Hypertension Self-management Research Articles

Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey.

BackgroundHigh blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison.ObjectiveThe present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc).MethodsBased on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses.ResultsAs expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians.ConclusionsIn summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

Impact of Behavioral Interventions on Patient Activation in Adults with Hypertension: A Systematic Review and Meta-Analysis.

Introduction: Behavioral interventions assist patients in maintaining optimal self-management of their health, especially in those at risk of certain conditions. Little is known about the effects of self-management interventions on patient activation in adults with hypertension. Therefore, this systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension. Methods: We searched online databases: PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between January 2004 and May 2021. We included randomized controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension and reported patient activation using the patient activation measure (PAM). Results: 4 Four studies (N = 1415 participants) met the inclusion criteria. In adults with hypertension, self-management interventions improved patient activation with moderate strength of evidence. A community-based self-management program, motivational interviewing strategies, and home-based patient-activated care were associated with better PAM scores than usual care. Conclusion: Our findings reinforce the need for healthcare providers to incorporate these interventions into primary care to support the adoption of recommended hypertension self-management behaviors. Future studies must focus on tailoring support to the patient’s level of activation in hypertension self-management.

The readiness of frontline health workers in enhancing diabetes and hypertension self-management education and practice in the community settings in Delhi, India

The present study was conducted among accredited social health activists (ASHAs), female frontline health workers of India, to assess their knowledge of self-care management for diabetes mellitus (DM) and hypertension (HTN) and understand their readiness to promote medical adherence. Only 21 (41.2%) participants (n = 51) were aware of all the four major behavioral risk factors, including physical inactivity, unhealthy diet, tobacco smoking, and harmful alcohol use that increased the risk of development and progression of DM and HTN. The ASHAs were positively inclined toward participation in health education activities through home visits but were disinclined to be involved in the home distribution of medications.

Control of Elderly Hypertension with Merona Program

Hypertension is a silent killer is the most common health problem experienced by the elderly. Control of hypertension in the elderly is very necessary to reduce complications of hypertension. Based on these conditions, the MERONA Program was developed. The purpose is to provide an overview of the implementation of the blush program in the elderly with hypertension. The method used is a family case study and an aggregate using a family and community nursing process approach involving 10 foster families and 60 elderly people in the community selected using cluster random sampling. This program is an integration of hypertension self-management and relaxation therapy, namely music therapy, progressive muscle relaxation, and deep breathing relaxation which is carried out for 12 weeks. Evaluation of changes in behavior and family independence was carried out at the end of the 12th week using a questionnaire. Blood pressure measurements were carried out at weeks 4, 8, and 12. The results of the implementation were an increase in the behavior of the elderly, an increase in the level of family independence, and a significant decrease in systolic and diastolic blood pressure (p<0.05). The MERONA program is recommended to be applied in community health services.

Developing Educational Materials to Support Older Adults With Hypertension Management

A comprehensive approach to hypertension management requires medication adherence as well as more general health behavior changes. Our primary objective is to provide evidence-based and tailored education about hypertension, medications, and health self-management strategies with consideration for different stages of behavior change, health literacy, education, disease knowledge, and experience. To facilitate health behavior change, enable information seeking, and increase engagement, the educational materials provide different layers of information, including tips and information in the MEDSReM app, as well as more detailed educational content on the web portal. We will present examples of the materials in different formats to show how they are tailored to ease comprehension, support adherence, and influence behavior change. These educational materials will have broad utility outside of the MEDSReM system, and will also serve as the education-only comparison condition for the randomized controlled trial.

A longitudinal examination of tablet self-management technology acceptance by patients with chronic diseases: Integrating perceived hand function, perceived visual function, and perceived home space adequacy with the TAM and TPB

BackgroundHealth information technologies (HITs) are increasingly being used to support the self-management of chronic diseases. However, patients’ initial or continued acceptance of such technologies is not always achieved. ObjectiveThe aim of this study was to develop a theory-driven HIT acceptance model to examine factors affecting acceptance of HIT (measured by behavioral intention; BI) for disease self-management among patients with chronic diseases, in which we also focused on three additional, previously unexplored factors related to perceived hand function (PHF), perceived visual function (PVF), and perceived space adequacy (PSA) and a longitudinal scrutinization of changes in the effects of these factors on acceptance over time. MethodsThe theoretical basis of our acceptance model was drawn from the technology acceptance model and the theory of planned behavior. The model was further extended by including patients' PHF, PVF (related to patients with chronic diseases who are mostly elderly), and PSA (related to the patients’ home environment). The model was tested in the context of type 2 diabetes and hypertension self-management via a touchscreen tablet-based system over a 24-week period. A questionnaire was administered at four time points (baseline and 8, 16, and 24 weeks after implementation) to collect data from 151 patients with coexisting type 2 diabetes and hypertension. We tested the model at each time point using partial least squares structural equation modeling. ResultsPerceived usefulness of the self-management system influenced BI directly at 8 and 24 weeks and indirectly at 8, 16, and 24 weeks. Perceived ease of use indirectly affected BI at 8, 16, and 24 weeks. Attitude directly affected BI at 8, 16, and 24 weeks. Perceived behavioral control directly influenced BI at baseline and 8 and 16 weeks. Subjective norms indirectly influenced BI at 8, 16, and 24 weeks. PHF and PVF indirectly influenced BI over the entire study period. PSA influenced BI directly at 16 weeks and indirectly at 8, 16, and 24 weeks. ConclusionThe effects of the proposed factors in our model on patient-focused HIT acceptance changed over a longer time period, emphasizing the importance of further investigation of the longitudinal mechanisms influencing technology acceptance behavior. It is recommended that healthcare practitioners consider such changes when implementing comparable technologies. Moreover, beyond technology attributes, the characteristics, needs, and limitations of older adults and elderly patient users and their home environments should also be considered in the design and implementation of patient-focused HIT systems for chronic disease self-management at home.

Incorporating African American Veterans' Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol.

BackgroundPeer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives.ObjectiveIn our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans.MethodsWe used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed.ResultsWithin the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences.ConclusionsWe crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans.Trial RegistrationClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590International Registered Report Identifier (IRRID)DERR1-10.2196/29423

Psychometric Analysis of Hypertension Self-Management Behaviors Questionnaire; an Application of Intervention Mapping Approach in Questionnaire Development

Aims: High blood pressure is one of the common main preventable risk factors for many diseases. This study aimed to psychometric properties of the cognitive determinants of hypertension self-management questionnaire among Iranian hypertensive patients based on the Intervention Mapping approach. Instrument & Methods: This psychometric study was conducted in Abadan in 2019. Content Validity Ratio and Content Validity Index of the questionnaire were calculated by ten hypertensive patients and 12 experts. Construct validity was investigated using Classical Item Analysis and Exploratory Factor Analysis by the participation of 315 hypertensive patients. The internal consistency was measured by using Cronbach’s Coefficient Alpha of the various cognitive determinants of the questionnaire. Data were analyzed by SPSS 16. Findings: The mean age of patients was 57.53±11.30 years, ranging from 30 to 70 years. Five factors (attitude, outcome expectation, self-efficacy, subjective norms, and barriers) and behavior were confirmed. The Kaiser-Meyer Olkin test was generally satisfactory (calculated: 0.817). The factors explained 61.86% of the variance of the hypothesized model. Estimated reliability using alpha Cronbach coefficient for each cognitive determinants were as follows: attitude (α=0.75), outcome expectations (α=0.79), self-efficacy (α=0.80), subjective norms (α=0.85), barriers (α=0.88), behavior (α=0.82). Conclusion: The application of the intervention mapping approach in questionnaire development offers a useful questionnaire to measurement self-management hypertension behaviors, and psychometric analysis shows that it could be useful for related planning programs.

Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study.

BackgroundSmartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts.ObjectiveThe aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system.MethodsThis study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants’ attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis.ResultsIn the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users’ data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants.ConclusionsOnly 5 apps were deemed potentially effective and secure. Patients’ and doctors’ discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall.

Determinants of Hypertension Self-management Behaviors: An Application of the Intervention Mapping Approach

Background: Hypertension is one of the key risk factors for several diseases. Objectives: The aim of this study was to determine the determinants of hypertension self-management behaviors (HSBs) based on intervention mapping approach. Methods: A cross-sectional study was conducted among 800 hypertensive patients in southwestern Iran in 2018. A structured questionnaire was applied for data collection. Data were analyzed using SPSS version 16. Results: The mean age of respondents was 58.25 years (SD: 12.10; age range: 30 - 74 years). The best predictors for HSBs were perceived barriers, outcome expectations, and self-efficacy. Conclusions: Our findings have implications for the evidence-based design of HSBs promotion interventions.

Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program

It is unclear whether mobile technology hypertension self-management programs are associated with blood pressure (BP) control. To examine whether engagement with a hypertension self-management program with a BP monitor and connected smartphone application with clinically based digital coaching was associated with BP control during a follow-up period of as long as 3 years. This cohort study enrolled US adults with elevated BP or hypertension between January 1, 2015, and July 1, 2020. The hypertension self-management program was provided through the participant's (or their spouse's) employer health plan. Program engagement, defined by average number of application sessions. Systolic and diastolic BP measured by a US Food and Drug Administration-cleared BP monitor, with categories defined as normal (systolic BP, <120 mm Hg), elevated (systolic BP, 120-129 mm Hg), stage 1 hypertension (systolic BP, 130-139 mm Hg), and stage 2 hypertension (systolic BP ≥140 mm Hg). Other measures included age, gender, depression, anxiety, diabetes, high cholesterol, smoking, geographic region, area deprivation index, self-reported weight, and device-measured physical activity (steps per day). Among 28 189 participants (median [IQR] age, 51 [43-58] years; 9424 women [40.4%]; 13 902 men [59.6%]), median (IQR) baseline systolic BP was 129.5 mm Hg (120.5-139.6 mm Hg) and diastolic BP was 81.7 mm Hg (75.7-88.4 mm Hg). Median systolic BP at 1 year improved at least 1 category for 495 of 934 participants (53.0%) with baseline elevated BP, 673 of 966 (69.7%) with baseline stage 1 hypertension, and 920 of 1075 (85.7%) with baseline stage 2 hypertension. Participants in the program for 3 years had a mean (SEM) systolic BP reduction of 7.2 (0.4), 12.2 (0.7), and 20.9 (1.7) mm Hg compared with baseline for those starting with elevated, stage 1 hypertension, and stage 2 hypertension, respectively. Greater engagement was associated with lower systolic BP over time (high-engagement group: 131.2 mm Hg; 95% CI, 115.5-155.8 mm Hg; medium-engagement group: 133.4 mm Hg; 95% CI 116.3-159.5 mm Hg; low-engagement group: 135.5 mm Hg; 95% CI, 117.3-164.8 mm Hg; P < .001); these results persisted after adjusting for age, gender, depression, anxiety, diabetes, high cholesterol, smoking, area deprivation index rank, and US region, which was partially mediated by greater physical activity. A very high BP (systolic BP >180 mm Hg) was observed 11 637 times from 3778 participants. Greater engagement was associated with lower risk of very high BP; the estimated probability of a very high BP was greater in the low-engagement group (1.42%; 95% CI, 1.26%-1.59%) compared with the medium-engagement group (0.79%; 95% CI, 0.71%-0.87%; P < .001) and the high-engagement group (0.53%; 95% CI, 0.45%-0.60%; P < .001 for comparison with both groups). The findings of this study suggest that a mobile technology hypertension self-management program can support long-term BP control and very high BP detection. Such programs may improve real-world BP monitoring and control.

A pilot evaluation of Swasthya Pahal program using SMAART informatics framework to support NCD self-management.

Empirical research acknowledges the capability of mHealth and eHealth interventions for ensuring high-quality and tailored healthcare to individuals. People living with various health conditions get access to a wide range of healthcare services through digital interventions. The aim of the study is to examine the usefulness of Swasthya Pahal, a community-based Health for all program, aimed to enhance screening and self-management of diabetes, hypertension, and obesity among police personnel. A convenient sample of 64 individuals aged 18 years and above present at the Police Sanchar Training Centre, Dehradun, Uttarakhand were enrolled over 2 days in January 2020. The Swasthya Pahal pilot program was approved by the Uttarakhand State Police authorities. Individuals' health data was recorded using an interactive, bi-lingual, touch screen, computer-based program. Subjective data was collected and self-reported information was gathered about (I) socio-demographics, (II) health behaviors, (III) clinical status, and (IV) Knowledge, Attitudes, and Practices (KAP). Objective data assessments included measurements such as weight, blood pressure, and blood sugar levels using a series of physiological sensors. Additional information gathered at 1 month follow up included modifications that individuals made in their self-management of diabetes and hypertension, diet, physical activity, alcohol consumption, and smoking. Information was gathered related to individuals' interest in receiving SMS based health messages. The average age of study participants was 37 (SD =8) years, 88% were males, and 42% had graduate education. Hypertension (31%) was found to be the most common family history. Thirty-six percent of individuals were presently smokers or consumed alcohol. Sixty-two percent of them self-reported doing some form of exercise. Walking, jogging and yoga were the most common exercise types. Eighty-seven percent of them were not receiving any treatment to self-manage hypertension. Based on the JNC 8 criteria, 37% of the individuals were hypertensive. Fifty of the 64 individuals expressed interest to receive SMS message, 64% of them expressed keenness to receive weekly SMS messages. Messages related to diet, physical activity, sleep, and smoking and alcohol consumption were perceived as important. The Swasthya Pahal program using the SMAART informatics framework is a useful tool to enhance screening and self-management of non-communicable diseases (NCDs) among police personnel.

Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis.

BackgroundHypertension is a long-term medical condition. Electronic and mobile health care services can help patients to self-manage this condition. However, not all management is effective, possibly due to different levels of patient engagement (PE) with health care services. Health care provider follow-up is an intervention to promote PE and blood pressure (BP) control.ObjectiveThis study aimed to discover and characterize patterns of PE with a hypertension self-management app, investigate the effects of health care provider follow-up on PE, and identify the follow-up effects on BP in each PE pattern.MethodsPE was represented as the number of days that a patient recorded self-measured BP per week. The study period was the first 4 weeks for a patient to engage in the hypertension management service. K-means algorithm was used to group patients by PE. There was compliance follow-up, regular follow-up, and abnormal follow-up in management. The follow-up effect was calculated by the change in PE (CPE) and the change in systolic blood pressure (CSBP, SBP) before and after each follow-up. Chi-square tests and z scores were used to ascertain the distribution of gender, age, education level, SBP, and the number of follow-ups in each cluster. The follow-up effect was identified by analysis of variances. Once a significant effect was detected, Bonferroni multiple comparisons were further conducted to identify the difference between 2 clusters.ResultsPatients were grouped into 4 clusters according to PE: (1) PE started low and dropped even lower (PELL), (2) PE started high and remained high (PEHH), (3) PE started high and dropped to low (PEHL), and (4) PE started low and rose to high (PELH). Significantly more patients over 60 years old were found in the PEHH cluster (P≤.05). Abnormal follow-up was significantly less frequent (P≤.05) in the PELL cluster. Compliance follow-up and regular follow-up can improve PE. In the clusters of PEHH and PELH, the improvement in PE in the first 3 weeks and the decrease in SBP in all 4 weeks were significant after follow-up. The SBP of the clusters of PELL and PELH decreased more (–6.1 mmHg and –8.4 mmHg) after follow-up in the first week.ConclusionsFour distinct PE patterns were identified for patients engaging in the hypertension self-management app. Patients aged over 60 years had higher PE in terms of recording self-measured BP using the app. Once SBP reduced, patients with low PE tended to stop using the app, and a continued decline in PE occurred simultaneously with the increase in SBP. The duration and depth of the effect of health care provider follow-up were more significant in patients with high or increased engagement after follow-up.

Effect of Community Chronic Disease Management on Self-management of Hypertension

Effect of Community Chronic Disease Management on Self-management of Hypertension

Self-management using crude herbs and the health-related quality of life among adult patients with hypertension living in a suburban setting of Malaysia.

PurposeTo determine the prevalence of crude herbs’ use in the self-management of hypertension and the health-related quality of life (HRQOL) in patients with hypertension.MethodsThis cross-sectional study was performed among patients with hypertension attending a government health clinic. Socio-demographic characteristics, lifestyle modifications, medical history and predictors of crude herbs users were obtained. The diversity of crude herbs used was assessed using a modified international complementary and alternative medicine questionnaire (I-CAM-Q) and the HRQOL was assessed using the SF36 instrument.ResultsOut of the 294 patients recruited, 52.4% were female, 41.5% were Malay and 38.8% were within the 60 to69 age category. The prevalence of crude herbs users was 30.6% and the most common herbs used were pegaga (Centella asiatica), peria (Momordica charantia) and betik (Carica papaya). Using the regression analysis, significantly higher odds of using crude herbs are noted among Malay or Indian patients who have these characteristics: attained secondary education, experienced falls or muscle pain, and had systolic blood pressure of more than 140 mmHg. There was no significant difference in HRQOL domains between the crude herb users and non-users (p>0.05).ConclusionBesides taking allopathic medications, certain patients with hypertension use crude herbs as a form of self-management. Although patients are adamant about integrating crude herbs as a form of self-management, the effects of doing so have not been properly investigated. This implies that the healthcare staff members need to communicate with the patients regarding the use of crude herbs together with conventional drugs.

Reported self-management of hypertension among adult hypertensive patients in a developing country: a cross-sectional study in a Nigerian tertiary hospital.

Sustained control of blood pressure, is dependent on degree of self-management, which includes self-integration, self-regulation, self-monitoring and adherence to regimen. We assessed the pattern of self-management of hypertension among adult hypertensive patients in a developing country. Cross-sectional study design and convenience sampling, was used to recruit adult hypertensive patients, attending Lagos State University Teaching Hospital, Lagos, Nigeria. Interviewer-administered questionnaire was used to obtain data on self-management components. SPSS version 21.0 was used to analyze data, with p-value set at 0.05. One hundred and seven (107) respondents, had mean age of 49.0 ± 12.0 years. Mean value for self-management was 3.15 ± 0.55, comprising self-integration (3.06 ± 0.36), self-regulation (3.32 ± 0.63), self-monitoring (3.29 ± 0.84) and adherence to regimen (3.15 ± 0.55). Most components of self-management, had high levels of mean score. Respondents that were less than 40 years, compared with those that were more than 40 years, had greater mean values for self-integration (3.37 vs 3.05), but significantly lesser values for all other components (p < 0.05). Young hypertensives had poor levels of most components of self-management. There is urgent need for health educational programs on self-management of hypertension among young people in sub-Saharan Africa.

Hypertension self-management and antihypertensive prevalence amid patients in Saudi Arabia via knowledge, attitude, and practice assessment

Background: Diagnosed cases with hypertension (HT) are elevating worldwide and in Saudi Arabia (SA). HT self-management amid patients is important for controlling the disease and its complications. The aim of this study is to perform an HT KAP evaluation amid patients with HT in SA. Subjects and methods: This Cross-sectional study was performed between January and April 2021. An administered validated online survey was presented to the patients via the Survey Monkey website-link. Data collectors contacted possible patients in several sites comprising; hospitals, shopping malls, and leisure-centers. The associations amid categorical variables were assessed via the chi-square test application. The Pearson correlation coefficient (r) measured potential correlations between the patients’ KAP and outcome variables. Results: This study surveyed 410 patients with HT with mean systolic blood pressure (SBP) of 144.1 mmHg ± 15.4 and diastolic blood pressure (DBP) 90.2 mmHg ± 10.2, mean age 56 ± 11 years, range 18–80 years. Generally, 73% of patients showed good HT knowledge and 78% showed good HT attitude, whereas 77% revealed poor HT practice. Significant positive linear correlations were found amid attitude versus (with) knowledge (r= 0.40, P &lt;0.001), practice with knowledge (r= 0.26, P &lt;0.001), practice with attitude (r= 0.26, P &lt;0.001), SBP with DBP (r= 0.57, P &lt;0.001), whereas significant negative linear correlations were found amid SBP with knowledge (r= −0.13, P &lt;0.05), SBP with attitude (r= −0.11, P &lt;0.05), SBP with practice (r= −0.10, P &lt;0.05), DBP with knowledge (r= −0.10, P &lt;0.05), DBP with attitude (r= −0.14, P &lt;0.05), and DBP with practice (r= −0.10, P &lt;0.05). Surprisingly, 59% of patients didn’t administer any prescribed anti-hypertensives. Conclusion: The patients showed a very good attitude and knowledge regarding HT; however, these were not mirrored in their practice towards HT. Unproper administration of prescribed anti-hypertensive medicines without a proper healthy diet and exercise caused a direct contribution resulted in poor HT practice despite increased HT knowledge and awareness. Consequently, patients are advised to participate in the free HT health education programs provided by the ministry of health (MOH) to increase their knowledge of the importance of drug compliance and applications for improving HT self-management to better manage HT and its complications.

Addressing Diabetes Distress in Self-Management Programs: Results of a Randomized Feasibility Study.

BackgroundWest Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.MethodsThis study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN (n=10 per group) completed baseline and 12-week assessments. Diabetes distress was measured by using a validated Diabetes Distress Survey (17-item Likert scale; four sub-scales of emotional burden, physician related burden, regimen related burden, and interpersonal distress). Baseline and post-intervention changes in diabetes distress were compared for both groups; reduction in distress in the intervention groups are depicted using waterfall plots. The mean age, HbA1c and BMI were 55 ± 9.6 years, 7.8 ± 2.24 and 36.4 ± 8.8, respectively. Diabetes distress (total; mean) was 1.84±0.71.ResultsParticipants reported higher diabetes distress related to emotional burden (2.1±0.94) and regimen-related distress (2.0 ± 0.74); physician-related distress was the lowest (1.18±0.64). In general, diabetes distress reduced among intervention participants and was especially significant among those with HbA1c ≤ 8% (r=0.28, p=0.4), and systolic/diastolic BP ≤140/80 mm Hg (r=0.045, P=0.18).ImplicationsFindings suggest that lifestyle self-management programs have the potential to reduce diabetes distress.

Efficacy of Hypertension Self-Management Classes Among Patients at a Federally Qualified Health Center.

Structural racism has contributed to persistent racial disparities in hypertension control, with Black men suffering the highest prevalence of uncontrolled hypertension. Lincoln Community Health Center, our urban Federally Qualified Health Center (FQHC), aimed to use hypertension self-management classes to improve hypertension control among our clinic patients, particularly Black men. Patients attending classes learned about hypertension, were given blood pressure cuffs to use at home, and had the opportunity to speak to physicians in a group setting. We used a nonexperimental quality improvement intervention design to identify baseline differences between participants who attended multiple classes and those who attended only 1 class. Participants who attended multiple classes, most of whom were Black men, achieved an average blood pressure reduction of 19.1/14.8 mm Hg. Although the classes were effective, current policies around health insurance reimbursement and federal quality reporting standards hamper the ability of health care providers to implement such patient education initiatives.

Randomized feasibility trial of a digital intervention for hypertension self-management.

Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial, we sought to generate preliminary evidence of feasibility and efficacy in community-dwelling adults ≥55 y/o with hypertension recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Preliminary measures of efficacy included BP readings from phone-supervised home measurements and a self-efficacy questionnaire. Sixty-two participants (40 women, 33 Blacks, mean age 66, mean office BP 164/91) were randomized to MyBP (n = 41) or a control group (n = 21). Median follow-up was 22.9 (SD = 6.7) weeks. In the MyBP group, median engagement with HBPM was 82.7% (Q1 = 52.5, Q3 = 89.6) and sustained over time. The decline in systolic [12 mm Hg (SD = 17)] and diastolic BP [5 mm Hg (SD = 7)] did not differ between the two treatment groups. However, participants with higher baseline systolic BP assigned to MyBP had a greater decline compared to controls [interaction effect estimate -0.56 (-0.96, -0.17)]. Overall hypertension self-efficacy improved in the MyBP group. In conclusion, trial results show that older hypertensive adults with substantial minority representation had sustained engagement with this digital self-monitoring program and may benefit clinically.