Brewer LaPrincess C, Jones Clarence, Slusser Joshua P, Pasha Maarya, Lalika Mathias, Chacon Megan, Takawira Patricia, Shanedling Stanton, Erickson Paul, Woods Cynthia, Krogman Ashton, Ferdinand Daphne, Underwood Paul, Cooper Lisa A, Patten Christi A, Hayes Sharonne N
Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States.
Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States.
JMIR Form Res. 2023 Jun 16;7:e45061. doi: 10.2196/45061.
African American individuals are at a higher risk of premature death from cardiovascular diseases than White American individuals, with disproportionate attributable risk from uncontrolled hypertension. Given their high use among African American individuals, mobile technologies, including smartphones, show promise in increasing reliable health information access. Culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population.
This formative study aimed to assess the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among African American patients.
A mixed methods study of African American patients with uncontrolled hypertension was conducted over 2 consecutive phases. In phase 1, patients and clinicians from 2 federally qualified health centers (FQHCs) in the Minneapolis-St Paul, Minnesota area, provided input through focus groups to refine an existing culturally tailored mHealth app (Fostering African-American Improvement in Total Health! [FAITH!] App) for promoting hypertension self-management among African American patients with uncontrolled hypertension (renamed as FAITH! Hypertension App). Phase 2 was a single-arm pre-post intervention pilot study assessing feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention using the FAITH! Hypertension App synchronized with a wireless BP monitor and community health worker (CHW) support to address social determinants of health-related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication and BP self-monitoring, and social networking. Primary outcomes were feasibility (app engagement and satisfaction) and preliminary efficacy (change in BP) at an immediate postintervention assessment.
In phase 1, thirteen African American patients (n=9, 69% aged ≥50 years and n=10, 77% women) and 16 clinicians (n=11, 69% aged ≥50 years; n=14, 88% women; and n=10, 63% African American) participated in focus groups. Their feedback informed app modifications, including the addition of BP and medication tracking, BP self-care task reminders, and culturally sensitive contexts. In phase 2, sixteen African American patients were enrolled (mean age 52.6, SD 12.3 years; 12/16, 75% women). Overall, 38% (6/16) completed ≥50% of the 10 education modules, and 44% (7/16) completed the postintervention assessment. These patients rated the intervention a 9 (out of 10) on its helpfulness in hypertension self-management. Qualitative data revealed that they viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. The mean systolic and diastolic BPs of the 7 patients decreased by 6.5 mm Hg (P=.15) and 2.8 mm Hg (P=.78), respectively, at the immediate postintervention assessment.
A culturally tailored mHealth app reinforced by CHW support may improve hypertension self-management among underresourced African American individuals receiving care at FQHCs. A future randomized efficacy trial of this intervention is warranted.
ClinicalTrials.gov NCT04554147; https://clinicaltrials.gov/ct2/show/NCT04554147.
非裔美国人死于心血管疾病的过早死亡风险高于美国白人，未控制的高血压导致的可归因风险不成比例。鉴于非裔美国人对移动技术（包括智能手机）的高使用率，这些技术有望增加可靠的健康信息获取途径。针对特定文化定制的移动健康（mHealth）干预措施可能会促进该人群的高血压自我管理。
这项形成性研究旨在评估将一种创新的mHealth干预措施整合到临床和社区环境中以改善非裔美国患者血压（BP）控制的可行性。
对未控制高血压的非裔美国患者进行了一项连续两个阶段的混合方法研究。在第1阶段，明尼苏达州明尼阿波利斯 - 圣保罗地区2家联邦合格健康中心（FQHC）的患者和临床医生通过焦点小组提供意见，以完善现有的针对特定文化定制的mHealth应用程序（促进非裔美国人全面健康改善！[FAITH！]应用程序），用于促进未控制高血压的非裔美国患者的高血压自我管理（重新命名为FAITH！高血压应用程序）。第2阶段是一项单臂干预前后试点研究，评估可行性和患者满意度。在FQHC接受治疗的患者使用FAITH！高血压应用程序参与了为期10周的干预，该应用程序与无线血压监测器同步，并得到社区卫生工作者（CHW）的支持，以解决与健康相关的社会需求的社会决定因素。该多媒体应用程序包括一个由10个模块组成的教育系列，重点关注高血压和心血管危险因素，具有交互式自我评估、药物和血压自我监测以及社交网络。主要结局是干预后立即评估的可行性（应用程序参与度和满意度）和初步疗效（血压变化）。
在第1阶段，13名非裔美国患者（n = 9，69%年龄≥50岁；n = 10，77%为女性）和16名临床医生（n = 11，69%年龄≥50岁；n = 14，88%为女性；n = 10，63%为非裔美国人）参加了焦点小组。他们的反馈为应用程序的修改提供了依据，包括增加血压和药物跟踪、血压自我护理任务提醒以及具有文化敏感性的背景信息。在第2阶段，招募了16名非裔美国患者（平均年龄52.6岁，标准差12.3岁；12/16，75%为女性）。总体而言，38%（6/16）完成了10个教育模块中的≥50%，44%（7/16）完成了干预后评估。这些患者对该干预措施在高血压自我管理方面的帮助给予了9分（满分10分）的评价。定性数据显示，他们认为该应用程序用户友好、引人入胜且信息丰富，并且认为社区卫生工作者提供了问责制和支持。在干预后立即评估时，7名患者的平均收缩压和舒张压分别下降了6.5 mmHg（P = 0.15）和2.8 mmHg（P = 0.78）。
在社区卫生工作者支持下针对特定文化定制的mHealth应用程序可能会改善在FQHC接受治疗的资源不足的非裔美国人的高血压自我管理。有必要对该干预措施进行未来的随机疗效试验。
ClinicalTrials.gov NCT04554147；https://clinicaltrials.gov/ct2/show/NCT04554147。
