Phases in development of an interactive mobile phone-based system to support self-management of hypertension

Inger Hallberg, Charles Taft, Agneta Ranerup, Ulrika Bengtsson, Mikael Hoffmann, Stefan Höfer, Dick Kasperowski, Asa Mäkitalo, Mona Lundin, Lena Ring, Ulf Rosenqvist, Karin Kjellgren, Inger Hallberg, Charles Taft, Agneta Ranerup, Ulrika Bengtsson, Mikael Hoffmann, Stefan Höfer, Dick Kasperowski, Asa Mäkitalo, Mona Lundin, Lena Ring, Ulf Rosenqvist, Karin Kjellgren

Abstract

Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%-50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.

Keywords: adherence; blood pressure; cellular phone; communication; devices; person-centered care.

Figures

Figure 1
Figure 1
Flowchart of the research program.
Figure 2
Figure 2
Overview of the interactive self-management support system. Notes: The system consists of: (A) mobile phone-based system for the self-report questions, together with optional motivational messages and reminders; (B) blood pressure device; (C) database for real-time registration of the daily self-reports captured from the mobile phone; and (D) web-based platform for real-time visualization of the patients’ reported data, available after log-in for the patient and physician/nurse and, for example, at consultations.
Figure 3
Figure 3
Graph shows combined responses to daily physical activity and perceived levels of stress over 8-week period.
Figure 4
Figure 4
Screenshot from the web-based platform (prepilot study of 12 weeks). Notes: Upper graphs show blood pressure. Systolic (black squares) and diastolic (red dots). Bottom graph shows drug intake (red squares). A distinct rise in blood pressure can be seen when the patient did not take the antihypertensive drug The communication system for mobile phones Circadian Questions (CQ) was used (http://www.cqmobil.se).

References

    1. Marshall IJ, Wolfe CD, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012;345:e3953.
    1. Sabaté E, editor. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003. [Accessed April 2, 2014]. Available from: .
    1. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303(20):2043–2050.
    1. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260.
    1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–2128.
    1. Tsiantou V, Pantzou P, Pavi E, Koulierakis G, Kyriopoulos J. Factors affecting adherence to antihypertensive medication in Greece: results from a qualitative study. Patient Prefer Adherence. 2010;4:335–343.
    1. Jolles EP, Clark AM, Braam B. Getting the message across: opportunities and obstacles in effective communication in hypertension care. J Hypertens. 2012;30(8):1500–1510.
    1. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension [review] Cochrane Database Syst Rev. 2010;3:CD005182.
    1. Nundy S, Dick JJ, Solomon MC, Peek ME. Developing a behavioral model for mobile phone-based diabetes interventions. Patient Educ Couns. 2013;90(1):125–132.
    1. Bokhour BG, Cohn ES, Cortés DE, et al. The role of patients’ explanatory models and daily-lived experience in hypertension self-management. J Gen Intern Med. 2012;27(12):1626–1634.
    1. Haynes RB, Ackloo E, Sahota N, McDonald Heather P, Yao X. Interventions for enhancing medication adherence [review] Cochrane Database Syst Rev. 2008;2:CD000011.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, Medical Research Council Guidance Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.
    1. Bosworth HB, Olsen MK, Neary A, et al. Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Educ Couns. 2008;70(3):338–347.
    1. World Health Organization . mHealth: New Horizons for Health through Mobile Technologies Second Global Survey on eHealth Global Observatory for eHealth Series. Vol. 3. Geneva, Switzerland: World Health Organization; 2011.
    1. Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care [review] Cochrane Database Syst Rev. 2012;12:CD007457.
    1. Li LC, Townsend AF, Badley EM. Self-management interventions in the digital age: new approaches to support people with rheumatologic conditions. Best Pract Res Clin Rheumatol. 2012;26(3):321–333.
    1. de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses [review] Cochrane Database Syst Rev. 2012;12:CD007459.
    1. Blake H. Mobile phone technology in chronic disease management. Nurs Stand. 2008;23(12):43–46.
    1. Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol. 2013;29(5):579–585.
    1. Whittaker R, Merry S, Dorey E, Maddison R. A development and evaluation process for mHealth interventions: examples from New Zealand. J Health Commun. 2012;17(Suppl 1):11–21.
    1. Ekman I, Swedberg K, Taft C, et al. Person-centered care – ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248–251.
    1. Spinuzzi C. The methodology of participatory design. Technical Communication. 2005;52(2):163–174.
    1. US Department of Health and Human Services, Food and Drug Administration . Guidance for Industry: Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. Rockville, MD, USA: Food and Drug Administration; 2009. [Accessed April 2, 2014]. Available from: .
    1. World Medical Association Inc . Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. Ferney-Voltaire; France: 2008. [Accessed April 2, 2014]. Available from: .
    1. Göteborg University Mobile Phone in Hypertension Management. [Accessed March 26, 2014]. Available from: . NLM identifier: NCT01510301.
    1. Mead N, Bower P. Measuring patient-centredness: a comparison of three observation-based instruments. Patient Educ Couns. 2000;39(1):71–80.
    1. Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil. 2007;29(20–21):1555–1565.
    1. Kucukarslan SN. A review of published studies of patients’ illness perceptions and medication adherence: lessons learned and future directions. Res Social Adm Pharm. 2012;8(5):371–382.
    1. Leventhal H, Leventhal EA, Breland JY. Cognitive science speaks to the “common-sense” of chronic illness management. Ann Behav Med. 2011;41(2):152–163.
    1. Meyer D, Leventhal H, Gutmann M. Common-sense models of illness: the example of hypertension. Health Psychol. 1985;4(2):115–135.
    1. Erickson SR, Williams BC, Gruppen LD. Perceived symptoms and health-related quality of life reported by uncomplicated hypertensive patients compared to normal controls. J Hum Hypertens. 2001;15(8):539–548.
    1. Benson J, Britten N. What effects do patients feel from their antihypertensive tablets and how do they react to them? Qualitative analysis of interviews with patients. Fam Pract. 2006;23(1):80–87.
    1. Svensson S, Kjellgren KI. Adverse events and patients’ perceptions of antihypertensive drug effectiveness. J Hum Hypertens. 2003;17(10):671–675.
    1. Middeke M, Lemmer B, Schaaf B, Eckes L. Prevalence of hypertension-attributed symptoms in routine clinical practice: a general practitioners-based study. J Hum Hypertens. 2008;22(4):252–258.
    1. Kjellgren KI, Ahlner J, Dahlöf B, Gill H, Hedner T, Säljö R. Perceived symptoms amongst hypertensive patients in routine clinical practice – a population-based study. J Intern Med. 1998;244(4):325–332.
    1. Kiousis S. Interactivity: a concept explication. New Media and Society. 2002;4(3):355–383.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
    1. Bengtsson U, Kasperowski D, Ring L, Kjellgren K. Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives. Blood Press. 2014 Feb 24; Epub.
    1. Beatty PC, Willis GB. Research Synthesis: The Practice of Cognitive Interviewing. Public Opin Q. 2007;71(2):287–311.
    1. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity – establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO Good Research Practices Task Force report: part 2 – assessing respondent understanding. Value Health. 2011;14(8):978–988.
    1. O’Brien E, Atkins N, Stergiou G, et al. Working Group on Blood Pressure Monitoring of the European Society of Hypertension European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010;15(1):23–38.
    1. Ekedahl A, Hoffmann M. Patients’ information on their prescribed current treatment. J Pharm Health Serv Res. 2012;3(2):79–84.
    1. Jordan B, Henderson A. Interaction Analysis: Foundations and Practice. Journal of the Learning Sciences. 1995;4(1):39–103.
    1. Ranerup A, Hallberg I, Bengtsson U, Kjellgren K. Mastery and Autonomy in Medication With a Mobile Self-Report System – A Project in Action: Adjunct Proceedings of the Seventh International Conference on Persuasive Technology; June 6–8, 2012. Linköping, Sweden: Linköping University Electronic Press; 2012.
    1. Mancia G, Fagard R, Narkiewicz K, et al. Task Force Members 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertens. 2013;31(7):1281–1357.
    1. Baguet JP. Out-of-office blood pressure: from measurement to control. Integr Blood Press Control. 2012;5:27–34.
    1. Snyder CF, Aaronson NK, Choucair AK, et al. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res. 2012;21(8):1305–1314.
    1. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15(3):231–240.
    1. Kronish IM, Ye S. Adherence to cardiovascular medications: lessons learned and future directions. Prog Cardiovasc Dis. 2013;55(6):590–600.
    1. Lupton D. Quantifying the body: monitoring and measuring health in the age of mHealth technologies. Crit Public Health. 2013;23(4):393–403.
    1. Go AS, Bauman M, King SM, et al. An Effective Approach to High Blood Pressure Control: A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2013 Nov 15; Epub.
    1. McGillicuddy JW, Gregoski MJ, Weiland AK, et al. Mobile health medication adherence and blood pressure control in renal transplant recipients: proof-of-concept randomized controlled trial. JMIR Res Protoc. 2013;2(2):e32.
    1. Kiselev AR, Gridnev VI, Shvartz VA, Posnenkova OM, Dovgalevsky PY. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension. J Am Soc Hypertens. 2012;6(5):346–355.
    1. Rhee H, Allen J, Mammen J, Swift M. Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study. Patient Prefer Adherence. 2014;8:63–72.
    1. Pearson TA, Palaniappan LP, Artinian NT, et al. American Heart Association Council on Epidemiology and Prevention American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 Update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013;127(16):1730–1753.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi