mHealth to address uncontrolled hypertension among hypertensive homeless adults

每年有数百万美国人无家可归。高血压（HTN）是最常见的 无家可归者（PEH）的健康状况，但往往不受控制; 40.1%的高血压患者 PEH的血压（BP）不受控制，而一般高血压成人中有24.8% 人口PEH面临着治疗性生活方式改变的多重障碍，这使他们的HTN管理复杂化。 针对自我管理行为和咨询的策略，以支持药物依从性， 生活方式的改变有助于更好地控制血压和显著降低心血管风险。但这些 战略是不可用的或可访问的PEH。在患者层面，教育干预， 通过持续数月的患者接触进行行为支持， 包括HTN在内的疾病。包括短信服务（SMS）在内的移动健康策略已经被 显示改善对BP药物和BP控制的依从性，并且是可行的和可接受的， 高血压成人大多数PEH都可以使用移动的电话，可以接收和发送短信。 考虑到PEH的移动性，我们建议使用SMS短信的mHealth策略可以用作 为BP控制提供更好的沟通和信息管理平台，便于协调 护理，支持行为改变，并改善有针对性的外展。HTN的移动健康战略从未 尽管越来越多的证据表明它们的有效性和移动的可访问性， 电话在PEH。这项研究将测试这一战略，并铺平了道路，其利用在卫生设置 PEH寻求护理，并有潜力适应PEH中的其他慢性病的控制。 这项研究将在纽约市的庇护所诊所实施，并与社区合作， 使干预效果的可持续性及其可扩展性成为可能的组织。我们提出一个混合的 方法研究：目的1：评估患者和提供者的态度，可接受性和6个月的经验， 在21岁或以上血压不受控制的高血压PEH患者中使用mHealth短信进行HTN管理， NYC的避难所诊所我们将使用半结构化访谈，使用PEH的随机和标准抽样 （n=30）和供应商（n=20）。目的2：评估针对HTN的6个月短信的有效性 管理（INT）与注意力控制（CL）对收缩压（SBP）和舒张压（DBP）变化的影响 血压不受控制的高血压PEH患者6个月时对血压药物和预约的依从性 年龄≥ 21岁（n=120）。H1）随机分配至INT组（n=60）的受试者将表现出至少8 mmHg的降低， 6个月时与随机分配至CL组的患者（n=60）相比的SBP或DBP。H2）INT组将 6个月时，与CL组相比，显示出更好的BP药物和预约依从性。BP 阅读和遵守约会和药物（自我报告的MMAS-8和未宣布的药丸计数） 将在0、1、2、3、4.5和6个月时进行测量。将在庇护所诊所的个人一级进行随机化。

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.