JMIR Publications

ABSTRACT

Background. Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. Objectives. This systematic literature review evaluates the extent to which app-based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. Methods. A systematic search of seven databases identified 4638 articles, of which 227 were included for full text screening. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. Fifteen randomised controlled trials were included in the review. Random effects meta-analysis method was used to account for the distribution of the effect across the studies. Results. In total 7415 patients with hypertension were included in the meta-analyses. Results found that app-based behavioral self-monitoring interventions had a small however significant effect in reducing systolic blood pressure by a mean of 1.64 mmHg (95%CI 2.73mmHg to 0.55mmHg, n=7301; OR=1.60 95%CI 0.74 to 3.42, n=114) and in improving changes in medication adherence behavior (SMD=0.78, 95%CI 0.22 to 1.34) compared to usual care or minimal intervention. The review found no effect of the intervention in supporting improvements in physical activity, healthy diet, alcohol consumption, or smoking cessation behaviors. A subgroup analysis found that self-monitoring behavioral interventions combined with tailored advice resulted in higher and significant reductions in both systolic and diastolic blood pressure in comparison to those not providing tailored advice (SBP = - 2.92 mmHg 95% CI -3.94 to -1.90 n=3102 vs. SBP = - 0.72 mmHg 95% CI -1.67 to 0.23 n=4199, Chi2=9.65, P=.002; DBP = -2.05 mmHg 95% CI -3.10 to -1.01 n=968 vs. DBP = 1.54 mmHg 95% CI -0.53 to 3.61 n=400, Chi2=9.19, P=.002). Conclusion. Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has modest but potentially clinically significant effect in reducing blood pressure. Future studies could use rigorous methods to explore its effects at supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision.