JMIR Publications

ABSTRACT

Background:

Hypertension has become an important global public health challenge. With the increasing use of smart devices, mobile health (mHealth) app intervention has become a viable strategy to improve clinical outcomes for patients with hypertension. Currently, however, the evidence on the effect of mHealth app interventions on self-management in hypertensive patients has yet to be updated, and the active ingredients in interventions that promote behavior change are unclear.

Objective:

To evaluate the effect of mHealth app intervention on blood pressure (BP) management, investigate the association between the effect size of intervention and study design, and identify the behavior change techniques (BCTs) utilized in interventions.

Methods:

A literature search was conducted in six online databases from January 2009 to October 2023 for randomized controlled trial (RCT) studies reporting the application of mHealth app in self-management interventions among patients with hypertension. Cochrane risk-of-bias v2 tool for RCT was used to assess the quality of the included studies. The coding of BCTs was performed according to Michie et al.’s Taxonomy of BCTs v1. The effect of interventions was evaluated by calculating the SDs and 95% CI using the Review Manager software v5.4.1. The association between study design factors and effect size of interventions were explored by subgroup analyses.

Results:

A total of 20 studies were included in the systematic review and 16 of them were included in the meta-analysis. 21 different BCTs from 12 BCT categories were reported in mHealth app interventions, with a mean number of BCTs of 8.7. mHealth app interventions had a -5.78mmHg (95% CI: -7.86mmHg to -3.69mmHg) reduction in SBP, and a -3.03mmHg (95% CI: -4.19mmHg to -1.87mmHg) reduction in DBP. The effect of interventions was associated with study design factors, including mHealth app components, presence of theorical foundation, intervention duration and number of BCTs. ‘Goal setting (behavior)’, ‘Social support’ and ‘Demonstration of the behavior’ were effective BCTs for BP management.

Conclusions:

The self-management interventions based on mHealth app were effective strategy for lowering BP in patients with hypertension. The effect of interventions was influenced by factors of study design and BCTs.