Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives

African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p < 0.0001) indicating significant reductions in resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the SMASH group vs. the standard care (SC) control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003). Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.

[1]  S. Oparil,et al.  Feasibility of treating prehypertension with an angiotensin-receptor blocker. , 2006, The New England journal of medicine.

[2]  J. Urquhart,et al.  Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis , 2013, Drugs.

[3]  F. Cappuccio,et al.  Blood pressure control by home monitoring: meta-analysis of randomised trials , 2004, BMJ : British Medical Journal.

[4]  C. T. Orleans,et al.  Does the chronic care model serve also as a template for improving prevention? , 2001, The Milbank quarterly.

[5]  V. Conn,et al.  Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients , 2011, Clinical transplantation.

[6]  Ihab Hajjar,et al.  Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. , 2003, JAMA.

[7]  G. Molenberghs.  Applied Longitudinal Analysis , 2005 .

[8]  Y. Ostchega,et al.  Recent trends in the prevalence of high blood pressure and its treatment and control, 1999-2008. , 2010, NCHS data brief.

[9]  Tom Fahey,et al.  Interventions used to improve control of blood pressure in patients with hypertension. , 2010, The Cochrane database of systematic reviews.

[10]  Ana Mari Cauce,et al.  Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. , 2002, Journal of consulting and clinical psychology.

[11]  Ronald R. O'Donnell.  Stepped Care and E-Health in Behavioral Managed Care , 2011 .

[12]  R. Romanelli,et al.  Disparities in adherence to and persistence with antihypertensive regimens: an exploratory analysis from a community-based provider network. , 2012, Journal of the American Society of Hypertension : JASH.

[13]  Gwen L. Alexander,et al.  Tailoring a Fruit and Vegetable Intervention on Novel Motivational Constructs: Results of a Randomized Study , 2008, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[14]  B. Riegel,et al.  Predictors of medication nonadherence differ among black and white patients with heart failure. , 2015, Research in nursing & health.

[15]  E. Deci,et al.  Nature and autonomy: An organizational view of social and neurobiological aspects of self-regulation in behavior and development , 1997, Development and Psychopathology.

[16]  Brian T. Austin,et al.  Improving chronic illness care: translating evidence into action. , 2001, Health affairs.

[17]  Y. Chiu,et al.  Pharmacokinetics and Safety of the Lopinavir/Ritonavir Tablet 500/125 mg Twice Daily Coadministered With Efavirenz in Healthy Adult Participants , 2012, Journal of clinical pharmacology.

[18]  E. Deci,et al.  Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. , 2000, The American psychologist.

[19]  R. Düsing.  Overcoming barriers to effective blood pressure control in patients with hypertension , 2006, Current medical research and opinion.

[20]  C. Gore-felton,et al.  A review of efficacious technology-based weight-loss interventions: five key components. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[21]  E. Deci,et al.  Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory , 2008 .

[22]  Bernadette Mazurek Melnyk,et al.  Systematic review of text-messaging interventions to promote healthy behaviors in pediatric and adolescent populations: implications for clinical practice and research. , 2012, Worldviews on evidence-based nursing.

[23]  Frank Treiber,et al.  Hispanic Migrant Farm Workers' Attitudes Toward Mobile Phone-Based Telehealth for Management of Chronic Health Conditions , 2013, Journal of medical Internet research.

[24]  Yi Yang,et al.  Predictors of medication nonadherence among patients with diabetes in Medicare Part D programs: a retrospective cohort study. , 2009, Clinical therapeutics.

[25]  Marylène Gagné,et al.  Facilitating autonomous motivation for smoking cessation. , 2002, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[26]  Aaron S Kesselheim,et al.  Electronic medication packaging devices and medication adherence: a systematic review. , 2014, JAMA.

[27]  B. Egan,et al.  US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. , 2010, JAMA.

[28]  J. Car,et al.  Mobile phone messaging for facilitating self-management of long-term illnesses. , 2012, The Cochrane database of systematic reviews.

[29]  J. Hanlon,et al.  Ethnic Disparities in Adherence to Antihypertensive Medications of Medicare Part D Beneficiaries , 2012, Journal of the American Geriatrics Society.

[30]  R. Bautista,et al.  Health disparities in medication adherence between African-Americans and Caucasians with epilepsy , 2011, Epilepsy & Behavior.

[31]  E. Deci,et al.  Autonomous regulation and long-term medication adherence in adult outpatients. , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[32]  Richard M. Ryan,et al.  Motivational Interviewing and Self–Determination Theory , 2005 .

[33]  R. Light,et al.  Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control: A Systematic Review and Meta-Analysis , 2011, Hypertension.

[34]  H. Bosworth,et al.  Racial Differences in Blood Pressure Control: Potential Explanatory Factors , 2008, Journal of General Internal Medicine.

[35]  Jackson T. Wright,et al.  2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). , 2014, JAMA.

[36]  N. Keenan,et al.  Prevalence of hypertension and controlled hypertension - United States, 2005-2008. , 2011, MMWR supplements.

[37]  Andreas Bock,et al.  Medication Adherence Assessment: High Accuracy of the New Ingestible Sensor System in Kidney Transplants , 2013, Transplantation.

[38]  D. Nease,et al.  Racial differences in adherence to antidepressant treatment in later life. , 2012, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[39]  Martina Mueller,et al.  Patient Attitudes Toward Mobile Phone-Based Health Monitoring: Questionnaire Study Among Kidney Transplant Recipients , 2013, Journal of medical Internet research.

[40]  Stephen S. Lim,et al.  Prevalence, Awareness, Treatment, and Control of Hypertension in United States Counties, 2001–2009 , 2013, PloS one.

[41]  Victor J Stevens,et al.  Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. , 2003, JAMA.

[42]  W. Elliott.  US Trends in Prevalence, Awareness, Treatment, and Control of Hypertension, 1988-2008 , 2011 .

[43]  P Michael Ho,et al.  Medication Adherence: Its Importance in Cardiovascular Outcomes , 2009, Circulation.

[44]  G. Reboldi,et al.  Validation of the A&D UA-774 (UA-767Plus) device for self-measurement of blood pressure , 2004, Blood pressure monitoring.

[45]  Frank A. Treiber,et al.  mHealth medication and blood pressure self-management program in Hispanic hypertensives: a proof of concept trial , 2013 .

[46]  A. Shennan,et al.  Validation of the DINAMAP ProCare blood pressure device according to the international protocol in an adult population , 2006, Blood pressure monitoring.

[47]  Rebecca A. Rock,et al.  Mobile Health Medication Adherence and Blood Pressure Control in Renal Transplant Recipients: A Proof-of-Concept Randomized Controlled Trial , 2013, JMIR research protocols.

[48]  E H Wagner,et al.  Quality improvement in chronic illness care: a collaborative approach. , 2001, The Joint Commission journal on quality improvement.

[49]  Jia-Rong Wu,et al.  Effect of a medication-taking behavior feedback theory-based intervention on outcomes in patients with heart failure. , 2012, Journal of cardiac failure.

[50]  A. Haines,et al.  The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review , 2013, PLoS medicine.

[51]  M. Lemstra,et al.  Proportion and risk indicators of nonadherence to antihypertensive therapy: a meta-analysis , 2014, Patient preference and adherence.

[52]  A. Lippman.  Adherence to medication. , 2005, The New England journal of medicine.

[53]  M. Tingen,et al.  Differential Impact of Stress Reduction Programs upon Ambulatory Blood Pressure among African American Adolescents: Influences of Endothelin-1 Gene and Chronic Stress Exposure , 2011, International journal of hypertension.

[54]  Mathew Gregoski,et al.  Facilitating medication adherence and eliminating therapeutic inertia using wireless technology: proof of concept findings with uncontrolled hypertensives and kidney transplant recipients , 2012, Wireless Health.

[55]  E. Deci,et al.  A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. , 1999, Psychological bulletin.

[56]  T. Brennan,et al.  Gender and racial disparities in adherence to statin therapy: a meta-analysis. , 2013, American heart journal.