Text Messaging to Improve Hypertension Medication Adherence in African Americans

描述(由申请人提供)：未受控制的高血压(HBP)是一个主要的公共卫生问题，也是全球心血管疾病的主要原因。HBP危机对非裔美国人来说尤其沉重，因为他们比非西班牙裔美国白人更容易感染HBP。对处方药方案的依从性差是一个主要问题，因为在被诊断为高血压的患者中，只有大约一半的人坚持服用处方药。手机和短信正越来越广泛地融入日常生活，并可能提供一种简单且非劳动密集型的策略，通过提高用药依从性来提高用药管理的质量。这项拟议的研究将分两个不同的阶段进行，以实现三个具体目标。对于特定的目标1(阶段I)，我们建议与目标人群中的参与者进行焦点小组，以便获得反馈，以指导移动电话短信系统的开发，该系统旨在提高对降压药的依从性。对于特定目标2(阶段II)，我们建议对新开发的短信干预进行试点测试，并进行随机对照试验。对于具体目标3(第二阶段)，我们建议确定参与者对干预效果和满意度的看法，以指导进一步的系统改进。在第一阶段，患有失控高血压的非裔美国人(n=24-32)将被招募参加四个焦点小组之一，这些小组将帮助指导短信干预的发展。在第二阶段，患有未控制高血压的非裔美国人将随机接受常规护理(n=30)与短信干预(n=30)。这项试验的主要结果将是一个月随访时服药依从性的变化；次要结果包括一个月随访时药物自我效能和收缩和舒张压的变化，以及参与者对短信干预的满意度。拟议的研究将利用韦恩州立大学(WSU)城市研究中心开展高质量和专业运营的重点小组，WSU计算和信息技术部的广播信息服务基础设施用于传递短信，WSU健康研究中心用于统计分析和赠款管理援助，以及来自WSU不同学科背景的多样化研究团队。因此，拟议的研究利用了大量的当地资源来调查针对这一高危人群的创新和亟需的干预措施。 与公共卫生相关：对处方药物治疗方案的依从性差是一个主要问题，特别是在高血压得不到控制的非裔美国人中。手机和短信可能会为提高服药依从性提供一种简单且非劳动密集型的策略。由于它依赖于个人已经采用的技术，该应用程序寻求开发和测试一种创新的、适应性强的、高度可扩展的短信干预措施，以提高我们目标人群的服药依从性。

DESCRIPTION (provided by applicant): Uncontrolled high blood pressure (HBP) is a major public health concern and leading cause of cardiovascular disease worldwide. The HBP crisis is particularly onerous to African Americans as they are disproportionately more susceptible to HBP than non-Hispanic White Americans. Poor adherence to prescribed medication regimens is a major problem, as only about half of patients who have been diagnosed with hypertension adhere to prescribed medications. Mobile phones and text messages are becoming widely integrated into routine daily life and may offer a simple and non-labor intensive strategy for improving the quality of medication management through enhancing medication adherence. This proposed research will be conducted in two distinct phases addressing three specific aims. For Specific Aim 1 (Phase I), we propose to conduct focus groups with participants from our target population in order to obtain feedback to guide the development of a mobile phone text message system that seeks to improve adherence to antihypertensive medications. For Specific Aim 2 (Phase II), we propose to pilot test the newly developed text message intervention with a randomized controlled trial. For Specific Aim 3 (Phase II), we propose to ascertain participant perceptions of intervention effectiveness and satisfaction in order to guide further system refinement. In Phase I, African Americans with uncontrolled hypertension (n=24-32) will be recruited to take part in one of four focus groups that will help guide the development of the text message intervention. In Phase II, African Americans with uncontrolled hypertension will be randomized to receive usual care (n=30) vs. the text message intervention (n=30). The primary outcome in this pilot will be change in medication adherence at one month follow-up; secondary outcomes include change in medication self-efficacy and systolic and diastolic blood pressure at one month follow-up, as well as participant satisfaction with the text message intervention. The proposed research will utilize the Wayne State University (WSU) Center for Urban Studies to conduct high quality and professionally run focus groups, the WSU Division of Computing and Information Technology's Broadcast Message Service infrastructure for the delivery of text messages, the WSU Center for Health Research for statistical analysis and grant management assistance, and a diverse study team from a variety of disciplinary backgrounds at WSU. As a result, the proposed research leverages the considerable local resources to investigate an innovative and much needed intervention for this high-risk population. PUBLIC HEALTH RELEVANCE: Poor adherence to prescribed medication regimens is a major problem, particularly among African Americans with uncontrolled high blood pressure. Mobile phones and text messages may offer a simple and non-labor intensive strategy for enhancing medication adherence. Due to its reliance on technologies already adopted by individuals, this application seeks to develop and test an innovative, adaptable, and highly scalable text message intervention for improving medication adherence in our target population.