College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China.
General Hospital of Ningxia Medical University, Yinchuan, China.
JMIR Mhealth Uhealth. 2020 Feb 25;8(2):e14466. doi: 10.2196/14466.
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.
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.
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.
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.
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.
高血压是一种威胁患者生命的生活方式引起的慢性病。控制高血压需要患者遵循自我管理方案；然而，不幸的是，患者对高血压自我管理的依从性很低，尤其是在发展中国家。提高患者的依从性是基于满足患者的需求。移动健康应用程序越来越受欢迎，可用于慢性病的自我管理。然而，很少有移动应用程序旨在满足患者对高血压自我管理的需求。
本研究旨在开发一款移动健康应用程序，以提高患者对高血压自我管理的依从性，并评估该应用程序在患者依从性方面的有效性。
目标导向设计方法被应用于指导研究设计。我们将研究分为 4 个阶段。第 1 至 3 阶段包括开发过程。为了提高目标导向设计方法在慢性病管理中的适用性，我们提取了与患者依从性相关的用户模型元素，并定义了一个具体的用户模型过程。在第 1 阶段，使用定性和定量方法构建了高血压患者的人物角色。基于问卷回答的聚类方法被用于对患者进行分组。进行定性访谈以确定不同组的需求。在第 2 阶段，根据第 1 阶段的结果，设计了几个功能模块以满足不同组的需求。在第 3 阶段，设计并实现了功能模块的原型作为一个真实的应用程序。第 4 阶段是部署过程，我们进行了一项试点研究，以调查患者使用该应用程序后的依从性。通过测量血压的频率来计算患者的依从性。此外，还进行了定性访谈，以了解依从性结果的潜在原因。
在第 1 阶段，根据 82 份有效问卷回答，将患者分为 3 组。对来自不同组的 18 名患者（7、5 和 6 名患者）进行了访谈，总结了各组的需求如下：提高自我管理能力、增强自我管理动机和获得自我管理支持。在第 2 阶段和第 3 阶段，根据特定需求设计并实现了 6 个功能模块，并通过可用性测试提高了应用程序的可用性。在第 4 阶段，招募了 143 名患者使用不同版本的应用程序进行了 2 个月的使用。结果表明，随着功能模块的添加，患者的依从性得到了提高（P<.001），并且保持在较高水平（比率为 0.73）。对 32 名患者的访谈结果表明，应用程序的设计满足了不同的需求；因此，患者对其的依从性更高。
本研究使用目标导向设计方法开发了一款用于高血压自我管理的移动健康应用程序。该应用程序被证明对提高患者对高血压自我管理的依从性是有效的。
