Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension

Abstract

BackgroundApproximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed.ObjectiveThe goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension.MethodsIn-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors.ResultsA number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider.ConclusionsInformation from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider.

A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App

“…Participants’ feedback also suggests that efficacious approaches should aim to strike a balance between the need for individualized and collective social support for more meaningful and beneficial user experiences. Similar themes advocating for personalization to the individual’s needs were identified by AA gatekeeper stakeholders involved in the development of an mHealth intervention for patients with hypertension [ 39 ]. Consistent with our participants, they emphasized the need to include churches in the launch of mHealth interventions.…”

“…As maintenance of a healthy religious/spiritual life is central to our prioritized audience [ 38 ], our connection of faith and healthy lifestyle through spiritual messaging and biblical scripture was harmonious. It has been previously shown that positive messaging through scripture may heighten the acceptability and use of mHealth interventions by AAs [ 39 ]. Our cultural tailoring strategies through both superficial (visual imagery of AAs) and deep (the Black Church) structures also likely increased the receptivity to adapting positive behavioral change strategies [ 40 ].…”

Validação de mensagens telefônicas para promoção da saúde de pessoas com HIV

“…A research study carried out with hypertensive elderly people revealed an interest in receiving objective and simple phone messages that stimulated adhesion to the treatment. (6) Regarding this fact, it is important to emphasize that effective communication between client and professional is fundamental in health care. To achieve this, it is necessary to provide information in a language suitable for the educational and cultural level of the client.…”

“…(4) Evidence points to the positive use of Short Message Service (SMS) to send text messages to boost health habits among clients with chronic conditions. (5)(6)(7)(8) With the expanded use of the Internet, smartphone apps such as WhatsApp Messenger have potentialized instant communication between client and professional regarding health communication, with a variety of resources of interaction, (9) increasing the possibilities of the use of text messages in health care.…”

Peace of mind: A community-industry-academic partnership to adapt dementia technology for Anishinaabe communities on Manitoulin Island

“…Within mHealth technologies a handful of products have been developed within Indigenous or American Indian communities using community-based participatory research (CBPR) methodologies including breastfeeding, medication adherence, alcohol consumption during pregnancy, hypertension, and general healthy lifestyle support. 14 – 20 While these are notably important health priorities, none of these medical conditions are related to dementia and aging-in-place. The general exploration of mHealth or eHealth applications among adults supports the feasibility and indicates a general interest in technologies, though economic and connectivity limitations in rural and remote areas are always a strong concern.…”