Vasti Elena, Pletcher Mark J
University of California, San Francisco School of Medicine, Stanford, CA, United States.
Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco, CA, United States.
JMIR Form Res. 2020 Aug 25;4(8):e13637. doi: 10.2196/13637.
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.
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.
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.
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.
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.
高血压在美国是一个重大问题，影响着三分之一的18岁以上成年人，并且与心血管疾病和中风的较高风险相关。在医疗服务不足地区（MUA），高血压的患病率有所上升。移动健康技术，如数字自我监测设备，已被证明可改善慢性健康状况的管理。然而，由于资源有限和健康素养较低，MUA地区的患者使用这些设备的机会减少。健康教练和同伴培训项目对于MUA地区管理高血压的医生短缺来说是一种潜在的具有成本效益的解决方案。让年轻人成为学生健康教练（SHC）是改善社区健康的一项有前景的策略。
本试点研究旨在评估（1）在MUA地区培训高中生成为健康技术教练的可行性，以及（2）在数字家庭监测中加入SHC是否能提高自我监测频率和总体血压（BP）控制。
总共15名高中生完成了为期3天的健康教练培训。有高血压确诊记录的患者被随机分配到3个干预组中的1组。仅使用QardioArm袖带（Q）组仅为方便起见提供了一个QardioArm袖带。仅SHC（S）组被指示每周与一名健康教练会面30分钟，持续5周，以制定降低血压的行动计划。学生+QardioArm（S+Q）组接受了两种干预。
参与者（n = 27）以9:9:9的比例随机分配到3组。所有15名学生完成了培训，其中40%（6/15）的学生与指定患者完成了全部5次会面。可行性的障碍包括交通问题以及研究结束时患者反应的减少。总体而言，92%（11/12）的学生将他们的经历评为非常好或更高，69%（9/13）的学生报告说这段经历使他们更有可能进入医疗领域。袖带使用频率存在统计学显著差异（S+Q组与Q组：37次对17次；P <.001）。与其他组相比，S+Q组的参与者在干预后报告血压控制更好。干预结束时，Q组、S组和S+Q组的平均血压分别为145/84（标准差9/18）mmHg、150/85（标准差18/12）mmHg和128/69（标准差20/14）mmHg。
本试点研究证明了将技术与年轻学生教练相结合的可行性，尽管存在挑战。S+Q组使用袖带的次数多于Q组。患者在S+Q组中参与度更高，对他们的SHC满意度更高，血压控制更好。
