JMIR Publications

ABSTRACT

Background:

Hypertension (HTN) is known as one of the major public health problems globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone short message service (SMS) is found to be an important remedy for HTN management.

Objective:

The study aimed to develop awareness and improve knowledge in order to enhance lifestyle behavioral changes among hypertensive individuals in a rural community of Bangladesh by using SMS and health education.

Methods:

A prospective randomized 5-months intervention, open-label, parallel group trial was implemented among the hypertensive individuals aged 35 years with either sex. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visit by community health workers (CHWs). After block randomization, they were assigned to either the intervention group (received SMS and health education (n=209)) or the control group (received only health education (n=211)). The primary endpoint was the evaluation of self-reported behavior changes related to their salt, fruits and vegetable intake, physical activity, and blood pressure (BP) and body weight monitoring behaviors. The secondary endpoints were measurements of food salt-intake, urinary salt excretion, BP values and quality of life (QOL).

Results:

During the study period, a total of eight participants were dropped whereas completion rate was 98.1% (412/420). In primary endpoint, the focused behavior, salt intake <6g/day, showed significant chronological improvement in both groups (P<.001). The fruit intake behavior steadily improved in both groups (P<.001). Physical activity showed sudden increase at starting and lasted till the end in both groups (P<.001). On contrary, participants had a habit of taking vegetable everyday with no statistical significance. BP and body weight monitoring were affected by their situation. Beyond our expectation, only salt and fruit intake behavior had time-group differences between two groups (P<.001), and adherence rates were higher in the control group (7.8% vs. 0.6%, respectively). The secondary endpoints resulted in a gradual reduction of food salt concentration and urine salinity, however, average urinary salt excretion remained as 10g/day. Systolic BP and diastolic BP significantly chronologically decreased in both groups (P<.05). All of those supported the self-reported behavior changes. In case of QOL, both groups were improved significantly over the study periods (P<.001).

Conclusions:

The results of our study suggest that our accomplishment of awareness significantly improved self-management behavior among the participants through health education. However, providing SMS-based health education more effective, we need to consider simple and timely messages, and increase benefit of the use of mHealth among the diverse population with various geographical areas. Clinical Trial: Bangladesh Medical Research council (BMRC) Registration # 06025072017, Clinical Trial Registration # NCT03614104, and UMIN # R000033736.