Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care Setting in Brazil: Mixed-Methods Field Study on Usability, Feasibility, and Utility

Silveira, Daniel Vitório; Marcolino, Milena Soriano; Machado, Elaine Leandro; Ferreira, Camila Gonçalves; Alkmim, Maria Beatriz Moreira; Resende, Elmiro Santos; Carvalho, Bárbara Couto; Antunes, André Pires; Ribeiro, Antônio Luiz Pinho

doi:10.2196/mhealth.9869

Cited by 41 publications

(46 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With the FHS actions, patients participate as actors in the construction of knowledge and practices that aim to favor health conditions and, consequently, patients can achieve independence in the decision-making process, with new possibilities to improve lifestyle 43 . In the context of FHS and primary care, digital technologies can assuage health care discrepancy, enabling the provision of integrated information on disease management, especially hypertension [44][45][46] . Using m-Health technologies represents an attractive option to improve health behaviors and outcomes given the widespread use of these technologies [47][48][49] .…”

Section: Discussionmentioning

confidence: 99%

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy

Debon

Bellei

Biduski

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Brazil's Family Health Strategy (FHS) leads public health policies and actions regarding community health, addressing arterial hypertension (AH) in primary care settings. In this scenario, the use of communication technologies becomes appropriate for the monitoring of patients with AH. To preliminary verify the intervention approach and the effects of using an m-Health application on the health conditions of patients with AH for a future study, we conducted a non-randomized, controlled, non-blind trial (N = 39), comparing the use of a mobile health app (m-Health) with conventional AH monitoring over 3 months. During the study, we promoted health information workshops to engage patients from both intervention and control groups. Pre and post-intervention, we compared measurements of systolic and diastolic blood pressure; food frequency questionnaire; Appraisal of Self-Care Agency Scale; blood tests of hemogram, creatinine, uric acid, sodium, potassium, lipid profile, and glycemia. Improvements were identified in both groups due to the workshops, including the reduction in total and non-HDL cholesterol, healthier consumption of salads and sugary drinks, and increased selfcare scores. Exclusively in the intervention group, which used the m-Health app, there was a change in systolic and diastolic pressure towards more adequate levels. In addition, the intervention group had improved levels of glucose and HDL cholesterol and reduced consumption of ultra-processed foods. In conclusion, the use of an m-Health app had positive effects on the health conditions of patients with AH under treatment within FHS, especially when combined with health information. On the context of FHS, the use of technology is encouraging supporting better health conditions. Arterial hypertension (AH) is one of the main modifiable risk factors for diseases of the circulatory system. With a high prevalence, AH is considered one of the most important public health problems. The World Health Organization estimates that about 600 million people have AH and, annually, 7.1 million individuals die from this disease, substantially burdening health systems 1. Among the AH modifiable factors, either by medication or by altering habits and behavior, there is obesity, sedentary lifestyle, eating habits, and stress. Controlling blood pressure can still be a challenge since, with everyday activities and lack of time, many people do not bother to maintain their normal blood pressure levels 2. Among the main non-medicinal recommendations that should be followed, there are healthy eating, physical activity, reduction of sodium and alcohol consumption, and non-consumption of tobacco 3 .

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy

Debon

Bellei

Biduski

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…mHealth is also increasingly used to aid physicians in their medical decision making [ 48 ] and to facilitate consultations with other providers and experts in their areas of expertise [ 49 , 50 ], highlighting the broad applicability of mHealth, not only for patients but also for medical providers. In a survey of health care providers, more than 70% of physicians had smartphones, and 77% of nurses and doctors used medical apps [ 51 ].…”

Section: Introductionmentioning

confidence: 99%

Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization: Protocol for an Efficacy and Implementation Study

et al. 2020

View full text Add to dashboard Cite

Background Hydroxyurea prevents disease complications among patients with sickle cell disease (SCD). Although its efficacy has been endorsed by the National Health Lung and Blood Institute evidence-based guidelines, its adoption is low, both by patients with SCD and providers. Mobile health (mHealth) apps provide benefits in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescription among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. Objective This study aims to increase hydroxyurea utilization through a combined two-level mHealth intervention for both patients with SCD and their providers with the goals of increasing adherence to hydroxyurea among patients and improve hydroxyurea prescribing behavior among providers. Methods We will test the efficacy of 2 mHealth interventions to increase both patient and provider utilization and knowledge of hydroxyurea in 8 clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that address memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox), addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared with their adherence at baseline. As secondary objectives, we will (1) examine the change in health-related quality of life, acute disease complications, perceived health literacy, and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health and (2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the reach, effectiveness, adoption, implementation, and maintenance framework and qualitatively evaluate the implementation of both mHealth interventions. Results The study is currently enrolling study participants. Recruitment is anticipated to be completed by mid-2021. Conclusions If this two-level intervention, that is, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future large-scale implementation-effectiveness study. Trial Registration ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167 International Registered Report Identifier (IRRID) DERR1-10.2196/16319

show abstract

“…In order to identify the components of the intervention, information was derived from the previous step, as well as previous assessments from our group [ 17 , 18 ]; discussions with primary care physicians, cardiologists, endocrinologists, nurses, nutritionists, pharmacists, and physical educators. Besides, meetings and internal workshops were conducted to discuss the topic with primary care practitioners, primary care unit coordinators, local health authorities, and stakeholders.…”

Section: Methodsmentioning

confidence: 99%

“…Previous experiences of our group were important for the development of this functionality. Suggestions received about usability in previous opportunities were decisive to improve and create new messages and resources [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Development and Implementation of a Decision Support System to Improve Control of Hypertension and Diabetes in a Resource-Constrained Area in Brazil: Mixed Methods Study

Marcolino¹,

Oliveira²,

Cimini³

et al. 2021

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

Background The low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care. Objective The aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction. Methods This mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals’ satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed. Results A total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach α of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application’s database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were co...

show abstract

Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care Setting in Brazil: Mixed-Methods Field Study on Usability, Feasibility, and Utility

Cited by 41 publications

References 36 publications

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy

Effects of using a mobile health application on the health conditions of patients with arterial hypertension: A pilot trial in the context of Brazil’s Family Health Strategy

Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization: Protocol for an Efficacy and Implementation Study

Development and Implementation of a Decision Support System to Improve Control of Hypertension and Diabetes in a Resource-Constrained Area in Brazil: Mixed Methods Study

Contact Info

Product

Resources

About