Digitally based blood pressure self-monitoring program that promotes hypertension self-management and health education among patients with low-income: usability study
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Abstract
BACKGROUND: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. OBJECTIVE: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). METHODS: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. RESULTS: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. CONCLUSIONS: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.
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Patients frequently struggle with digital health literacy gaps, technology-induced anxiety, and the logistical burden of integrating rigid measurement protocols into their daily routines.
“patients frequently struggle with digital health literacy gaps, technology-induced anxiety, and the logistical burden of integrating rigid measurement protocols into their daily routines [9,10].”
From Clinical Efficacy and Patient Adherence Hurdles of Remote Patient Monitoring (RPM) Frameworks in Managing Hypertension and Type 2 Diabetes: A Scoping Review (2026) · cites this paper as [10]
Table 6 (pp. 3–4) reports device-operation difficulties, busy schedules, and fear of viewing worrisome results; Principal Findings reports that only 27% met the measurement threshold and suggests it may be too stringent. These support practical barriers to monitoring, but the paper does not establish frequent technology-induced anxiety. Fear of a blood-pressure result is not the same as anxiety caused by the technology. (LLM, conf=0.85)
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- Authors
- Poblete, J. Y., Vawter, N. L., Lewis, S. V., Felisme, E. M., Mohn, P. A., Shea, J., Northrup, A. W., Liu, J., Al-Rousan, T., & Godino, J. G.
- Affiliations
- Family Health Centers of San Diego (US)
- University of California San Diego (US)
- Corresponding author
- Godino, Job Gideon
- ORCID
- Venue
- JMIR Human Factors
- Publisher
- JMIR Publications Inc.
- Published
- 2023-07-24
- Volume
- 10
- Pages
- e46313
- ISSN
- 2292-9495 (ISSN-L)
- OpenAlex
- W4381095292
- Cited by
- 9
- References
- 22
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 1
- FWCI
- 3.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Human Factors (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- American Heart Association
- National Institutes of Health
- National Heart, Lung, and Blood Institute (K23HL148530)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- hypertension, self-measured blood pressure, hypertension self-management, low-income patients, digital health interventions, SMS reminders, health education, blood pressure control, device compliance, usability, family health centers, primary care, health equity
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