mHealth to address uncontrolled hypertension among hypertensive homeless adults

移动医疗解决无家可归成人高血压患者不受控制的高血压问题

• 批准号: 10195799
• 负责人: Ramin Asgary
• 金额: $ 33.65万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-10 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10195799
• 关键词: 21 year old; Address; Adherence; Adopted; Adult; American; Appointment; Attitude; Baby Booms; Behavior; Behavioral; Blood Pressure; Car Phone; Chronic Disease; Clinic; Collaborations; Communication; Communities; Control Groups; Counseling; Data; Diastolic blood pressure; Disease; Disease Management; Dose; Educational Intervention; Effectiveness; Elements; Evidence based intervention; Exhibits; Face; Feedback; General Population; Health; Health Services; Health behavior change; Health system; Healthcare; Healthcare Systems; Heart Diseases; Homelessness; Hypertension; Individual; Information Management; Intervention; Interview; Life Style; Measures; Medical; Mental Health; Methods; New York City; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Phenotype; Pilot Projects; Primary Health Care; Provider; Randomized; Reading; Risk; Risk Reduction; Sampling; Self Management; Services; Shelter facility; Structure; Substance abuse problem; System; Testing; Text; Text Messaging; Treatment Efficacy; arm; attentional control; base; behavior change; blood pressure medication; blood pressure regulation; cardiovascular disorder risk; cardiovascular risk factor; care coordination; care seeking; chronic care model; community organizations; efficacy evaluation; ethnic minority population; experience; group intervention; hypertension control; improved; interdisciplinary approach; intervention effect; mHealth; medication nonadherence; mortality; outreach; pill; programs; racial minority; social factors; therapeutic lifestyle change; tool; vigilance

Annually, millions of Americans experience homelessness. Hypertension (HTN) is one of the most common conditions among persons experiencing homelessness (PEH) but is often uncontrolled; 40.1% of hypertensive PEH have uncontrolled blood pressure (BP) compared to 24.8% of hypertensive adults in the general population. PEH face multiple barriers to therapeutic lifestyle changes that complicate their HTN management. Strategies targeting self-management behaviors and counseling to support adherence to medications and lifestyle changes contribute to better BP control and significant cardiovascular risk reduction. However, these strategies are not available or accessible to the PEH. At the patient level, educational interventions with behavioral support through continued patient contact over months are effective in the treatment of chronic diseases including HTN. The mHealth strategies including short messaging service (SMS) texting have been shown to improve adherence to BP medications and BP control and were feasible and acceptable among hypertensive adults. Majority of the PEH have access to mobile phones that can receive and send SMS texts. Considering mobility of the PEH, we propose that an mHealth strategy using SMS texting could be used as a platform for better communication and information management for BP control, facilitate coordination of care, support behavior changes, and improve targeted outreach. The mHealth strategies for HTN have never been evaluated in the PEH despite the growing evidence of their effectiveness and the accessibility of mobile phones among PEH. This study will test this strategy and pave the way for its utilizations in the health settings where the PEH seek care, and has potentials for adaptation for control of other chronic diseases among PEH. This study will be implemented in shelter-clinics in New York City (NYC) and in collaboration with community organizations making sustainability of the intervention effects and its scalability feasible. We propose a mixed methods study: AIM1: To assess patients’ and providers’ attitudes, acceptability, and experience of a 6-month mHealth SMS texting for HTN management in hypertensive PEH age 21 or older with uncontrolled BP in NYC’s shelter-clinics. We will use semi-structured interviews using random and criteria sampling of the PEH (n=30) and providers (n=20). AIM2: To evaluate the efficacy of a 6-month SMS texting targeted on HTN management (INT) versus an attention control (CL) on changes in systolic BP (SBP) and diastolic BP (DBP) and adherence to BP medications and appointments at 6 months in hypertensive PEH with uncontrolled BP age 21 or older (n=120). H1) Those randomized to the INT (n=60) will exhibit at least 8 mmHg reduction in either SBP or DBP compared to those randomized to the CL (n=60) at 6 months. H2) The INT group will exhibit better adherence to BP medications and appointments compared to those in the CL at 6 months. BP readings and adherence to appointments and medications (self-reported MMAS-8 & unannounced pill counts) will be measured at 0,1,2,3,4.5,&6 months. Randomization will be at the individual level in the shelter-clinics.

每年都有数百万美国人无家可归。高血压（HTN）是最常见的疾病之一 无家可归者 (PEH) 的状况，但往往不受控制； 40.1% 高血压 与一般情况下 24.8% 的高血压成人相比，PEH 的血压 (BP) 不受控制 人口。 PEH 在改变治疗性生活方式方面面临多重障碍，这使得他们的高血压管理变得复杂。 针对自我管理行为和咨询的策略，以支持坚持药物治疗和 生活方式的改变有助于更好地控制血压并显着降低心血管风险。然而，这些 PEH 无法获得或无法获得策略。在患者层面，教育干预措施 通过持续几个月的患者接触来提供行为支持对于治疗慢性病是有效的 疾病包括高血压。包括短信服务 (SMS) 在内的移动医疗策略已 已被证明可以提高对血压药物和血压控制的依从性，并且在人群中是可行和可接受的 高血压成人。大多数 PEH 都可以使用可以接收和发送短信的手机。 考虑到 PEH 的移动性，我们建议使用短信的移动医疗策略可以用作 为BP控制提供更好的沟通和信息管理平台，促进协调 护理、支持行为改变并改善有针对性的外展活动。 HTN 的移动医疗策略从未有过 尽管越来越多的证据表明其有效性和移动设备的可访问性，但 PEH 仍对其进行了评估 PEH 之间的电话。这项研究将测试该策略并为其在健康环境中的应用铺平道路 PEH 寻求护理的地方，并且具有适应控制 PEH 中其他慢性疾病的潜力。 这项研究将在纽约市 (NYC) 的避难诊所与社区合作实施 使干预效果的可持续性及其可扩展性变得可行的组织。我们建议混合 方法研究：AIM1：评估患者和提供者的态度、可接受性和 6 个月的经验 mHealth 短信用于 21 岁或以上且血压不受控制的高血压 PEH 患者的 HTN 管理 纽约市的庇护所诊所。我们将使用半结构化访谈，对 PEH 进行随机抽样和标准抽样 (n=30) 和提供者 (n=20)。 AIM2：评估针对 HTN 的 6 个月 SMS 短信的效果 收缩压 (SBP) 和舒张压 (DBP) 变化的管理 (INT) 与注意力控制 (CL) 血压未受控制的高血压 PEH 患者 6 个月时坚持使用降压药物和预约 21 岁或以上 (n=120)。 H1) 那些随机接受 INT (n=60) 的患者将表现出至少 8 mmHg 的降低 与 6 个月时随机接受 CL (n=60) 的患者相比，收缩压或舒张压。 H2) INT 组将 与 CL 中的患者相比，6 个月时表现出更好的对 BP 药物和预约的依从性。血压 读数以及遵守预约和药物治疗（自我报告的 MMAS-8 和未公布的药物计数） 将在0、1、2、3、4.5和6个月时测量。随机化将在庇护所诊所的个人层面上进行。