JMIR Publications

ABSTRACT

Background:

The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring in promoting health outcomes and behavioral changes among hypertensive patients, is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among hypertensive individuals.

Objective:

The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the Behaviour Change Wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence.

Methods:

A two-arm, randomized trial design was employed. Sixty-eight hypertensive patients aged over 60 were randomly assigned in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: 1. Developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP. 2. Utilizing the BCW theory to select behavior change techniques (BCTs) 3. Constructing the intervention's logic following the guidelines of the DMIC model. 4. Creating an intervention manual including the elements above. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes include BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t-tests, chi-square tests, paired t-tests, and McNemar's tests employed. A P-value less than .05 was considered statistically significant.

Results:

The final analysis included 54 participants with a mean age of 67.24±4.19 years, comprising 23 individuals in the experimental group and 31 in the control group. Improvements were observed in systolic blood pressure (SBP:-7.36 mmHg), exercise time(+856.35 MET-min/week), medication adherence (MA:+0.56), BP monitoring frequency (P<.05), diet types/amounts(P<.05), subendocardial viability ratio (SEVR:+0.16), and learning performance (+ 3.23) among experimental group participants (P<.05). Both groups showed a reduction in weight (1.2 and 1.11 kg) after intervention (P<.05). However, there were no statistically significant changes in other health outcomes (P>.05). The adherence curve for exercise and medication displayed a notable decline compared to the first week after health education. The dietary adherence (DA) curve exhibited substantial fluctuations, whereas blood pressure monitoring adherence (BPMA) showed the smallest degree of variation.

Conclusions:

The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in elderly hypertensive patients. However, it is necessary to conduct longer-term and larger-scale trial to validate the effectiveness. Clinical Trial: ChiCTR2200062643 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 14 August 2022).