management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers? adoption of these technologies. Objective: The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) with uncontrolled diabetes and/or hypertension. Patients entered clinical data into the app, which also supported messaging between patients and providers. After a 4-month period of vigorous recruitment, the trial was suspended due to low enrollment and inconsistent use of the app by enrolled patients. The project aim was changed to understanding why the trial was unsuccessful. Methods: We used the user-task-context (eUTC) usability framework to develop a set of interview questions for patients and staff who were involved in the trial. All interviews were done by phone and lasted 20 to 30 minutes. Interviews were not recorded. Results: There was a poor fit between the app, end users, and recruitment and treatment approaches in our setting. Usability testing might have revealed this prior to launch but was not an option. There was not sufficient time during routine care for clinical staff to familiarize patients with the app or to check clinical data and messages, which are unreimbursed activities. Some patients did not use the app appropriately. The lack of integration with the electronic health record (EHR) was cited as a problem for both patients and staff who also said the app was just one more thing to attend to. Conclusions: This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users? electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies. UR - https://humanfactors.jmir.org/2017/4/e24/ UR - http://dx.doi.org/10.2196/humanfactors.7709 UR - http://www.ncbi.nlm.nih.gov/pubmed/28974481 ID - info:doi/10.2196/humanfactors.7709 ER - TY - JOUR AU - Johnson, M. Heather AU - LaMantia, N. Jamie AU - Brown, M. Colleen AU - Warner, C. Ryan AU - Zeller, M. Laura AU - Haggart, C. Ryan AU - Stonewall, Keven AU - Lauver, R. Diane PY - 2017/09/25 TI - My Hypertension Education and Reaching Target (MyHEART): Development and Dissemination of a Patient-Centered Website for Young Adults with Hypertension JO - JMIR Cardio SP - e5 VL - 1 IS - 2 KW - hypertension KW - young adults KW - World Wide Web KW - quality improvement KW - patient engagement N2 - Background: 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. Objective: 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. Methods: 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). Results: 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. Conclusions: 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. UR - http://cardio.jmir.org/2017/2/e5/ UR - http://dx.doi.org/10.2196/cardio.8025 UR - http://www.ncbi.nlm.nih.gov/pubmed/29664482 ID - info:doi/10.2196/cardio.8025 ER - TY - JOUR AU - Peters, Mattson Robert AU - Shivakumar, Nishkala AU - Xu, Ran AU - Javaherian, Kavon AU - Sink, Eric AU - Patel, Kunjan AU - Brown, Angela AU - Huynh, Justin AU - Blanchard, Melvin AU - Ross, Will AU - Byrd, Jonathan PY - 2017/07/27 TI - Assessing the Utility of a Novel SMS- and Phone-Based System for Blood Pressure Control in Hypertensive Patients: Feasibility Study JO - JMIR Cardio SP - e2 VL - 1 IS - 2 KW - telemedicine KW - hypertension KW - quality improvement KW - text messaging KW - primary care KW - eHealth KW - mHealth KW - disease management N2 - Background: Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. Objective: The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix?s EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. Methods: We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. Results: After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI ?14.5 to ?7.2, P<.001) and DBP by 6.6 mm Hg (95% CI ?9.9 to ?3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. Conclusions: EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care. UR - http://cardio.jmir.org/2017/2/e2/ UR - http://dx.doi.org/10.2196/cardio.7915 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758763 ID - info:doi/10.2196/cardio.7915 ER -