Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study
Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study
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DOI：
10.2196/12639
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发表时间：
2019-12-09
影响因子：
5
通讯作者：
Tobe, Sheldon W.
中科院分区：
文献类型：
--
作者：
Barsky, Jordan;Hunter, Rebekah;Tobe, Sheldon W.
背景：DREAM-GLOBAL（在原住民和低收入和中等收入国家诊断高血压，采取行动和降低血压的管理）研究了加拿大原住民和坦桑尼亚社区基于短信的血压测量和高血压管理系统。 SMS 文本消息的使用因其可扩展性、可定制性、可转移性和成本效益而成为全球医疗保健计划中的一个新兴关注点。 目的：本研究的目的是评估主动高血压管理消息或被动健康行为消息对降低血压的差异的影响。该系统设计用于在具有无线可用性的偏远地区实施。这项研究描述了技术组成部分的实施和评估，包括血压测量传输的定量数据以及从参与者、医疗保健提供者和社区领导层收集的系统运行方面的定性数据。 方法：该研究在六个偏远的加拿大原住民社区和两个坦桑尼亚农村社区进行。社区卫生工作者采集血压读数，并通过蓝牙传输到手机，然后无线传输到编程的中央服务器。读数也从服务器发送到参与者自己的手机上。参与者还在手机上每两周收到一次定制的短信。从研究中央服务器收集血压读数传输的定量数据。通过调查、焦点小组以及对参与者、医疗保健提供者和健康领导者的关键信息访谈来收集定性数据。 结果：在加拿大，2014 年 2 月至 2017 年 2 月期间，来自 243 名患者的 2818 份血压读数被传输到中央服务器。在坦桑尼亚，2014 年 10 月至 2015 年 8 月期间，130 名患者的 1165 份读数被传输到中央服务器。蓝牙技术的使用使得信息能够安全、可靠地从参与者传输到他们的医疗保健提供者。 187 名参与者中的 137 名 (73.2%) 参与者对时间安排和频率感到满意，支持在周一和周四上午 11 点发送两次每周消息的过程。共有 97.0% (164/169) 的受访者表示，他们会向患有高血压的朋友或亲戚推荐参加 DREAM-GLOBAL 计划。结论：在偏远社区，DREAM-GLOBAL 研究帮助当地医疗保健提供者提供血压管理计划，使患者和社区工作人员感受到联系。该研究的技术部分按计划实施，患者通过短信和移动健康计划感到在管理中得到了支持。通过故障排除解决了技术问题。总体而言，该研究项目的技术方面增强了临床护理和研究评估，并受到参与者、卫生保健工作者和社区领导的好评。
Background: DREAM-GLOBAL (Diagnosing hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging-based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness.Objective: The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership.Methods: The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant's own phone as well. Participants also received biweekly tailored SMS text messages on their phones Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership.Results: In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension.Conclusions: In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership.