Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Mar 20, 2018)
Date Submitted: Dec 26, 2017
Open Peer Review Period: Dec 26, 2017 - Mar 20, 2018
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Combining Wireless technology and Behavioral Economics to Engage Patients with cardiometabolic disease (WiBEEP): A Pilot Study
Background:
The long-term management of cardiometabolic diseases, such as type 2 diabetes and hypertension, is complex and can be facilitated by supporting patient-directed behavioral changes. The concurrent application of wireless technology and personalized text messages (PTMs) based on behavioral economics in managing cardiometabolic diseases although promising, has not been studied.
Objective:
The aim of this pilot study was to evaluate the feasibility and acceptability of the concurrent application of wireless home blood pressure (BP) monitoring (as an example of “automatic hovering”) and PTMs (as an example of “nudging”) targeting pharmacotherapy and lifestyle habits in patients with type 2 diabetes and/or hypertension.
Methods:
The Wireless technology and Behavioral Economics to Engage Patients with cardiometabolic disease (WiBEEP) study was a single-arm, open-label, 7-week long pilot study in 12 patients (age 58.5 y) with access to a mobile phone. The study took place at Tufts Medical Center (Boston, MA) between March and September 2017. All patients received PTMs; nine patients received wireless home BP monitoring. At baseline, patients completed questionnaires to learn about their health goals and to assess medication adherence; at the end of week 7, all participants completed questionnaires to evaluate the feasibility and acceptability of the intervention and assess for medication adherence. Hemoglobin A1c was ascertained from data collected during routine clinical care in 7 patients.
Results:
The majority of patients reported the texts messages to be easy to understand (88%), appropriate in frequency (71%) and language (88%). All patients reported BP monitoring to be useful. Mean arterial pressure was lower at the end-of-study compared to baseline (-3.4 mmHg [95% CI, -5 to -1.8]. Mean change in HbA1c was -0.31% [95% CI, -0.56 to -0.06].
Conclusions:
Among patients with type 2 diabetes and/or hypertension the combination of wireless BP monitoring and lifestyle-focused text messaging was feasible and acceptable. Larger studies will determine the long-term effectiveness of such an approach.
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