JMIR Publications

ABSTRACT

Background:

Hypertension is a significant problem in the United States, affecting 1 in 3 adults over the age of 18 and is associated with higher risk for cardiovascular disease and stroke. Prevalence of hypertension is increased in medically underserved areas (MUAs). Mobile health technology, such as digital self-monitoring devices, has been shown to improve management of chronic health conditions, however, patients from MUAs have reduced access to these devices because of limited resources and low health literacy. Health coaches and peer training programs are a potentially cost-effective solution for the shortage of physicians available to manage hypertension in MUAs. Activating young people in a health coaching role is a promising strategy to improve community health.

Objective:

This pilot study aims to assess (1) the feasibility of training high school students as health technology coaches in MUAs (2) whether the addition of student health coaches to digital home monitoring improve the frequency of self-monitoring and overall blood pressure (BP) control.

Methods:

Fifteen high school students completed a 3-day health coaching training. Patients who had a documented diagnosis of hypertension were randomly assigned to 1 of 3 intervention arms. The “home monitor alone (HM)” group was provided a QardioArm cuff only to use at their convenience. The “student alone (S)” group was instructed to meet for 30 minutes once a week for 5 weeks with a health coach to create action plans for reducing BP. The “home monitor+student (HM+S)” group received both interventions.

Results:

Participants (n=27) were randomly assigned (9:9:9). All 15 students completed training, while 6/15 students (40%) completed all 5 meetings with their assigned patient. Barriers to feasibility included transportation and patient response drop-off at the end of the study. 92% of students rated their experience as “very good” or higher and 69% reported that this experience made them more likely to go into the medical field. There was a statistically significant difference in frequency of cuff use (HM+S vs HM groups, 37v17, p<0.01). The difference in baseline and final systolic BPs for HM+S, HM and S groups were -11 mmHg, -4 mmHg, and -8 mmHg, respectively. Though not a statistically significant difference between groups (p=0.89), the HM+S group demonstrated the largest reduction in systolic BP.

Conclusions:

This pilot demonstrated feasibility of pairing technology with young student coaches, though challenges existed. The HM+S group used their cuff more than HM group. Patients were more engaged in the HM+S group, which resulted in better BP control.