Abstract
BackgroundEngagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown.ObjectiveThis systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented.MethodsA systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review.ResultsThe engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs.ConclusionsAvailable studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology.
Highlights
BackgroundHypertension is an impactful risk factor for heart disease and stroke, both of which are leading causes of death in the United States [1]
Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified
Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement
Summary
BackgroundHypertension is an impactful risk factor for heart disease and stroke, both of which are leading causes of death in the United States [1]. Effective treatment of hypertension requires patients to work with their health care providers and follow self-management guidelines, relating to medication adherence. MHealth interventions used for disease self-management belong to digital behavior change interventions, defined as those involving digital technologies (eg, mHealth apps) to promote or support behavior change for improved health and self-management of chronic disease [3,4] for better health, which have been used to facilitate hypertension self-management. Potential benefits of mHealth interventions for disease self-management include (1) increasing medication adherence [5], (2) increasing knowledge, (3) empowering patients for self-care, (4) providing personalized self-care recommendations, and (5) facilitating patient–care provider communication and decision-making [6,7]. Hundreds of mHealth apps, often with features such as educational resources and monitoring reminders, have previously been developed to support hypertension self-management [8], and studies have demonstrated the effectiveness of using apps in blood pressure (BP) control and self-management behavior change such as medication adherence [6,9,10]. Engagement in the prevention or management of hypertension is largely unknown
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