Higher doses of mHealth components, such as healthy behavior text messaging (difference -0.5 mm Hg; 95% CI -6.0 to 5; P=0.86), did not significantly reduce systolic BP at 12 months.
RCT (n=488)
2x2x2 factorial
No
Do higher-dose mobile health components (text messaging, daily BP monitoring, facilitated scheduling/transportation) reduce systolic blood pressure more than lower-dose components in hypertensive patients evaluated in a safety-net Emergency Department?
A mobile health intervention in a safety-net Emergency Department setting was associated with overall blood pressure reduction over 12 months, but specific higher-intensity mHealth components did not provide additional blood pressure-lowering benefit.
Background: Mobile health (mHealth) strategies initiated in safety-net Emergency Departments may be one approach to address the US hypertension epidemic, but the optimal mHealth components or dose are unknown. Methods: Reach Out is an mHealth, health theory-based, 2×2×2 factorial trial among hypertensive patients evaluated in a safety-net Emergency Department in Flint, Michigan. Reach Out consisted of 3 mHealth components, each with 2 doses: (1) healthy behavior text messaging (yes versus no), (2) prompted self-measured blood pressure (BP) monitoring and feedback (weekly versus daily), and (3) facilitated primary care provider appointment scheduling and transportation (yes versus no). The primary outcome was a change in systolic BP from baseline to 12 months. In a complete case analysis, we fit a linear regression model and accounted for age, sex, race, and prior BP medications to explore the association between systolic BP and each mHealth component. Results: Among 488 randomized participants, 211 (43%) completed follow-up. Mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a primary care doctor, 21% lacked transportation, and 51% were not taking antihypertensive medications. Overall, systolic BP declined after 6 months (−9.2 mm Hg 95% CI, −12.2 to −6.3) and 12 months (−6.6 mm Hg, −9.3 to −3.8), without a difference across the 8 treatment arms. The higher dose of mHealth components were not associated with a greater change in systolic BP; healthy behavior text messages (point estimate, mmHG=−0.5 95% CI, −6.0 to 5; P =0.86), daily self-measured BP monitoring (point estimate, mmHG=1.9 95% CI, −3.7 to 7.5; P =0.50), and facilitated primary care provider scheduling and transportation (point estimate, mmHG=0 95% CI, −5.5 to 5.6; P =0.99). Conclusions: Among participants with elevated BP recruited from an urban safety-net Emergency Department, BP declined over the 12-month intervention period. There was no difference in change in systolic BP among the 3 mHealth components. Reach Out demonstrated the feasibility of reaching medically underserved people with high BP cared for at a safety-net Emergency Departments, yet the efficacy of the Reach Out mHealth intervention components requires further study. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03422718.
Skolarus et al. (Mon,) conducted a rct in hypertension (n=488). Reach Out mHealth intervention vs. Lower dose or no component was evaluated on change in systolic BP from baseline to 12 months. Higher doses of mHealth components, such as healthy behavior text messaging (difference -0.5 mm Hg; 95% CI -6.0 to 5; P=0.86), did not significantly reduce systolic BP at 12 months.
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