Effectiveness and Acceptability of a Mobile Phone Text Messaging Intervention to Improve Blood Pressure Control (TEXT4BP) among Patients with Hypertension in Nepal: A Feasibility Randomised Controlled Trial

Abstract

Background: Uncontrolled blood pressure (BP) is the leading cause of preventable deaths in low-and middle-income countries. mHealth interventions, such as mobile phone text messaging, are a promising tool to improve BP control, but research on feasibility and effectiveness in resource-limited settings remains limited.Objective: This feasibility study assessed the effectiveness and acceptability of a mobile phone text messaging intervention (TEXT4BP) to improve BP control and treatment adherence among patients with hypertension in Nepal. Methods:The TEXT4BP study was a two-arm, parallel-group, unblinded, randomised controlled pilot trial that included 200 participants (1:1) (mean age: 50.5 years, 44.5% women) with hypertension at a tertiary referral hospital in Kathmandu, Nepal. Patients in the intervention arm (n = 100) received text messages three times per week for three months. The control arm (n = 100) received standard care. The COM-B model informed contextual co-designed text messages. Primary outcomes were change in BP and medication adherence at three months. Secondary outcomes included BP control, medication adherence self-efficacy and knowledge of hypertension. A nested qualitative study assessed the acceptability of the intervention.Results: At three months, the intervention group had greater reductions in systolic and diastolic BP vs usual care [-7.09/-5.86 (p ≤ 0.003) vs -0.77/-1.35 (p ≥ 0.28) mmHg] [adjusted difference: systolic β = -6.50 (95% CI, -12.6; -0.33) and diastolic BP β = -4.60 (95% CI, -8.16; -1.04)], coupled with a greater proportion achieving target BP (70% vs 48%, p = 0.006). The intervention arm showed an improvement in compliance to antihypertensive therapy (p < 0.001), medication adherence (p < 0.001), medication adherence self-efficacy (p = 0.023) and knowledge on hypertension and its treatment (p = 0.013). Participants expressed a high rate of acceptability and desire to continue the TEXT4BP intervention. Conclusion:The TEXT4BP study provides promising evidence that text messaging intervention is feasible, acceptable, and effective to improve BP control in low-resource settings.

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

“…As these were the result of a thematic analysis, there are cases of multiple observations of the same theme in the same article; therefore, the frequency may not have aligned with the number of references. Of the 92, there were 31 (34%) instances of an increase in physical health [ 30 , 33 , 39 - 42 , 44 , 47 , 49 , 51 - 55 , 57 , 58 ]. This theme included maximum oxygen consumption, comparison of bad cholesterol with good cholesterol, pain, diastolic blood pressure, systolic blood pressure, hypoglycemia, lipids, overall blood pressure, average blood sugar over last 3 months, physical function, fasting blood glucose, cholesterol, and BMI.…”

The Adoption and Acceptance of mHealth Interventions for Self-Management of Hypertension Among Adult Patients: A Systematic Review

“…Bhandari et al also reported decreased systolic and diastolic blood pressure in the intervention group that was exposed to automated text messages and video messages. In addition, the intervention arm showed an improvement in compliance with antihypertensive therapy (p<0.001), medication adherence (p<0.001), medication adherence self-efficacy (p=0.023), and knowledge of hypertension and its treatment (p=0.013) [26]. [23].…”

“…Various researchers have discussed a couple of outcomes, more appearing to be a reduction in blood pressure, systolic and diastolic blood pressure, user acceptance and user compliance, medication adherence, and reduced hypertensive symptoms. Of the 13 studies, 10 [ 19 , 20 , 22 - 26 , 29 - 31 ] have reported a significant reduction in blood pressure following the use of automated messages, video messages, self-monitoring applications, and mobile applications. Davidson et al reported using reminders and signals as mobile health interventions among individuals with essential hypertension [ 24 ].…”

“…Bhandari et al also reported decreased systolic and diastolic blood pressure in the intervention group that was exposed to automated text messages and video messages. In addition, the intervention arm showed an improvement in compliance with antihypertensive therapy (p<0.001), medication adherence (p<0.001), medication adherence self-efficacy (p=0.023), and knowledge of hypertension and its treatment (p=0.013) [ 26 ]. Chandler et al also noted that systolic blood pressure averages were significantly lower in the SMASH versus control groups (first month: 125.3 versus 140.6; third month: 120.4 versus 137.5, sixth month: 121.2 versus 145.7; ninth month: 121.8 versus 145.7; p<0.01) [ 23 ].…”

“…Participants expressed a high acceptability rate and a desire to continue the TEXT4BP intervention [ 26 ]. This study reported positive user acceptance and the user’s willingness to continue with the mobile health intervention for self-management.…”