Abstract
BackgroundHypertension 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.ObjectiveThis 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.MethodsIn 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.ResultsParticipants (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.ConclusionsThis 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.
Highlights
BackgroundDespite advances in management, hypertension remains a significant public health challenge in the United States, affecting approximately 33% of adults aged above 18 years [1,2]
Patients were assigned to student health coaches (SHCs) in a nonrandom way at an orientation event held at the clinic where SHCs introduced themselves to patients and signed up for the 5 meetings together
One hypertensive emergency was accurately identified by an SHC, who followed the protocol and advised the patient to go to the emergency room for treatment
Summary
BackgroundDespite advances in management, hypertension remains a significant public health challenge in the United States, affecting approximately 33% of adults aged above 18 years [1,2]. In one meta-analysis, lower occupational status and level of education were associated with odds ratios for hypertension of 1.31 and 2.02, respectively [4] Another prospective trial demonstrated that incident hypertension was lower in participants from higher SES groups than in lower SES groups, suggesting that having limited social and economic resources plays a role in the disproportionate burden of hypertension seen in disadvantaged neighborhoods [5]. 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. Objective: 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. Patients were more engaged in the S+Q group, reporting higher satisfaction with their SHC and better control of their BP
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