title: Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives.
abstract: African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p < 0.0001) indicating significant reductions in resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the SMASH group vs. the standard care (SC) control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003). Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.
authors.affiliation: College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. davidst@musc.edu.|College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. davidst@musc.edu.
authors.forename: Tatiana M
authors.initials: TM
authors.lastname: Davidson
authors.affiliation: College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. mcgillij@musc.edu.
authors.forename: John
authors.initials: J
authors.lastname: McGillicuddy
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. muellerm@musc.edu.
authors.forename: Martina
authors.initials: M
authors.lastname: Mueller
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Brunner-Jackson
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. favela@musc.edu.
authors.forename: April
authors.initials: A
authors.lastname: Favella
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. anderan@musc.edu.
authors.forename: Ashley
authors.initials: A
authors.lastname: Anderson
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. torresma@musc.edu.
authors.forename: Magaly
authors.initials: M
authors.lastname: Torres
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. ruggierk@musc.edu.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ruggiero
authors.affiliation: College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. treiberf@musc.edu.|College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA. treiberf@musc.edu.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Treiber
keywords: essential hypertension; iterative design; mHealth; patient centered