Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 31, 2018
Open Peer Review Period: Nov 3, 2018 - Dec 29, 2018
Date Accepted: Aug 31, 2019
(closed for review but you can still tweet)
Evaluation of Implementation, User Perspectives and Feedback from DREAM-GLOBAL, a mobile Health Intervention in Canadian Indigenous and Tanzanian Communities for Individuals living with Hypertension
ABSTRACT
Background:
Background:
DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), studied a short message service (SMS) based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS messages is an emerging point of interest in global healthcare initiatives due to its scalability, customizability, transferability, and cost effectiveness. The objective of the study was to assess the effect of active hypertension management messages or passive health behaviours messages on the difference in blood pressure reduction. The aim was to improve health care services in remote and low-resource regions by linking patients and their interprofessional health care team using mobile health technology. The system was designed to use widely available technology, and to be implemented in remote areas with wireless availability.
Objective:
This paper describes the components of the DREAM-GLOBAL study implementation and evaluation of technical components including quantitative data from the transmission of blood pressure measurements as well as qualitative data collected on the operational aspects of the system from the participants, the health care providers and community leadership.
Methods:
The study was implemented in six remote Indigenous Canadian communities and two rural Tanzanian communities. The blood pressure readings were taken by a Community Health Worker with a Bluetooth-enabled blood pressure monitor and transmitted them to their smartphone via a mobile application and then to a programmed central server and to the participant’s health care provider and to the participant’s own phone. Participants received biweekly tailored short messages service (SMS) messages on their phones. Quantitative data on transmission was collected from the study central server. Qualitative data was collected by surveys, focus groups and key informant interviews of participants, health care providers and community leadership.
Results:
In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable, and widespread transmission of information from participant to their health care provider, including transmission of guideline-based SMS messages to participants. Technical issues in transmission of readings occurred largely due to the operating system from older versions of BlackBerry phones. Of the participants surveyed, 164 of 169 (97%) said they would recommend participating in the DREAM-GLOBAL program to a friend or relative with hypertension.
Conclusions:
In remote communities the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned and patients feel supported in their management through the text messaging and mobile health program. Technological issues were solved with troubleshooting; none impaired the overall functioning of the study. Overall the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership. Clinical Trial: Clinicaltrials.gov NCT02111226 https://clinicaltrials.gov/ct2/show/NCT02111226
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