Diagnosing hypertension in Indigenous Canadians (DREAM‐GLOBAL): A randomized controlled trial to compare the effectiveness of short message service messaging for management of hypertension: Main results

Abstract

Hypertension, the leading cause of cardiovascular morbidity and mortality, affects more than 1 billion people globally. The rise in mobile health in particular the use of mobile phones and short message service (SMS) to support disease management provides an opportunity to improve hypertension awareness, treatment, and control, in remote and vulnerable patient populations. The primary objective of this randomized controlled study was to assess the effect of active (with hypertension specific management SMS) or passive (health behaviors SMS alone) on the difference in blood pressure (BP) reduction between the active and passive SMS groups in hypertensive Canadian First Nations people from six rural and remote communities. Pragmatic features of the study included shifting of BP measures to non‐medical health workers. Despite an overall reduction in BP over the study, there was no difference in the BP change between groups from baseline to final for systolic 0.8 (95% CI −4.2 to 5.8 mm Hg) or diastolic −1.0 (95% CI −3.7 to 1.8 mm Hg, P = 0.5) BP. Achieved BP control was 37.5% (25.6%‐49.4%, 95% CI) in the active group and 32.8% (20.6%‐44.8%, 95% CI) in the passive group (difference in proportions −4.74% (−21.7% to 12.2%, 95% CI, P = 0.6). The study looked at changes in health services delivery, mobile health technologies, and patient engagement to support better management of hypertension in Canadian First Nations communities. The active hypertension specific SMS did not lead to improvements in BP control.

Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study

“…Training and support requirements were pragmatic. With achievement of improved blood pressure control, there is at least indirect evidence that study information was positively impacting on participant health care [16]. A theme emerging from community health workers was that the DREAM-GLOBAL technology could be more user friendly.…”

“…During the study, there was an evaluation of the acceptability and accessibility to the SMS text messages, the blood pressure measurement process, including data transmission, the impact of the messages on participants, and the impact of the study process on health care providers. After completion of the study, the main outcome was an assessment of impact on blood pressure control and change of knowledge from the SMS text messages [16]. We have published on the formative data, with early community engagement and readiness [9], and the SMS development process [17].…”

Wise Practices for Cultural Safety in Electronic Health Research and Clinical Trials With Indigenous People: Secondary Analysis of a Randomized Clinical Trial

“…Briefly, the objective in Canada was to evaluate the effectiveness of an innovative mHealth program using SMS text messages and electronic transfer of BP measures from patients to providers on BP control of Indigenous peoples [12]. DREAM-GLOBAL requires changes in the way services are provided that affect patients, providers, and the local health system [37].…”

Designing interventions for blood pressure control in challenging settings: Active not passive intervention is needed

“…In this issue of the Journal, Tobe and colleagues report the results of a 243‐patient randomized controlled trial comparing the efficacy of “active” vs “passive” text messaging to achieve BP control in six rural and remote Canadian First Nations communities . Active messaging included advice and education on BP management plus health behavior management suggestions whereas passive messaging consisted of only the latter.…”

“…The setting in which the trial was conducted is important because of the higher risk of cardiovascular disease and lower socioeconomic status that exists in First Nations communities relative to the rest of the Canadian population . The results of the trial demonstrate that active text messaging was not better than passive messaging in terms of reducing systolic BP (between‐group difference of 0.8 mm Hg [95% CI: −4.2 to +5.8 mm Hg]), diastolic BP (−1.0 mm Hg [−3.7 to 1.8 mm Hg]) or achieving BP control (37.5% vs 32.8%; P = 0.6) …”