Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 22, 2023
Open Peer Review Period: Sep 21, 2023 - Oct 9, 2023
Date Accepted: Feb 26, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Health Behavioral Digital Intervention for Hypertensive Patients Based on Intelligent Health Promotion System and WeChat: Development and Evaluation
ABSTRACT
Background:
The effectiveness of timely medication, physical activity (PA), healthy diet, and blood pressure (BP) monitoring in managing hypertension is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether interventions delivered through the Internet or smartphone applications can improve adherence to healthy behaviors among individuals with hypertension.
Objective:
The aim of this study 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 among patients with hypertension.
Methods:
A two-arm, randomized trial design was employed. Sixty-eight hypertensive patients over 60 were randomly allocated 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 personalized health recommendations through the Intelligent Health Promotion System. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine off-line health education and a self-management manual. The primary outcomes include BP and adherence indicators, while the secondary outcomes encompass cardiovascular function indicators, body composition indicators, and learning performance. 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 (mean age 67.24±4.19 years): 23 in the intervention group and 31 in the control group. Improvements were observed in systolic blood pressure (SBP), exercise time, medication adherence (MA), BP monitoring frequency, diet types/amounts, subendocardial viability ratio (SEVR), and learning performance among experimental group participants (P<.05). Both groups showed a reduction in weight 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, future research is required to elucidate the mechanisms. Clinical Trial: ChiCTR2200062643 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 14 August 2022).
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.