Health Freedom Path to Wellness: A Culturally-Relevant and Patient-Centered mHealth Intervention to Promote Cardiovascular Health Equity

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ABSTRACT Despite decades of recognition, African Americans (AAs) and adults living in urban communities continue to experience disproportionately higher rates of cardiovascular diseases (CVD) and associated risk factors, such as hypertension, diabetes, obesity, and kidney disease, than their representation in the general population. As the leading cause of mortality in the US and worldwide, CVD also causes serious morbidity, disability, and economic losses. AAs and adults living in low-income and urban communities represent particularly vulnerable subgroups of persons burdened by major CVD risk factors and experience poorer health outcomes. These health disparities in CVD burden and outcomes are influenced by complex sociodemographic, socioeconomic, healthcare system, and community factors, including patient self-management behaviors, utilization and quality of health services, provider-patient communication, healthy food availability, education, and social support. Effective strategies for CVD risk reduction and self-management behaviors include self-blood pressure (BP) monitoring, lifestyle changes (including healthy diet and physical activity habits), adherence to medications, and shared medical decision-making. These strategies represent a cornerstone of recommended care for CVD risk reduction and have been associated with significant improvements in CVD control among treated patients. Our primary study goal is to adapt an existing evidence-based, face-to-face, CVD educational and behavioral strategy intervention, the Health Freedom Circle of Friends program, into a mobile health (mHealth) intervention. The two-phase project will use principles of community-based participatory research (CBPR), human-centered computing, and personal informatics to develop a culturally-sensitive educational and behavioral mHealth intervention to promote CVD risk reduction and self-management behaviors among AAs and other groups disproportionately burdened by CVD (phase 1) and later test the mHealth intervention’s acceptability, usability, and satisfaction among key stakeholders (phase 2). We will use a mixed-methods, user-centered design approach to identify goals, needs, challenges, and preferences for participating in the culturally-sensitive, community-based mHealth personal informatics tool to promote CVD health equity. Aim 1 will establish patients’ needs and preferences for a community-based mHealth intervention tool to support CVD prevention and self-management using semi-structured interviews. Aim 2 will design a culturally-sensitive mHealth intervention prototype and tailor content using an iterative process within sequential in-person participatory design workshops. Aim 3 will assess the acceptability, usability, and satisfaction of the mHealth tool within a feasibility study among AAs and other groups disproportionately burdened by CVD. Our existing community stakeholder advisory board will provide input throughout all study phases. Our proposed study will contribute to the NIH’s mission to design and test culturally-sensitive mHealth tools for CVD health equity.