JMIR Publications

ABSTRACT

Background:

Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals’ involvement in SDM and mHealth usage across different racial and ethnic groups in the United States (U.S.) is still limited.

Objective:

To investigate the extent of involvement in SDM and the utilization of mHealth technology in health-related activities among U.S adults with hypertension from diverse racial and ethnic backgrounds, and to examine whether the mHealth usage differed by individual’ level of engagement in SDM.

Methods:

This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted in the U.S. Adults with self-reported hypertension and race/ethnicity data were included. The exposure of interest was race/ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: “In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?”. mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race/ethnicity and SDM/mHealth usage adjusted for covariates and stratified by the level of engagement in SDM.

Results:

This study included 4893 adults with hypertension, the mean (± standard deviation) age was 61 (±13) years; of whom 53% were female, 61% (n=3006) were non-Hispanic (NH) White, 19% (n=907) were NH Black or African American, 12% (n=605) were Hispanic, 4% (n=193) were NH Asian, and 4% (n=182) were NH other. Compared to the NH White adults, NH Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio 1.70, 95% confidence interval [CI], 1.23-2.34), share health information (1.46 [95% CI, 1.02-2.08]), and discuss health decisions with health providers (1.38 [95% CI, 1.02-1.87]). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (0.51 [95% CI, 0.26-0.99]) and were more likely to use mHealth to track progress on a health-related goal (2.07 [95% CI, 1.28-3.34]) than NH White adults. Hispanic adults were less likely to use mHealth to share health information (0.47 [95% CI, 0.33-0.67]) and discuss health decisions with health providers (0.65 [95% CI, 0.46-0.94]) compared to NH White adults.

Conclusions:

This study observed racial/ethnic disparities in SDM and mHealth usage among U.S. adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and utilization of mHealth technology within racially and ethnically diverse populations.