Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study

Abstract

Objective The purpose of this study was to explore perceived ease of use, usability, and the feasibility of using mobile health applications to manage hypertension self-care in rural Black older adults with hypertension. Methods A convergent parallel mixed method design was used to study a purposeful sample of 30 Black older adults (29 females, 1 male) from rural East Texas. Quantitative data included demographic characteristics and measured blood pressure, height, and weight, along with questionnaires: the Hill-Bone Compliance to High Blood Pressure Therapy Scale, the Krousel-Wood Medication Adherence Scale-4, and the Technology Acceptance Model Questionnaire (adapted). Qualitative data were obtained from five focus groups and analyzed using thematic analysis. Results Mean age was 66.3 ± 9.6 years. Less than half of the participants (46.7%) had a systolic and/or diastolic blood pressure >130/80. Greater participant adherence was noted with the Hill-Bone Compliance scale (63.3%) than the Krousel-Wood scale (23.3%). With the Technology Acceptance Model, perceived ease of use was significantly correlated with behavioral intention (r = 0.654, p < 0.000) and perceived usefulness (r = 0.585, p < 0.001), while behavioral intention was negatively associated with age r = −0.047 ( p =0.009). Focus group data revealed five themes: 1) useful, 2) counterintuitive, 3) communication, 4) comfort with the status quo, and 5) educate/show me how. Conclusion Smartphone technology and other health-related computer technologies were not preferred by older adults in this study due to limited digital literacy. Simplicity and easy navigation in the design of mHealth apps are needed to improve treatment adherence and blood pressure control in rural older adults with hypertension. Clinical Relevance Mobile health applications have the potential to increase self-management of chronic hypertension if users are digitally literate. Health-care providers need to assess older patients for digital literacy and offer educational support and assistance.

Barriers and Facilitators to Implementing Evidence for Improving Medication Adherence in Elderly Patients with Hypertension: a scoping review

“…Other personal attributes are de ned as a broad construct to include other personal traits such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity, and learning style. Language barriers in elderly patients were also found to hinder the implementation of the evidence, leading to poor communication between healthcare professionals and them (29), as well as refusal to use smartphones because of their limited knowledge, lack of skills in using mobile phones, and fear of lack of privacy and mistrust (30,34). Also, having dementia was considered to be a barrier factor(26).…”

“…Pharmacy re ll-adherence metrics can identify potential clinical adherence issues and facilitate targeted interventions, and pharmacists can then use this information to promote patient adherence. Complexity was mentioned in 2 studies, with easy-to-use mobile apps(30), multimodal interventions including individualized teaching on medication adherence and healthy lifestyles, lea ets on medication adherence and healthy lifestyles, weekly medication reminder boxes and follow up telephone reminders, as well as nurses contributing to improving medication adherence…”

Smartphone App Designed to Collect Health Information in Older Adults: Usability Study

“…We also sought to understand whether participant feedback differed depending on the response format of each measure. Because FHS participants were White, we enrolled a diverse sample of older adults at a second site to understand if any additional barriers to mobile app survey completion were observed given that digital literacy and preferences for using technologies can vary across older adults of different races and ethnic backgrounds [12,18]. Importantly, little is known about the usability of mobile apps for racially or ethnically diverse populations [8].…”