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Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses
npj Digital Medicine ( IF 15.2 ) Pub Date : 2021-07-22 , DOI: 10.1038/s41746-021-00486-5
Elaine C Khoong 1, 2 , Kristan Olazo 1, 2 , Natalie A Rivadeneira 1, 2 , Sneha Thatipelli 3 , Jill Barr-Walker 4 , Valy Fontil 1, 2 , Courtney R Lyles 1, 2 , Urmimala Sarkar 1, 2
Affiliation  

Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = −4.10, 95% CI: [−6.38, −1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.



中文翻译:

具有数字障碍的城市人群血压自我管理的移动健康策略:系统评价和荟萃分析

移动医疗 (mHealth) 技术可改善高血压结果,但尚不清楚这种益处是否适用于所有人群。本综述旨在描述移动健康干预对数字健康使用差异人群血压结果的影响。我们进行了系统搜索,以确定位于高收入国家城市环境中收缩压 (SBP) 结果的研究,其中包括数字健康差异人口,定义为平均年龄 65 岁以上;受教育程度较低(≥60% ≤高中学历);和/或种族/少数族裔(美国研究中<50% 的非西班牙裔白人)。使用既定的自我管理分类法对干预措施进行分类。我们进行了叙事综合;在具有 6 个月 SBP 结果的随机临床试验 (RCT) 中,我们进行了随机效应荟萃分析。纳入了 29 篇文章(代表 25 项研究),其中 15 篇是 RCT。15 项研究使用了短信;十二个使用过的移动应用程序。根据种族/民族 (14)、教育 (10) 和/或年龄 (6) 纳入研究。常见的干预措施包括:生活方式建议 (20);提供自我监测设备(17);和数字设备使用培训 (15)。在七项 RCT 的荟萃分析中,干预组 6 个月时的 SBP 降低(平均 SBP 差异 = -4.10,95% CI:[-6.38,-1.83])是显着的,但 SBP 没有显着差异干预组和对照组之间的变化(根据种族/民族 (14)、教育 (10) 和/或年龄 (6) 纳入研究。常见的干预措施包括:生活方式建议 (20);提供自我监测设备(17);和数字设备使用培训 (15)。在七项 RCT 的荟萃分析中,干预组 6 个月时的 SBP 降低(平均 SBP 差异 = -4.10,95% CI:[-6.38,-1.83])是显着的,但 SBP 没有显着差异干预组和对照组之间的变化(根据种族/民族 (14)、教育 (10) 和/或年龄 (6) 纳入研究。常见的干预措施包括:生活方式建议 (20);提供自我监测设备(17);和数字设备使用培训 (15)。在七项 RCT 的荟萃分析中,干预组 6 个月时的 SBP 降低(平均 SBP 差异 = -4.10,95% CI:[-6.38,-1.83])是显着的,但 SBP 没有显着差异干预组和对照组之间的变化(p  = 0.48)。移动医疗工具的使用已显示出慢性病管理的前景,但很少有研究包括老年人、受教育程度有限或少数民族。需要对这些人群进行更多有力的研究,以确定哪种干预措施最适合不同的高血压患者。

更新日期:2021-07-22
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