Efficacy of mHealth and education-led peer counselling of patients with hypertension and coronary artery disease in Pakistan: Study protocol for a double-blinded pragmatic randomized-controlled trial with factorial design

Background: Hypertension is a highly relevant public health challenge. Digital interventions may support in improving adherence to anti-hypertensive medications and alter health behavior. Therefore, this protocol describes a study which aims to assess the effectiveness of mHealth and educational support through peer counseling (Ed-counselling) to control blood pressure in hypertensive patients when compared to standard care. Methods: We chose a double-blinded pragmatic randomized-controlled with factorial design for this investigation. The trial is going to recruit 1440 hypertensive patients with coronary artery disease at the age of 21 to 70 years. All participants will already be on anti-hypertensive medication and own a smartphone. They will be randomized into four groups with each having 360 participants. The first group will only receive standard care; while the second group, in addition to standard care will receive monthly Ed-counselling (educational booklets with animated infographics and peer counselling); the third group will receive daily written and voice reminders and an education-led video once weekly together with standard care; while the fourth one gets both interventions given to second and third groups respectively. All groups will be followed-up for one year (0, 6, and 12 months). The primary outcome will be the change in systolic blood pressure while secondary outcomes include health-related quality of life and changes in medication adherence. Discussion: Besides adding up to existing evidence in the literature on the subject, our designed modules using mHealth technology can help reducing hypertension-related morbidity and mortality in developing countries. Trial registration: ClinicalTrials.gov (NCT05106790), October 24, 2021