JMIR Publications

ABSTRACT

Background:

Mobile health interventions serve as a scalable opportunity to engage hypertensive individuals in self-measured blood pressure monitoring (SMBP), an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is a text message-based SMBP mHealth trial which aims to reduce BP among hypertensive patients recruited from the emergency department of a low-income, predominately Black city’s safety-net hospital.

Objective:

As the benefits of Reach Out are predicated on participants’ engagement with the intervention, we sought to understand participant’s determinants of engagement with prompted SMBP with tailored feedback (SMBP+feedback).

Methods:

We conducted telephone, semi-structured interviews based on the Digital Behavior Change Interventions (DBCI) framework Participants were purposively sampled from three engagement categories: high engager (≥80% response to SMBP prompts), low engager (≤20% response to BP prompts), and early ender (participants who withdrew from the trial).

Results:

We conducted interviews with 13 participants of which 54% were Black people and the mean age was 53.6 years (SD 13.25). Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider and less likely to be taking anti-hypertensive medications than their counterparts. Overall, participants liked the text-message design of the intervention including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity, with one notable exception of a high engager with high health-related social needs.

Conclusions:

Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants unmet health-related social needs, and strategies to cultivate social norms. Clinical Trial: NCT03422718