TY - JOUR AU - Xu, Hongxuan AU - Long, Huanyu PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/21759 UR - http://www.ncbi.nlm.nih.gov/pubmed/33074161 DO - 10.2196/21759 ID - info:doi/10.2196/21759 ER - TY - JOUR AU - Cho, So Mi Jemma AU - Lee, Jung Hyun AU - Shim, Jee-Seon AU - Yeom, Hyungseon AU - Lee, Su Jin AU - Jeon, Yong Woo AU - Kim, Hyeon Chang PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/17435 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034564 DO - 10.2196/17435 ID - info:doi/10.2196/17435 ER - TY - JOUR AU - Gordon, Kayleigh AU - Dainty, Katie N AU - Steele Gray, Carolyn AU - DeLacy, Jane AU - Shah, Amika AU - Resnick, Myles AU - Seto, Emily PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/22118 DO - 10.2196/22118 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 DA - 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 AB - 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 - https://doi.org/10.2196/17135 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965230 DO - 10.2196/17135 ID - info:doi/10.2196/17135 ER - TY - JOUR AU - Chaniaud, Noémie AU - Métayer, Natacha AU - Megalakaki, Olga AU - Loup-Escande, Emilie PY - 2020 DA - 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 AB - 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 (χ²2,146=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 - https://doi.org/10.2196/17983 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955454 DO - 10.2196/17983 ID - info:doi/10.2196/17983 ER - TY - JOUR AU - McCarthy, Stephen AU - O'Raghallaigh, Paidi AU - Woodworth, Simon AU - Lim, Yoke Yin AU - Kenny, Louise C AU - Adam, Frédéric PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/17416 UR - http://www.ncbi.nlm.nih.gov/pubmed/32940610 DO - 10.2196/17416 ID - info:doi/10.2196/17416 ER - TY - JOUR AU - Vasti, Elena AU - Pletcher, Mark J PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/13637 UR - http://www.ncbi.nlm.nih.gov/pubmed/32840489 DO - 10.2196/13637 ID - info:doi/10.2196/13637 ER - TY - JOUR AU - Buis, Lorraine R AU - Roberson, Dana N AU - Kadri, Reema AU - Rockey, Nicole G AU - Plegue, Melissa A AU - Danak, Shivang U AU - Guetterman, Timothy C AU - Johnson, Melanie G AU - Choe, Hae Mi AU - Richardson, Caroline R PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/19882 UR - http://www.ncbi.nlm.nih.gov/pubmed/32780026 DO - 10.2196/19882 ID - info:doi/10.2196/19882 ER - TY - JOUR AU - Dorsch, Michael P AU - Cornellier, Maria L AU - Poggi, Armella D AU - Bilgen, Feriha AU - Chen, Peiyu AU - Wu, Cindy AU - An, Lawrence C AU - Hummel, Scott L PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/16696 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663139 DO - 10.2196/16696 ID - info:doi/10.2196/16696 ER - TY - JOUR AU - Jongsma, Karin Rolanda AU - van den Heuvel, Josephus F M AU - Rake, Jasmijn AU - Bredenoord, Annelien L AU - Bekker, Mireille N PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/17271 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749225 DO - 10.2196/17271 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 DA - 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 AB - 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 - https://doi.org/10.2196/17721 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749224 DO - 10.2196/17721 ID - info:doi/10.2196/17721 ER - TY - JOUR AU - Kan, Wei-Chih AU - Kuo, Shu-Chun AU - Chien, Tsair-Wei AU - Lin, Jui-Chung John AU - Yeh, Yu-Tsen AU - Chou, Willy AU - Chou, Po-Hsin PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/11627 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716306 DO - 10.2196/11627 ID - info:doi/10.2196/11627 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Marta Elena AU - Martínez-Jiménez, Eva María AU - Calvo-Lobo, César AU - Romero-Morales, Carlos AU - López-López, Daniel AU - Palomo-López, Patricia PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/19781 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706672 DO - 10.2196/19781 ID - info:doi/10.2196/19781 ER - TY - JOUR AU - Mena, Luis J AU - Félix, Vanessa G AU - Ostos, Rodolfo AU - González, Armando J AU - Martínez-Peláez, Rafael AU - Melgarejo, Jesus D AU - Maestre, Gladys E PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/18012 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459642 DO - 10.2196/18012 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 DA - 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 AB - 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 - https://doi.org/10.2196/16695 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628615 DO - 10.2196/16695 ID - info:doi/10.2196/16695 ER - TY - JOUR AU - Radha, Mustafa AU - den Boer, Niels AU - Willemsen, Martijn C AU - Paardekooper, Thom AU - IJsselsteijn, Wijnand A AU - Sartor, Francesco PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/16354 UR - http://www.ncbi.nlm.nih.gov/pubmed/32597789 DO - 10.2196/16354 ID - info:doi/10.2196/16354 ER - TY - JOUR AU - Hasan, S M Tafsir AU - Ahmed, Syed Imran AU - Khan, Md Alfazal AU - Sarker, Shafiqul Alam AU - Ahmed, Tahmeed PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/16676 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459639 DO - 10.2196/16676 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 DA - 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 AB - 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 - https://doi.org/10.2196/17349 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469318 DO - 10.2196/17349 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 DA - 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 AB - 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 - https://doi.org/10.2196/16019 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432556 DO - 10.2196/16019 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, A Toby AU - Griffin, Simon AU - Sutton, Stephen PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/16629 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427113 DO - 10.2196/16629 ID - info:doi/10.2196/16629 ER - TY - JOUR AU - Park, Yong-Seok AU - Kim, Sung-Hoon AU - Lee, Yoon Se AU - Choi, Seung-Ho AU - Ku, Seung-Woo AU - Hwang, Gyu-Sam PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/13156 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412413 DO - 10.2196/13156 ID - info:doi/10.2196/13156 ER - TY - JOUR AU - Weerahandi, Himali AU - Paul, Soaptarshi AU - Quintiliani, Lisa M AU - Chokshi, Sara AU - Mann, Devin M PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/13989 UR - http://www.ncbi.nlm.nih.gov/pubmed/32379049 DO - 10.2196/13989 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 DA - 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 AB - 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 - https://doi.org/10.2196/13536 UR - http://www.ncbi.nlm.nih.gov/pubmed/32329737 DO - 10.2196/13536 ID - info:doi/10.2196/13536 ER - TY - JOUR AU - Bernabe-Ortiz, Antonio AU - Pauschardt, Julia AU - Diez-Canseco, Francisco AU - Miranda, J Jaime PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/14595 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314970 DO - 10.2196/14595 ID - info:doi/10.2196/14595 ER - TY - JOUR AU - Ramirez, Magaly AU - Chen, Kimberly AU - Follett, Robert W AU - Mangione, Carol M AU - Moreno, Gerardo AU - Bell, Douglas S PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/16421 UR - http://www.ncbi.nlm.nih.gov/pubmed/32301741 DO - 10.2196/16421 ID - info:doi/10.2196/16421 ER - TY - JOUR AU - Lisón, Juan Francisco AU - Palomar, Gonzalo AU - Mensorio, Marinna S AU - Baños, Rosa M AU - Cebolla-Martí, Ausiàs AU - Botella, Cristina AU - Benavent-Caballer, Vicent AU - Rodilla, Enrique PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/14196 UR - http://www.ncbi.nlm.nih.gov/pubmed/32286232 DO - 10.2196/14196 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, Sławomir PY - 2020 DA - 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. AB - 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 - https://doi.org/10.2196/17201 UR - http://www.ncbi.nlm.nih.gov/pubmed/32271148 DO - 10.2196/17201 ID - info:doi/10.2196/17201 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Marta Elena AU - López-López, Daniel AU - Calvo-Lobo, César AU - Rodríguez-Sanz, David AU - Martínez-Jiménez, Eva María AU - Palomo-López, Patricia PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/14702 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238337 DO - 10.2196/14702 ID - info:doi/10.2196/14702 ER - TY - JOUR AU - Li, Ran AU - Liang, Ning AU - Bu, Fanlong AU - Hesketh, Therese PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/17776 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217503 DO - 10.2196/17776 ID - info:doi/10.2196/17776 ER - TY - JOUR AU - Timpel, Patrick AU - Oswald, Sarah AU - Schwarz, Peter E H AU - Harst, Lorenz PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/16791 UR - http://www.ncbi.nlm.nih.gov/pubmed/32186516 DO - 10.2196/16791 ID - info:doi/10.2196/16791 ER - TY - JOUR AU - Ni, Zhao AU - Atluri, Namratha AU - Shaw, Ryan J 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, Lijing L PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/15419 UR - http://www.ncbi.nlm.nih.gov/pubmed/32149712 DO - 10.2196/15419 ID - info:doi/10.2196/15419 ER - TY - JOUR AU - McDonough, Caitrin W AU - Smith, Steven M AU - Cooper-DeHoff, Rhonda M AU - Hogan, William R PY - 2020 DA - 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 AB - 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 - https://doi.org/10.2196/14777 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130152 DO - 10.2196/14777 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 DA - 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 AB - 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 - https://doi.org/10.2196/14466 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130161 DO - 10.2196/14466 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, Marion A AU - Tobe, Sheldon W PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12639 UR - http://www.ncbi.nlm.nih.gov/pubmed/31815678 DO - 10.2196/12639 ID - info:doi/10.2196/12639 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Marta Elena AU - López-López, Daniel AU - Rodríguez-Sanz, David AU - Casado-Hernández, Israel AU - Calvo-Lobo, Cesar AU - Palomo-López, Patricia PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/14686 UR - http://www.ncbi.nlm.nih.gov/pubmed/31789600 DO - 10.2196/14686 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 DA - 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 AB - 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 - https://doi.org/10.2196/14926 UR - http://www.ncbi.nlm.nih.gov/pubmed/31670694 DO - 10.2196/14926 ID - info:doi/10.2196/14926 ER - TY - JOUR AU - Islam, Sheikh Mohammed Shariful AU - Cartledge, Susie AU - Karmakar, Chandan AU - Rawstorn, Jonathan Charles AU - Fraser, Steve F AU - Chow, Clara AU - Maddison, Ralph PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/14706 UR - http://www.ncbi.nlm.nih.gov/pubmed/31628788 DO - 10.2196/14706 ID - info:doi/10.2196/14706 ER - TY - JOUR AU - Nordyke, Robert J AU - Appelbaum, Kevin AU - Berman, Mark A PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/15814 UR - http://www.ncbi.nlm.nih.gov/pubmed/31599740 DO - 10.2196/15814 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 DA - 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 AB - 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 - https://doi.org/10.2196/13351 UR - http://www.ncbi.nlm.nih.gov/pubmed/31228175 DO - 10.2196/13351 ID - info:doi/10.2196/13351 ER - TY - JOUR AU - Ogink, Paula AM AU - de Jong, Jelske M AU - Koeneman, Mats AU - Weenk, Mariska AU - Engelen, Lucien JLPG AU - van Goor, Harry AU - van de Belt, Tom H AU - Bredie, Sebastian JH PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11164 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219050 DO - 10.2196/11164 ID - info:doi/10.2196/11164 ER - TY - JOUR AU - Brandt, Lena R AU - Hidalgo, Liliana AU - Diez-Canseco, Francisco AU - Araya, Ricardo AU - Mohr, David C AU - Menezes, Paulo R AU - Miranda, J Jaime PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11701 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215511 DO - 10.2196/11701 ID - info:doi/10.2196/11701 ER - TY - JOUR AU - Hui, Chi Yan AU - Creamer, Emily AU - Pinnock, Hilary AU - McKinstry, Brian PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/13257 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162124 DO - 10.2196/13257 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 DA - 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 AB - 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 - https://doi.org/10.2196/13571 UR - http://www.ncbi.nlm.nih.gov/pubmed/31152529 DO - 10.2196/13571 ID - info:doi/10.2196/13571 ER - TY - JOUR AU - Moon, Eui Whan AU - Tan, Ngiap Chuan AU - Allen, John Carson AU - Jafar, Tazeen Hasan PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/13153 UR - http://www.ncbi.nlm.nih.gov/pubmed/30905872 DO - 10.2196/13153 ID - info:doi/10.2196/13153 ER - TY - JOUR AU - Alessa, Tourkiah AU - Hawley, Mark S AU - Hock, Emma S AU - de Witte, Luc PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/13645 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140434 DO - 10.2196/13645 ID - info:doi/10.2196/13645 ER - TY - JOUR AU - Rodriguez, Sarah AU - Hwang, Kevin AU - Wang, Jing PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/10388 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124468 DO - 10.2196/10388 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 DA - 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 AB - 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 - https://doi.org/10.2196/13048 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758790 DO - 10.2196/13048 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, Lena R AU - Diez-Canseco, Francisco AU - Miranda, J Jaime AU - Price, LeShawndra N AU - Mohr, David C AU - Araya, Ricardo PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11698 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025949 DO - 10.2196/11698 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 DA - 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 AB - 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 - https://doi.org/10.2196/11959 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012863 DO - 10.2196/11959 ID - info:doi/10.2196/11959 ER - TY - JOUR AU - Wetterholm, Madeleine AU - Bonn, Stephanie Erika AU - Alexandrou, Christina AU - Löf, Marie AU - Trolle Lagerros, Ylva PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12772 UR - http://www.ncbi.nlm.nih.gov/pubmed/30994459 DO - 10.2196/12772 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, Inge M AU - Grieten, Lars AU - Gyselaers, Wilfried PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/10887 UR - http://www.ncbi.nlm.nih.gov/pubmed/30985286 DO - 10.2196/10887 ID - info:doi/10.2196/10887 ER - TY - JOUR AU - Leong, Amanda Y AU - Makowsky, Mark J PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/10809 UR - http://www.ncbi.nlm.nih.gov/pubmed/30977739 DO - 10.2196/10809 ID - info:doi/10.2196/10809 ER - TY - JOUR AU - Lewinski, Allison A AU - Patel, Uptal D AU - Diamantidis, Clarissa J AU - Oakes, Megan AU - Baloch, Khaula AU - Crowley, Matthew J AU - Wilson, Jonathan AU - Pendergast, Jane AU - Biola, Holly AU - Boulware, L Ebony AU - Bosworth, Hayden B PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12541 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964439 DO - 10.2196/12541 ID - info:doi/10.2196/12541 ER - TY - JOUR AU - Schroeder, Emily B AU - Moore, Kelly AU - Manson, Spero M AU - Baldwin, Megan A AU - Goodrich, Glenn K AU - Malone, Allen S AU - Pieper, Lisa E AU - Xu, Stanley AU - Fort, Meredith M AU - Johnson, David AU - Son-Stone, Linda AU - Steiner, John F PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11794 UR - http://www.ncbi.nlm.nih.gov/pubmed/30938688 DO - 10.2196/11794 ID - info:doi/10.2196/11794 ER - TY - JOUR AU - Pattin, Anthony AU - Panak, Rebekah L AU - Hunold, Rebecca AU - Kirwen, Abagail AU - Minnich, Samantha R AU - Chen, Tian PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12527 UR - http://www.ncbi.nlm.nih.gov/pubmed/30932864 DO - 10.2196/12527 ID - info:doi/10.2196/12527 ER - TY - JOUR AU - Shaffer, Victoria Anne AU - Wegier, Pete AU - Valentine, KD AU - Belden, Jeffery L AU - Canfield, Shannon M AU - Patil, Sonal J AU - Popescu, Mihail AU - Steege, Linsey M AU - Jain, Akshay AU - Koopman, Richelle J PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11366 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912759 DO - 10.2196/11366 ID - info:doi/10.2196/11366 ER - TY - JOUR AU - Palacholla, Ramya Sita 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 DA - 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 AB - 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 - https://doi.org/10.2196/11951 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758771 DO - 10.2196/11951 ID - info:doi/10.2196/11951 ER - TY - JOUR AU - Silveira, Daniel Vitório AU - Marcolino, Milena Soriano AU - Machado, Elaine Leandro AU - Ferreira, Camila Gonçalves AU - Alkmim, Maria Beatriz Moreira AU - Resende, Elmiro Santos AU - Carvalho, Bárbara Couto AU - Antunes, André Pires AU - Ribeiro, Antonio Luiz Pinho PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/mhealth.9869 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907740 DO - 10.2196/mhealth.9869 ID - info:doi/10.2196/mhealth.9869 ER - TY - JOUR AU - Daugherty, Stacie L AU - Vupputuri, Suma AU - Hanratty, Rebecca AU - Steiner, John F AU - Maertens, Julie A AU - Blair, Irene V AU - Dickinson, L Miriam AU - Helmkamp, Laura AU - Havranek, Edward P PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12498 UR - http://www.ncbi.nlm.nih.gov/pubmed/30907744 DO - 10.2196/12498 ID - info:doi/10.2196/12498 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Marta Elena AU - López-López, Daniel AU - Palomo-López, Patricia AU - Rodríguez-Sanz, David AU - Calvo-Lobo, César PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/13137 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888331 DO - 10.2196/13137 ID - info:doi/10.2196/13137 ER - TY - JOUR AU - Fitzpatrick, Annette L AU - van Pelt, Maurits AU - Heang, Hen AU - Steinman, Lesley AU - Ide, Nicole AU - Chhea, Chhorvann AU - LoGerfo, James P PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11614 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888330 DO - 10.2196/11614 ID - info:doi/10.2196/11614 ER - TY - JOUR AU - Guthrie, Nicole L AU - Berman, Mark A AU - Edwards, Katherine L AU - Appelbaum, Kevin J AU - Dey, Sourav AU - Carpenter, Jason AU - Eisenberg, David M AU - Katz, David L PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/13030 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758792 DO - 10.2196/13030 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 DA - 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 AB - 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 - https://doi.org/10.2196/12369 UR - http://www.ncbi.nlm.nih.gov/pubmed/30829574 DO - 10.2196/12369 ID - info:doi/10.2196/12369 ER - TY - JOUR AU - McManus, David D AU - Trinquart, Ludovic AU - Benjamin, Emelia J AU - Manders, Emily S AU - Fusco, Kelsey AU - Jung, Lindsey S AU - Spartano, Nicole L AU - Kheterpal, Vik AU - Nowak, Christopher AU - Sardana, Mayank AU - Murabito, Joanne M PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12143 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821691 DO - 10.2196/12143 ID - info:doi/10.2196/12143 ER - TY - JOUR AU - Park, Jaram AU - Kim, Jeong-Whun AU - Ryu, Borim AU - Heo, Eunyoung AU - Jung, Se Young AU - Yoo, Sooyoung PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/11757 UR - http://www.ncbi.nlm.nih.gov/pubmed/30767907 DO - 10.2196/11757 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 DA - 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 AB - 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 - https://doi.org/10.2196/11280 UR - http://www.ncbi.nlm.nih.gov/pubmed/30702439 DO - 10.2196/11280 ID - info:doi/10.2196/11280 ER - TY - JOUR AU - Buis, Lorraine R AU - Dawood, Katee AU - Kadri, Reema AU - Dawood, Rachelle AU - Richardson, Caroline R AU - Djuric, Zora AU - Sen, Ananda AU - Plegue, Melissa AU - Hutton, David AU - Brody, Aaron AU - McNaughton, Candace D AU - Brook, Robert D AU - Levy, Phillip PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12601 UR - http://www.ncbi.nlm.nih.gov/pubmed/30681965 DO - 10.2196/12601 ID - info:doi/10.2196/12601 ER - TY - JOUR AU - Langford, Aisha T AU - Solid, Craig A AU - Scott, Ebony AU - Lad, Meeki AU - Maayan, Eli AU - Williams, Stephen K AU - Seixas, Azizi A PY - 2019 DA - 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 AB - 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 - https://doi.org/10.2196/12228 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344667 DO - 10.2196/12228 ID - info:doi/10.2196/12228 ER - TY - JOUR AU - Sinnenberg, Lauren AU - Mancheno, Christina AU - Barg, Frances K AU - Asch, David A AU - Rivard, Christy Lee AU - Horst-Martz, Emma AU - Buttenheim, Alison AU - Ungar, Lyle AU - Merchant, Raina PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/11177 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578222 DO - 10.2196/11177 ID - info:doi/10.2196/11177 ER - TY - JOUR AU - Warner, Bronwen E AU - Velardo, Carmelo AU - Salvi, Dario AU - Lafferty, Kathryn AU - Crosbie, Sarah AU - Herrington, William G AU - Haynes, Richard PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/11332 UR - http://www.ncbi.nlm.nih.gov/pubmed/30596204 DO - 10.2196/11332 ID - info:doi/10.2196/11332 ER - TY - JOUR AU - Mazoteras-Pardo, Victoria AU - Becerro-De-Bengoa-Vallejo, Ricardo AU - Losa-Iglesias, Marta Elena AU - López-López, Daniel AU - Palomo-López, Patricia AU - Rodríguez-Sanz, David AU - Calvo-Lobo, César PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/11632 UR - http://www.ncbi.nlm.nih.gov/pubmed/30361193 DO - 10.2196/11632 ID - info:doi/10.2196/11632 ER - TY - JOUR AU - Fuchs, Sandra C AU - Harzheim, Erno AU - Iochpe, Cirano AU - David, Caroline N de AU - Gonçalves, Marcelo R AU - Sesin, Guilhermo P AU - Costa, Cassio M AU - Moreira, Leila B AU - Fuchs, Flavio D PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/resprot.9619 UR - http://www.ncbi.nlm.nih.gov/pubmed/30087093 DO - 10.2196/resprot.9619 ID - info:doi/10.2196/resprot.9619 ER - TY - JOUR AU - Albrecht, Lauren AU - Wood, Peter W AU - Fradette, Miriam AU - McAlister, Finlay A AU - Rabi, Doreen AU - Boulanger, Pierre AU - Padwal, Raj PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/10975 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518242 DO - 10.2196/10975 ID - info:doi/10.2196/10975 ER - TY - JOUR AU - Alessa, Tourkiah AU - Abdi, Sarah AU - Hawley, Mark S AU - de Witte, Luc PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/10723 UR - http://www.ncbi.nlm.nih.gov/pubmed/30037787 DO - 10.2196/10723 ID - info:doi/10.2196/10723 ER - TY - JOUR AU - Rivera-Romero, Octavio AU - Olmo, Alberto AU - Muñoz, Rocío AU - Stiefel, Pablo AU - Miranda, María Luisa AU - Beltrán, Luis M PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/mhealth.9671 DO - 10.2196/mhealth.9671 ID - info:doi/10.2196/mhealth.9671 ER - TY - JOUR AU - Sak, Gabriele AU - Schulz, Peter Johannes PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/cardio.8903 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758784 DO - 10.2196/cardio.8903 ID - info:doi/10.2196/cardio.8903 ER - TY - JOUR AU - Tanaka, Rika AU - Nolan, Robert P PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/jmir.8757 UR - http://www.ncbi.nlm.nih.gov/pubmed/29752248 DO - 10.2196/jmir.8757 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, Devore S AU - Alfreds, Shaun T AU - Stearns, Frank AU - Sylvester, Karl G AU - Widen, Eric AU - McElhinney, Doff AU - Ling, Xuefeng PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/jmir.9268 UR - http://www.ncbi.nlm.nih.gov/pubmed/29382633 DO - 10.2196/jmir.9268 ID - info:doi/10.2196/jmir.9268 ER - TY - JOUR AU - Marcolino, Milena Soriano AU - Oliveira, João Antonio Queiroz AU - D'Agostino, Marcelo AU - Ribeiro, Antonio Luiz AU - Alkmim, Maria Beatriz Moreira AU - Novillo-Ortiz, David PY - 2018 DA - 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 AB - 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 - https://doi.org/10.2196/mhealth.8873 UR - http://www.ncbi.nlm.nih.gov/pubmed/29343463 DO - 10.2196/mhealth.8873 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 DA - 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 AB - 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 - https://doi.org/10.2196/mhealth.7886 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212629 DO - 10.2196/mhealth.7886 ID - info:doi/10.2196/mhealth.7886 ER - TY - JOUR AU - Mileski, Michael AU - Kruse, Clemens Scott AU - Catalani, Justin AU - Haderer, Tara PY - 2017 DA - 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 AB - 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 - https://doi.org/10.2196/medinform.6603 UR - http://www.ncbi.nlm.nih.gov/pubmed/29066424 DO - 10.2196/medinform.6603 ID - info:doi/10.2196/medinform.6603 ER - TY - JOUR AU - Usher-Smith, Juliet A AU - Winther, Laura R AU - Shefer, Guy S AU - Silarova, Barbora AU - Payne, Rupert A AU - Griffin, Simon J PY - 2017 DA - 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 AB - 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 - https://doi.org/10.2196/jmir.7697 UR - http://www.ncbi.nlm.nih.gov/pubmed/29038095 DO - 10.2196/jmir.7697 ID - info:doi/10.2196/jmir.7697 ER - TY - JOUR AU - Buis, Lorraine R AU - Roberson, Dana N AU - Kadri, Reema AU - Rockey, Nicole G AU - Plegue, Melissa A AU - Choe, Hae Mi AU - Richardson, Caroline R PY - 2017 DA - 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 AB - 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 - https://doi.org/10.2196/resprot.8059 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017994 DO - 10.2196/resprot.8059 ID - info:doi/10.2196/resprot.8059 ER - TY - JOUR AU - Thies, Kathleen AU - Anderson, Daren AU - Cramer, Benjamin PY - 2017 DA - 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 AB - 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 - https://doi.org/10.2196/humanfactors.7709 UR - http://www.ncbi.nlm.nih.gov/pubmed/28974481 DO - 10.2196/humanfactors.7709 ID - info:doi/10.2196/humanfactors.7709 ER - TY - JOUR AU - Johnson, Heather M AU - LaMantia, Jamie N AU - Brown, Colleen M AU - Warner, Ryan C AU - Zeller, Laura M AU - Haggart, Ryan C AU - Stonewall, Keven AU - Lauver, Diane R PY - 2017 DA - 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 AB - 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 - https://doi.org/10.2196/cardio.8025 UR - http://www.ncbi.nlm.nih.gov/pubmed/29664482 DO - 10.2196/cardio.8025 ID - info:doi/10.2196/cardio.8025 ER - TY - JOUR AU - Peters, Robert Mattson 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 DA - 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 AB - 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 - https://doi.org/10.2196/cardio.7915 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758763 DO - 10.2196/cardio.7915 ID - info:doi/10.2196/cardio.7915 ER -