Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses

Abstract

Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = −4.10, 95% CI: [−6.38, −1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials

“…A recent review investigated the effectiveness of mobile health apps for blood pressure management in populations with digital barriers, among other older adults. The authors confirmed the promise of ATs for chronic disease management but also emphasized the need for more studies including vulnerable populations [ 57 ]. The willingness for and success of AT-supported self-management can also be dependent on the disease [ 59 ].…”

“…Only 19 RCTs fulfilled the inclusion criteria. The selected trials were very heterogeneous with respect to the ATs applied as well as the outcomes, which made it difficult to summarize the evidence [ 57 ]. Our analysis did not provide strong confirmation for the overall effectiveness of AT in older adults.…”

“…Almost half of the studies included were pilot or feasibility trials. This shows that there is still a lack of research addressing the use of ATs for older adults at home or in similar settings [ 57 , 62 , 64 ]. A crossover design, where the control group changes to the intervention after a predefined period, was found to be commonly used when evaluating ATs.…”

Digitally Enabled Health Service for the Integrated Management of Hypertension: A Participatory User-Centred Design Process

“…HSMonitor also provides the opportunity to target persons at risk of developing hypertension through personalized decision support, education, and coaching that are pivotal to avoid or delay disease onset and progression. Hypertension is a highly prevalent disease, and although relatively easy ease to treat, it shows heterogeneous outcomes that are influenced by educational background, ethnicity, and age that, for example, can hinder access to primary care [ 29 ]. mHealth solutions such as HSMonitor can play a crucial role in addressing some of these inequalities, providing the opportunity for remote management and telemonitoring that have already proved effective for such patients.…”

Mobile health technology for diverse populations: challenges and opportunities

“…Mobile technology presents an opportunity to reduce financial, geographic, and workforce barriers, but little data currently support its use in populations with digital disparities 2 . A recent article by Khoong et al 3 . systematically reviews the literature to quantify outcomes for these populations and provide a roadmap toward more inclusive mobile health strategies.…”