The Use of Wireless, Smartphone App-Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: Pilot Randomized Controlled Trial

Personalized Antihypertensive Treatment Optimization With Smartphone-Enabled Remote Precision Dosing of Amlodipine During the COVID-19 Pandemic (PERSONAL-CovidBP Trial)

BACKGROUND

The objective of the PERSONAL-CovidBP (Personalised Electronic Record Supported Optimisation When Alone for Patients With Hypertension: Pilot Study for Remote Medical Management of Hypertension During the COVID-19 Pandemic) trial was to assess the efficacy and safety of smartphone-enabled remote precision dosing of amlodipine to control blood pressure (BP) in participants with primary hypertension during the COVID-19 pandemic.

METHODS AND RESULTS

This was an open-label, remote, dose titration trial using daily home self-monitoring of BP, drug dose, and side effects with linked smartphone app and telemonitoring. Participants aged ≥18 years with uncontrolled hypertension (5-7 day baseline mean ≥135 mm Hg systolic BP or ≥85 mm Hg diastolic BP) received personalized amlodipine dose titration using novel (1, 2, 3, 4, 6, 7, 8, 9 mg) and standard (5 and 10 mg) doses daily over 14 weeks. The primary outcome of the trial was mean change in systolic BP from baseline to end of treatment. A total of 205 participants were enrolled and mean BP fell from 142/87 (systolic BP/diastolic BP) to 131/81 mm Hg (a reduction of 11 (95% CI, 10-12)/7 (95% CI, 6-7) mm Hg, P<0.001). The majority of participants achieved BP control on novel doses (84%); of those participants, 35% were controlled by 1 mg daily. The majority (88%) controlled on novel doses had no peripheral edema. Adherence to BP recording and reported adherence to medication was 84% and 94%, respectively. Patient retention was 96% (196/205). Treatment was well tolerated with no withdrawals from adverse events.

CONCLUSIONS

Personalized dose titration with amlodipine was safe, well tolerated, and efficacious in treating primary hypertension. The majority of participants achieved BP control on novel doses, and with personalization of dose there were no trial discontinuations due to drug intolerance. App-assisted remote clinician dose titration may better balance BP control and adverse effects and help optimize long-term care.

REGISTRATION

URL: clinicaltrials.gov. Identifier: NCT04559074.

Web-based interventions to improve blood pressure control in patients with hypertension: a protocol for a systematic review

INTRODUCTION

Hypertension is the major cause of cardiovascular disease and mortality in the world. Blood pressure control (BPC) is recognised as a key measure in the management of hypertension. Several studies have been conducted assessing the impact of specific web-based interventions in improving BPC. Our systematic review intends to identify all the available web-based interventions and determine if and which are more effective than usual care in improving BPC.

METHODS AND ANALYSIS

We will include randomised control trials completed until April 2023 including patients diagnosed with hypertension comparing the effect of receiving usual care versus web-based interventions in BPC. No language restriction will be applied. We will start with an extensive electronic database search, in the Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, EU Clinical Trials Register, Pan-African Clinical Trials Registry and ClinicalTrials.gov. Eligibility criteria will be applied blindly and independently by two researchers to the title and abstract of the references, in the first stage, and to the full version of the ones selected. All divergences will be solved by a third researcher. We will conduct a narrative description and meta-analysis (if adequate) of the results of the included studies, structured according to the type of intervention, characteristics of the population and outcome measurement. We will extract features of the web-based interventions, selecting the ones with the best outcomes regarding BPC, to later propose an ideal web-based intervention to improve BPC in hypertensive patients and/or guide future research on this topic. The risk of bias will be assessed using Cochrane's RoB2 Tool.

ETHICS AND DISSEMINATION

Ethical approval is not required since this is a protocol for a systematic review. The findings of this study will be disseminated through peer-reviewed publications and national or international conference presentations. Updates of the review will be conducted, as necessary.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020184166.

Feedback based on health advice via tracing bracelet and smartphone in the management of blood pressure among hypertensive patients: A community-based RCT trial in Chongqing, China

BACKGROUND

Lifestyle interventions have been recognized as a line of treatment for noncommunicable diseases. This study aimed to evaluate a bespoke mHealth approach to deliver personalized feedback to improve blood pressure and weight for hypertensive patients in community settings.

METHODS

A total of 307 participants, 50 from each community, were expected to be in the intervention or control group. A professional health facilitator was assigned for each of the 6 communities. The primary outcomes of the study are the reduction in blood pressure and weight at baseline and postintervention.

RESULTS

Of 307 recruited, 192 participants (62.5%) completed the study (intervention: 104 and control: 88). There was no difference in attrition rates between the 2 groups (33.5% vs 41.9%, P = .291). After 6 month of intensive feedback intervention through the mHealth approach, patients had better blood pressure (133.4 ± 15.3 vs 139.7 ± 16.0) compared with control.

CONCLUSIONS

People who were adherent to the intervention demonstrated a clinical benefit in weight and blood pressure.

Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey

Background

High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison.

Objective

The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc).

Methods

Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses.

Results

As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R²=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R²=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians.

Conclusions

In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis

Background

Hypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications.

Objective

This study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension.

Methods

A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes.

Results

The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services.

Conclusions

The mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions.

Determining the Intellectual Structure and Academic Trends of Smart Home Health Care Research: Coword and Topic Analyses

Background

With the rapid development of information and communication technologies, smart homes are being investigated as effective solutions for home health care. The increasing academic attention on smart home health care has primarily been on the development and application of smart home technologies. However, comprehensive studies examining the general landscape of diverse research areas for smart home health care are still lacking.

Objective

This study aims to determine the intellectual structure of smart home health care in a time series by conducting a coword analysis and topic analysis. Specifically, it investigates (1) the intellectual basis of smart home health care through overall academic status, (2) the intellectual foci through influential keywords and their evolutions, and (3) intellectual trends through primary topics and their evolutions.

Methods

Analyses were conducted in 5 steps: (1) data retrieval from article databases (Web of Science, Scopus, and PubMed) and the initial dataset preparation of 6080 abstracts from the year 2000 to the first half of 2019; (2) data preprocessing and refinement extraction of 25,563 words; (3) a descriptive analysis of the overall academic status and period division (ie, 4 stages of 3-year blocks); (4) coword analysis based on word co-occurrence networks for the intellectual foci; and (5) topic analysis for the intellectual trends based on latent Dirichlet allocation (LDA) topic modeling, word-topic networks, and researcher workshops.

Results

First, regarding the intellectual basis of smart home health care, recent academic interest and predominant journals and research domains were verified. Second, to determine the intellectual foci, primary keywords were identified and classified according to the degree of their centrality values. Third, 5 themes pertaining to the topic evolution emerged: (1) the diversification of smart home health care research topics; (2) the shift from technology-oriented research to technological convergence research; (3) the expansion of application areas and system functionality of smart home health care; (4) the increased focus on system usability, such as service design and experiences; and (5) the recent adaptation of the latest technologies in health care. Based on these findings, the pattern of technology diffusion in smart home health care research was determined as the adaptation of technologies, the proliferation of application areas, and an extension into system design and service experiences.

Conclusions

The research findings provide academic and practical value in 3 aspects. First, they promote a comprehensive understanding of the smart home health care domain by identifying its multifaceted intellectual structure in a time series. Second, they can help clinicians discern the development and dispersion level of their respective disciplines. Third, the pattern of technology diffusion in smart home health care could help scholars comprehend current and future research trends and identify research opportunities based on upcoming research waves of newly adapted technologies in smart home health care.

A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial

Background

A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children.

Objective

This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses.

Methods

The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed.

Results

Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing.

Conclusions

NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world.

Trial Registration

ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382

International Registered Report Identifier (IRRID)

DERR1-10.2196/17561