mHealth to address uncontrolled hypertension among hypertensive homeless adults

每年，数以百万计的美国人经历无家可归。高血压(HTN)是最常见的 无家可归(PEH)但经常失控的人的情况；40.1%的高血压患者 Peh的血压(BP)不受控制，而一般成人高血压患者的比例为24.8% 人口。Peh在改变治疗生活方式方面面临着多重障碍，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，以支持坚持服药和 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。然而，这些 战略对PEH是不可用或不可访问的。在患者层面，教育干预包括 通过持续与患者接触数月的行为支持对慢性阻塞性肺疾病的治疗是有效的 包括HTN在内的疾病。包括短信服务(SMS)短信在内的移动健康战略已经 显示改善了对BP药物的依从性和BP控制，在以下方面是可行和可接受的 成年高血压患者。PEH中的大多数人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，我们建议使用短信发送的mHealth策略作为一种 为BP控制提供更好的沟通和信息管理平台，促进协调 关心、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 在PEH中进行了评估，尽管越来越多的证据表明它们的有效性和移动设备的可访问性 PEH中的电话。这项研究将测试这一策略，并为其在健康环境中的应用铺平道路 PEH寻求照顾，并有潜力适应于控制PEH中的其他慢性病。 这项研究将在纽约市(NYC)的庇护所诊所实施，并与社区合作 组织使干预效果的可持续性及其可扩展性成为可能。我们建议一种混合的 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 21岁或21岁以上高血压伴血压失控的高血压患者发短信进行HTN管理 纽约市的庇护所-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)和提供者(n=20)。目的：评估针对HTN的6个月短信服务的效果 管理(INT)与注意控制(CL)对收缩压(SBP)和舒张压(DBP)变化的比较 血压未得到控制的高血压性高血压患者6个月后坚持用药和服药 年龄21岁或以上(n=120)。H1)那些被随机分配到INT(n=60)的人将表现出至少8毫米汞柱的减少 与6个月后随机分为CL组(n=60)的SBP或DBP进行比较。H2)INT组将 在6个月时，与CL组相比，患者对BP药物和预约的依从性更好。BP 阅读和遵守预约和药物治疗(自我报告的MMA-8和未公布的药片计数) 将在0、1、2、3、4.5和6个月时测量。在收容所-诊所，将在个人层面进行随机化。

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.