The Chinese University of Hong Kong, 6/F, Esther Lee Building, The Nethersole School of Nursing, Shatin, N.T., Hong Kong Special Administrative Region.
The Chinese University of Hong Kong, 8/F, Esther Lee Building, The Nethersole School of Nursing, Shatin, N.T., Hong Kong Special Administrative Region.
Int J Nurs Stud. 2019 Apr;92:27-46. doi: 10.1016/j.ijnurstu.2018.11.007. Epub 2018 Dec 31.
Hypertension is a global health issue. Electronic health (eHealth) is a potential alternative for managing hypertension and modifying hypertension-related self-care set of behaviour. This review aims to identify the delivery mode and strategies used by current eHealth interventions and examine the effectiveness of eHealth on blood pressure control, self-care behavioural outcomes and psychosocial well-being.
Systematic review and meta-analysis.
Ten English databases (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Joanna Briggs Institute EBP Database, MEDLINE, CINAHL Plus, PsycINFO, SCOPUS, Web of Science and INSPEC) and two Chinese databases (China Journal Net and WanFang Data) were searched from January 2000 to November 2017.
This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Two reviewers independently selected potential articles and extracted the details of each eligible article. The Randomized Controlled Trial Checklist of Joanna Briggs Institute was used to assess the methodological quality of the included articles. Meta-analysis was conducted using Review Manager 5.3 for at least two studies reporting the same outcome. Otherwise, narrative synthesis was performed.
Fifteen articles from fourteen studies satisfied the inclusion criteria. The pooled result of 13 studies reported that eHealth intervention significantly affected the reduction of systolic blood pressure (mean difference [MD]: -5.96 mmHg, 95% confidence interval [CI]: -9.21 to -2.70, p < .001) and diastolic blood pressure (MD: -3.35 mmHg, 95% CI: -6.36 to -0.35, p < .05). eHealth interventions significantly decreased the proportion of patients with inadequate blood pressure control (risk ratio: 0.69, 95% CI: 0.57-0.84, p < .001) and their body weight (MD: -1.08 kg, 95% CI: -2.04 to -0.13, p < .05). Regarding self-care behavioural outcomes, the pooled results show that eHealth interventions significantly reduced the sodium intake.
This study reported that eHealth interventions positively affect blood pressure control and thus could be a promising alternative in the management of hypertension. However, their effectiveness on self-care behavioural change and psychosocial well-being is insufficient. Therefore, additional eHealth interventions with rigorous experimental design on hypertension self-care are needed to provide a robust evidence for a wide population and to address the increasing health care needs of patients with hypertension.
高血压是一个全球性的健康问题。电子健康（eHealth）是管理高血压和改变与高血压相关的自我保健行为的一种潜在选择。本综述旨在确定当前电子健康干预措施的传递模式和策略，并研究电子健康对血压控制、自我保健行为结果和心理健康的影响。
系统评价和荟萃分析。
2000 年 1 月至 2017 年 11 月，检索了 10 个英文数据库（Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、Embase、乔安娜·布里格斯研究所循证实践数据库、MEDLINE、CINAHL Plus、PsycINFO、SCOPUS、Web of Science 和 INSPEC）和 2 个中文数据库（中国知网和万方数据）。
本综述是根据系统评价和荟萃分析报告的首选报告项目进行的。两名评审员独立选择潜在的文章，并提取每篇合格文章的详细信息。使用乔安娜·布里格斯研究所的随机对照试验清单评估纳入文章的方法学质量。至少有两项研究报告了相同的结果时，使用 Review Manager 5.3 进行荟萃分析。否则，进行叙述性综合。
14 项研究中有 15 项符合纳入标准。13 项研究的汇总结果表明，电子健康干预显著影响收缩压（平均差值 [MD]：-5.96mmHg，95%置信区间 [CI]：-9.21 至 -2.70，p<0.001）和舒张压（MD：-3.35mmHg，95% CI：-6.36 至 -0.35，p<0.05）的降低。电子健康干预显著降低了血压控制不足的患者比例（风险比：0.69，95% CI：0.57-0.84，p<0.001）和体重（MD：-1.08kg，95% CI：-2.04 至 -0.13，p<0.05）。关于自我保健行为结果，汇总结果表明，电子健康干预显著减少了钠的摄入。
本研究报告称，电子健康干预措施对血压控制有积极影响，因此可能是高血压管理的一种有前途的替代方法。然而，它们对自我保健行为改变和心理健康的影响还不够。因此，需要进行更多的、设计严谨的高血压自我保健电子健康干预研究，为更广泛的人群提供有力的证据，并满足高血压患者日益增长的医疗保健需求。
