A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis

Abstract

Background Hypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective This study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions The mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions.

Measuring Success of Patients’ Continuous Use of Mobile Health Services for Self-management of Chronic Conditions: Model Development and Validation

“…The results also support the importance of providing feedback to patients about their health status that is reflected by the vital signs they uploaded in mHealth services [ 8 ]. Awareness of their own health status, particularly if the disease is deteriorating, will drive them to formulate an intention to continuously use the mHealth services.…”

“…With increasing awareness and ability, patients are motivated to self-manage their behavior, that is, adhere to treatment, thereby controlling their chronic conditions and maintaining the quality of life. When used over a long period of time, these apps are likely to result in positive outcomes such as obvious changes in health behaviors [ 6 - 8 ]. Despite their potential benefits, mHealth apps are rarely used.…”

“…It reflects the physiological, behavioral, social, and psychological conditions that a person experiences, which can be difficult to capture by other objective indicators [ 38 ]. Song et al [ 8 ] found that many patients reduced usage frequency or even stopped using the mHealth service once their blood pressure was under control. However, they would resume use once their blood pressure increased again.…”

Re-Conceptualizing the Drivers Toward mHealth Adoption in a Least Developing Country: A Qualitative Exploration

“…These findings indicate the necessity for additional research into the end-user’s aspect and preferences to discover which features and delivery mechanisms are most beneficial. In this regard, qualitative research provides opportunities to explore end-user’s experiences and get detailed information about how they perceive user engagement via in-depth interviews (Song et al, 2021). Therefore, the end-user’s usage of mHealth applications and the behavioral approach’s mechanism to utilize mHealth continue to be debated and require more research (Glomsås et al, 2021; Tajudeen et al, 2022).…”

Identification of factors affecting using health information technology for hypertension management: A systematic review

“…This study showed that the use of health information technology is useful in improving hypertension management (19)(20)(21). However, better use of health information technology and identi cation of motivating and inhibiting factors that affect the use of technology is important (22,23).…”