Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system

I Hallberg, A Ranerup, K Kjellgren, I Hallberg, A Ranerup, K Kjellgren

Abstract

Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients' experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.

Figures

Figure 1
Figure 1
Overview of the study procedures.
Figure 2
Figure 2
Overview of the sub-themes and overarching themes. The figure shows the relation between the themes.

References

    1. 1Sabate E. World Health Organization. Adherence to long-term therapies. Evidence for action. 2003. Geneva, Switzerland, Available from Accessed January 7, 2014.
    1. 2Denford S, Frost J, Dieppe P, Britten N. Doctors' understanding of individualisation of drug treatments: a qualitative interview study. BMJ Open 2013; 3: e002706.
    1. 3Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25 Suppl 2): S76–S99.
    1. 4Middeke 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. 5Marshall IJ, Wolfe CD, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ 2012; 345: e3953.
    1. 6World Health Organization. mHealth: New Horizons for Health through Mobile Technologies. Second Global Survey on eHealth. Global Observatory for eHealth Series. (World Health Organization: Geneva, Switzerland), 2011; 3.
    1. 7Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol 2013; 29(5): 579–585.
    1. 8Jolles 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. 9Patel S, Jacobus-Kantor L, Marshall L, Ritchie C, Kaplinski M, Khurana PS et al. Mobilizing your medications: an automated medication reminder application for mobile phones and hypertension medication adherence in a high-risk urban population. J Diabetes Sci Technol 2013; 7(3): 630–639.
    1. 10Logan AG, McIsaac WJ, Tisler A, Irvine MJ, Saunders A, Dunai A et al. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients. Am J Hypertens 2007; 20(9): 942–948.
    1. 11Logan AG, Irvine MJ, McIsaac WJ, Tisler A, Rossos PG, Easty A et al. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension 2012; 60(1): 51–57.
    1. 12de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev 2012 Dec 12; 12: CD007459.
    1. 13Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev 2010 Mar 17; (3): CD005182.
    1. 14Hallberg I, Taft C, Ranerup A, Bengtsson U, Hoffmann M, Hofer S et al. Phases in development of an interactive mobile phone-based system to support self-management of hypertension. Integr Blood Press Control 2014; 7: 19–28.
    1. 15Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E et al. Person-centered care—ready for prime time. Eur J Cardiovasc Nurs 2011; 10(4): 248–251.
    1. 16Mead N, Bower P. Measuring patient-centredness: a comparison of three observation-based instruments. Patient Educ Couns 2000; 39(1): 71–80.
    1. 17US Department of Health and Human Services, Food and Drug AdministrationGuidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims 2009. Food and Drug Administration, Available from: . Accessed January 7, 2015.
    1. 18Bengtsson 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; 23(5): 288–295.
    1. 19Kjellgren KI, Ahlner J, Dahlof B, Gill H, Hedner T, Saljo R. Perceived symptoms amongst hypertensive patients in routine clinical practice- a population-based study. J Intern Med 1998; 244(4): 325–332.
    1. 20Ranerup A, Hallberg I. Actors and intentions in the development process of a mobile phone platform for self-management of hypertension. Inform Health Soc Care, e-pub ahead of print 24 June 2014.
    1. 21Bengtsson U, Kjellgren K, Hofer S, Taft C, Ring L. Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2: Content validity and usability. Blood Press 2014; 23(5): 296–306.
    1. 22Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y et al. European Society of Hypertension Practice Guidelines for home blood pressure monitoring. J Hum Hypertens 2010; 24(12): 779–785.
    1. 23O'Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R et al. 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. 24Braun V, Clarke V. Using thematic analysis in psychology. Qual Res in Psychol 2006; 3(2): 77–101.
    1. 25World Medical Association Inc. Declaration of Helsinki: ethical principles for medical research involving human subjects. 2008. Ferney-Voltaire: France, Available from: . Accessed January 7, 2015.
    1. 26Bokhour BG, Cohn ES, Cortes DE, Solomon JL, Fix GM, Elwy AR 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. 27Howes F, Warnecke E, Nelson M. Barriers to lifestyle risk factor assessment and management in hypertension: a qualitative study of Australian general practitioners. J Hum Hypertens 2013; 27(8): 474–478.
    1. 28Kronish IM, Ye S. Adherence to cardiovascular medications: lessons learned and future directions. Prog Cardiovasc Dis 2013; 55(6): 590–600.
    1. 29Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 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. 30Go AS, Bauman M, King SMC, Fonarow GC, Lawrence W, Williams KA 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; 63: 878–885.
    1. 31Agarwal S, Lau CT. Remote health monitoring using mobile phones and Web services. Telemed J E Health 2010; 16(5): 603–607.
    1. 32Rasmussen E, Jørgensen K, Leyshon S (eds). Person-centred care - co-creating a healthcare sector for future. DNV GL and Monday Morning / Sustainia: Rosendahls, Copenhagen, Denmark, 2014. Available from: . Accessed January 7, 2015.
    1. 33McManus RJ, Mant J, Haque M, Bray EP, Bryan S, Greenfield SM et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: The tasmin-sr randomized clinical trial. JAMA 2014; 312(8): 799–808.
    1. 34Stoddart A, Hanley J, Wild S, Pagliari C, Paterson M, Lewis S et al. Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial. BMJ Open 2013; 3: e002681.
    1. 35Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health 2008; 31(4): 391–398.
    1. 36Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation 1986; 1986(30): 73–84.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere