• equity-deserving groups
• health technology
• rural

• Humans
• Rural Population
• Biomedical Technology
• Health Services Accessibility
• Health Equity
• Healthcare Disparities

• blood pressure
• chronic disease
• community health services
• mobile applications
• rural
• telemedicine
• text messaging

• Humans
• Telemedicine
• Hypertension/therapy
• Rural Population
• Adult
• Randomized Controlled Trials as Topic

• Metro Health Research and Development Consortium

• hypertension
• mHealth
• mobile health interventions
• nutrition
• prehypertension
• preventive medicine
• text messages
• validation studies

• Humans
• Hypertension/drug therapy
• Hypertension/therapy
• Aged
• Text Messaging
• Exercise
• Mobile Applications
• Antihypertensive Agents/therapeutic use
• Female
• Male
• Medication Adherence
• Brazil
• Nutritional Status
• Communication

• Edital DPI/DPG/BCE-01/2024). Fundação de Apoio à Pesquisa do Distrito Federal (FAPDF) and UnB.

• Digital health
• eHealth
• healthcare
• hypertension

• artificial intelligence
• cardiovascular
• digital medicine
• mobile phone
• review
• telehealth
• telemedicine

To systematically review and synthesize the existing evidence on the effects of different telemedicine interventions on improving patient engagement among patients with hypertension. Patient engagement is defined as patients’ knowledge, skills, ability, and willingness to manage their healthcare within the context of interventions designed to promote positive patient behaviors.

Telemedicine is a rapidly growing method of healthcare services delivery. Telemedicine interventions are mainly used to facilitate communication between the patient and provider, measure, record, and track blood pressure, and educate and train patients about managing their blood pressure. Findings from several studies indicate the evidence of patient engagement, adherence to the care plan, improvement in knowledge about blood pressure, and patient satisfaction with telemedicine interventions for blood pressure.

Telemedicine interventions need to be customized depending on patient demographics and socioeconomic characteristics such as age and education level to ensure optimal patient engagement.

The online version contains supplementary material available at 10.1007/s11906-022-01186-5.

• Blood pressure
• Hypertension
• Patient adherence
• Patient engagement
• Telehealth
• Telemedicine

Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice.

This review aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging.

A systematic review was conducted and reported on in accordance with PRISMA guideline. Participants were aged 18 years and older and diagnosed with primary hypertension. The included studies used text messaging as a component of the intervention. We searched for randomized controlled trials published until June 30, 2020, from the following health-related electronic databases: Embase, Medline, CINAHL Complete, PsycINFO, and Scopus. Data were extracted for qualitative synthesis and meta-analysis. The Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study, and the quality of the included studies was assessed independently by two authors.

Twelve studies met the inclusion criteria. The overall methodological quality was fair (mean score 5.75). The frequency of text message delivery varied from daily to biweekly. Health education was identified in 4 studies as an additional intervention with text messaging. The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no significant difference in BP reduction between studies that lasted 6 months or less and those that lasted more than 7 months. Seven studies that lasted 6 months or less involving 1428 patients with hypertension were pooled for further meta-analysis. Text messages delivered at a lower frequency (once per week or less) had a small effect on SBP reduction (effect size 0.35, P<.01) and DBP reduction (effect size 0.28, P=.01). In addition, the use of a text messaging intervention halved the odds of uncontrolled BP among patients with hypertension in 6 months (odds ratio 0.46, P=.02).

This review found that a text messaging intervention was effective in BP control. One-way text messaging delivered in a weekly manner was suggested to be effective and required fewer resources. Future studies should use different forms of text message and be integrated into other interventions to improve adherence behaviors and BP control among patients with hypertension.

• blood pressure
• hypertension
• mHealth
• meta-analysis
• text messaging

• Adult
• Bias
• Blood Pressure
• Cardiovascular Diseases/prevention & control
• Cell Phone
• Cholesterol, LDL/blood
• Humans
• Medication Adherence
• Primary Prevention/methods
• Randomized Controlled Trials as Topic
• Text Messaging

Supplemental Digital Content is available in the text.

Blood pressure (BP) increase cardiovascular disease (CVD) risk. Indigenous Canadians experience slightly higher CVD compared with nonIndigenous Canadians. This study examined the role of polychlorinated biphenyls (PCBs), other organic compound concentrations (OCs), and toxic metals on blood pressure measures among Indigenous Canadians.

• Blood Pressure
• Contaminants
• Environmental exposure
• Indigenous

• Chronic disease
• Community engagement
• Indigenous
• Participatory research

• Adult
• Aged
• Aged, 80 and over
• Australia
• Canada
• Chronic Disease/therapy
• Community Health Services/organization & administration
• Community Participation/psychology
• Community Participation/statistics & numerical data
• Culturally Competent Care/organization & administration
• Decision Making
• Female
• Humans
• Indigenous Peoples/psychology
• Indigenous Peoples/statistics & numerical data
• Male
• Middle Aged
• New Zealand
• Population Groups
• United States

• Arterial hypertension
• mHealth
• mobile phones
• smartphone apps
• smartphones

Hypertension or high blood pressure is considered as a significant contributor and risk factor to many serious conditions, approximately 1.13 billion people have hypertension globally. However, the integrated technologies can upscale health provisions and improve the effectiveness of the healthcare system. WHO has recommended that the digital health interventions (DHIs) and the Health System Challenges should be used in tandem in addressing health.

To summarise the outcomes from a range of research which investigated the use of DHI to improve the medication-related quality of care (MRQOC) for hypertensive patients.

An integrative literature review was undertaken in October 2019 using the Medline, Cumulative Index of Nursing and Allied Health Literature, and Scopus databases for publications in English with no date limit.

In total, 18433 participants were included in this review from 28 studies meeting the eligibility criteria. There were 19 DHI identified within eight countries: Australia, Canada, India, South Korea, Lebanon, Pakistan, the United Kingdom, and the United States of America. The DHI were provided as community-based, clinical-based and home-based program through mobile phone, mobile health system, short message service, and telehealth, digital medicine, and online healthcare (web-based). The mean age of participants was 59 ranging from 42 to 81 years with an average mean systolic blood pressure of 143.3 mmHg at baseline, ranging from 129.0 mmHg to 159.0 mmHg. The proportion of male participants ranged from 13.9% to 92.0%. Eighteen interventions showed evidence of reduction in blood pressure and improvement of self-management in relation to medication adherence and blood pressure control. The reduction of systolic blood pressure ranged between 1.9 mmHg and 26.0 mmHg, with a mean of 10.8 mmHg. The digital health was found positively associated with the MRQOC for hypertensive patients such as improvement in medication adherence and medication management; better blood pressure control; maintaining follow-ups appointment and self-management; increasing access to healthcare particularly among patients living in rural area; and reducing adverse events. However, some interventions found no significant effect on hypertensive care. The follow up duration varied between 2 mo and 18 mo with an average attrition rate of 10.1%, ranging from 0.0% to 17.4%.

Utilising digital health innovation for hypertensive care in different settings with tailored interventions positively impacted on MRQOC leading to an improvement of patient outcomes and their quality of life. Nevertheless, inconclusive findings were found in some interventions, and inconsistent outcomes between DHI were noted. A future research and evidence-based DHI for hypertension or chronic diseases should be developed through the evidence-to-decision framework and guidelines.

• Hypertension
• Digital health
• eHealth
• mHealth
• Medication-related quality of care

• Telehealth
• indigenous
• mental health
• physical health
• telemedicine

• K24 DK093699 NIDDK NIH HHS
• R01 DK118038 NIDDK NIH HHS
• R01 DK120861 NIDDK NIH HHS
• R01 MD013826 NIMHD NIH HHS

DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging–based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness.

The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership.

The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant’s own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership.

In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension.

In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership.

Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226.

• blood pressure
• hypertension
• mHealth
• population groups
• short message service

There is a paucity of controlled clinical trial data based on research with Indigenous peoples. A lack of data specific to Indigenous peoples means that new therapeutic methods, such as those involving electronic health (eHealth), will be extrapolated to these groups based on research with other populations. Rigorous, ethical research can be undertaken in collaboration with Indigenous communities but requires careful attention to culturally safe research practices. Literature on how to involve Indigenous peoples in the development and evaluation of eHealth or mobile health apps that responds to the needs of Indigenous patients, providers, and communities is still scarce; however, the need for community-based participatory research to develop culturally safe technologies is emerging as an essential focus in Indigenous eHealth research. To be effective, researchers must first gain an in-depth understanding of Indigenous determinants of health, including the harmful consequences of colonialism. Second, researchers need to learn how colonialism affects the research process. The challenge then for eHealth researchers is to braid Indigenous ethical values with the requirements of good research methodologies into a culturally safe research protocol.

A recent systematic review showed that Indigenous peoples are underrepresented in randomized controlled trials (RCTs), primarily due to a lack of attention to providing space for Indigenous perspectives within the study frameworks of RCTs. Given the lack of guidelines for conducting RCTs with Indigenous communities, we conducted an analysis of our large evaluation data set collected in the Diagnosing Hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous Peoples and Low- and Middle- Income Countries (DREAM-GLOBAL) trial over a period of five years. Our goal is to identify wise practices for culturally safe, collaborative eHealth and RCT research with Indigenous communities.

We thematically analyzed survey responses and qualitative interview/focus group data that we collected over five years in six culturally diverse Indigenous communities in Canada during the evaluation of the clinical trial DREAM-GLOBAL. We established themes that reflect culturally safe approaches to research and then developed wise practices for culturally safe research in pragmatic eHealth research.

Based on our analysis, successful eHealth research in collaboration with Indigenous communities requires a focus on cultural safety that includes: (1) building a respectful relationship; (2) maintaining a respectful relationship; (3) good communication and support for the local team during the RCT; (4) commitment to co-designing the innovation; (5) supporting task shifting with the local team; and (6) reflecting on our mistakes and lessons learned or areas for improvement that support learning and cultural safety.

Based on evaluation data collected in the DREAM-GLOBAL RCT, we found that there are important cultural safety considerations in Indigenous eHealth research. Building on the perspectives of Indigenous staff and patients, we gleaned wise practices for RCTs in Indigenous communities.

ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226

• DREAM-GLOBAL
• Indigenous peoples
• SMS
• community-based participatory research
• health care texting
• hypertension
• implementation science
• mobile health
• process evaluation
• task shifting

• Aboriginal health
• blood pressure telemonitoring
• case management
• hypertension
• mHealth
• pharmacist