The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial

Ju Young Kim, Nathan E Wineinger, Steven R Steinhubl, Ju Young Kim, Nathan E Wineinger, Steven R Steinhubl

Abstract

Background: Active engagement in the management of hypertension is important in improving self-management behaviors and clinical outcomes. Mobile phone technology using wireless monitoring tools are now widely available to help individuals monitor their blood pressure, but little is known about the conditions under which such technology can effect positive behavior changes or clinical outcomes.

Objective: To study the influence of wireless self-monitoring program and patient activation measures on health behaviors, medication adherence, and blood pressure levels as well as control of blood pressure in hypertensive patients.

Methods: We examined a subset of 95 hypertensive participants from a 6-month randomized controlled trial designed to determine the utility of a wireless self-monitoring program (n=52 monitoring program, n=43 control), which consisted of a blood pressure monitoring device connected with a mobile phone, reminders for self-monitoring, a Web-based disease management program, and a mobile app for monitoring and education, compared with the control group receiving a standard disease management program. Study participants provided measures of patient activation, health behaviors including smoking, drinking, and exercise, medication adherence, and blood pressure levels. We assessed the influence of wireless self-monitoring as a moderator of the relationship between patient activation and health behaviors, medication adherence, and control of blood pressure.

Results: Improvements in patient activation were associated with improvements in cigarette smoking (beta=-0.46, P<.001) and blood pressure control (beta=0.04, P=.02). This relationship was further strengthened in reducing cigarettes (beta=-0.60, P<.001), alcohol drinking (beta=-0.26, P=.01), and systolic (beta=-0.27, P=.02) and diastolic blood pressure (beta=-0.34, P=.007) at 6 months among individuals participating in the wireless self-monitoring program. No differences were observed with respect to medication adherence.

Conclusions: Participation in a wireless self-monitoring program provides individuals motivated to improve their health management with an added benefit above and beyond that of motivation alone. Hypertensive individuals eager to change health behaviors are excellent candidates for mobile health self-monitoring..

Trial registration: ClinicalTrials.gov NCT01975428, https://ichgcp.net/clinical-trials-registry/NCT01975428 (Archived by WebCite at http://www.webcitation.org/6iSO5OgOG).

Keywords: blood pressure self-monitoring; health behavior; medication adherence; patient participation; telemedicine; wireless technology.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study enrollment flowchart.
Figure 2
Figure 2
Screenshot of HealthyCircles online portal in wireless monitoring program.
Figure 3
Figure 3
Screenshot of self-monitoring blood pressure data on mobile phone.

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