JMIR Publications

ABSTRACT

Background:

Technology-enabled interventions for chronic disease management, such as telehealth systems for hypertension self-monitoring, have demonstrated effectiveness but face challenges with sustained usage and high attrition rates. Understanding the factors associated with continued engagement is crucial for enhancing intervention design and sustainability. This study investigates the sustained usage of the Primary Technology Enhanced Care for Hypertension Program (PTEC-HT) in Singapore’s public primary care setting, focusing on patient adherence and the generation of Missed Reading (MR) alerts.

Objective:

To explore the sustained usage of the PTEC-HT intervention by: (1) quantitatively describing characteristics of participants generating MR alerts, (2) identifying factors associated with MR alert generation, (3) profiling participant subgroups based on MR alert patterns and blood pressure (BP) control, and (4) examining temporal trajectories of MR alerts and associated conversion rates over 12 months.

Methods:

A longitudinal observational study was conducted using backend data from the PTEC-HT system. The study included 491 participants, categorized into MR alert generator and non-generator groups, recruited before June 2022. Logistic regression identified factors associated with MR alert generation, while Latent Class Analysis (LCA) profiled participant subgroups. Generalized Estimating Equations (GEE) examined temporal trajectories of MR alerts and conversion rates. Statistical significance was set at 5%.

Results:

Results:

MR alert generators were younger (mean age 58.6 years vs. 61.6 years; P=.011) and had a longer program duration (15.6 months vs. 15.0 months; P =.038). Age (OR 0.97, 95% CI 0.95-0.99; P =.007) and program duration (OR 1.11, 95% CI 1.01-1.22; P =.030) were significantly associated with MR alert generation. LCA identified three latent classes: (a) Compliant Triers (low MR alerts, poor BP control), (b) Compliant Achievers (low MR alerts, good BP control, 74.9% (368/491) of sample), and (c) Non-Compliant Achievers (high MR alerts, good BP control). Temporal analysis showed consistent trajectories for Missed Reading Reminder (MRR) message counts and conversion rates, with MR alert generators having higher MRR message counts but lower conversion rates compared to non-generators.

Conclusions:

Sustained usage of the PTEC-HT program is influenced by age and program duration, with younger participants and longer durations linked to higher MR alert generation. The identification of distinct user profiles suggests that tailored intervention features could enhance engagement and BP control. The study underscores the importance of monitoring compliance patterns and optimizing message content to improve conversion rates. These insights contribute to the understanding of telehealth engagement dynamics and support targeted interventions for hypertension management.