JMIR FORMATIVE RESEARCH

Tran et al

Original Paper

mHealth Intervention for Elevated Blood Pressure Among College
Students: Single-Arm Intervention Study
Dieu-My Tran*, PhD; Catherine Dingley*, PhD; Roger Bonilla*, PhD
School of Nursing, University of Nevada, Las Vegas, Las Vegas, NV, United States*

all authors contributed equally

Corresponding Author:
Dieu-My Tran, PhD
School of Nursing
University of Nevada, Las Vegas
4505 S. Maryland Parkway
Box 453018
Las Vegas, NV, 89154
United States
Phone: 1 7028951220
Fax: 1 7028954807
Email: dieu-my.tran@unlv.edu

Abstract
Background: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing theirrisk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related tolifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening andpossible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identificationand intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective forcommunication and message delivery among this population.
Objective: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides
tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults.
Methods: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention
was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm
Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational
text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant’s BP
was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealthintervention.
Results: The participants’ (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese.
The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention
was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported
making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of theintervention and program. Overall, no significant changes were noted in BP over the 28 days.
Conclusions: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible toimplement, as our study indicated high rates of participation and acceptability. These encouraging findings support further
development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention
among college-aged adults, filling a gap in current research.
(JMIR Form Res 2024;8:e48520) doi: 10.2196/48520
KEYWORDS
blood pressure; mHealth; self-management; students; intervention; elevated blood pressure; college; hypertension; young adult;
mobile app; smartphone; monitoring; text messaging; text mining

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Introduction
Cardiovascular Risk Factors
Cardiovascular disease (CVD) remains one of the leading causesof death in the United States, with 840,768 deaths reported in2016 [1]. Based on the projections for 2019 onward, cardiac
events are predicted to occur in 1,055,000 individuals, 720,000
of which will be new cases [2]. Additionally, from 2014 to 2015,
the reported annual total cost for CVD-related treatments was
351.2 billion, and this is projected to increase to $1 trillion by2035 if current trends persist [3]. Chief among CVD risk factors
is high blood pressure (BP), with 63% of CVD-related eventsoccurring in individuals with a systolic BP (SBP) ≥140 mm Hg
and diastolic BP (DBP) ≥90 mm Hg [4]. The prevalence of highBP (SBP ≥140 mm Hg) has increased steadily since 1990, withan estimated 3.47 billion adults with hypertension worldwide
as of 2015 [5].

Background
The majority of studies focused on hypertension have involved
older adults; however, recent research reveals a growing patternof hypertension among young adults, starting as early as
childhood [6]. The prevalence of hypertension was estimatedto be 29.0% in 2015-2016, with increasing prevalence by age;
specifically, in young adults aged 18 years to 39 years, theprevalence was 7.5%. Men (9.2%) have a higher prevalence ofhypertension than women (5.6%) during young adulthood (18-39
years); however, as they become older adults, women catch up,
with a higher prevalence of hypertension than men [7].
Unfortunately, the prevalence of hypertension has increased in
the young adult population. According to National Health andNutrition Examination Survey 2015-2016 data, 13.3% ofchildren and adolescents 8 years to 17 years old had elevatedBP, while the 2017-2020 data demonstrated that young adults
between the ages of 20 years and 44 years had a 28.5%
prevalence of hypertension [6]. Based on the 30-year
Framingham risk score, 17.3% of men and 9.2% of women in
the National Longitudinal Study for Adolescent Health(n=14,333) were at risk of developing general CVD
complications later in life [8]. Despite these findings, among
adults 20 years to 45 years old, less than 50% of women andless than 40% of men are screened for risk factors [9]. Early
screening becomes increasingly critical, as early interventions,such as dietary and behavioral changes, in early adulthood canprevent as much as 80% of cases later in life [10]. Screening is
acknowledged for its importance; however, due to the increasing
prevalence of hypertension in this population, intervention is
warranted to delay or prevent the increase in hypertension
development during young adulthood.
Targeting young adults of college age is particularly significant,as many of the risk factors for high BP commonly start during
this period of life. Studies have shown the transition to college
life is often associated with poor dietary choices such as
reduction in fruit and vegetable consumption; increased
consumption of sugary drinks; and high-fat, high-sodium foodconsumption [11]. On average, college students gain 6 pounds
over the course of a 4-year education [12]. Additionally,
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Tran et al
drinking and smoking contribute further to high BP [13]. The
stress of pursuing a college education along with the increase
in sedentary behaviors during this time period further increase
the risk factors for high BP and other cardiovascular conditions[14].
Although behavioral and dietary changes can mitigate futurerisk, a study of college-aged young adults showed that, although
they possessed high knowledge of the risks factors for CVD
and high BP as well as a functional understanding of the foods
required for a healthy diet and activity levels necessary for
cardiovascular health, many perceived themselves to be at low
risk despite their lack of compliance to these standards [15].
Further study suggests that, although college students may haveknowledge of risk factors, a lack of convenient delivery ofintervention information and reinforcement of risk factors may
cause college students to underestimate the long-term effects
of poor cardiovascular health choices [16].
Mobile health (mHealth) has been identified as an ideal
technology to deliver health care interventions to young adults.
mHealth refers to the use of mobile devices and respective
technologies such as apps as a means to exchange healthinformation in order to encourage positive health behaviors[17]. A pilot study conducted by Poddar et al [18] demonstrated
improved self-efficacy in daily calcium intake andself-regulation in college students who were sent educational
flyers through email. In another study using Facebook messaging
to deliver an evidence-based weight loss program to 52
participants, 97% of the participants who completed asatisfaction questionnaire found the program to be helpful [19].
A larger-scale example that has shown promise is the Choosing
Healthy Options in College Environments and Settings(CHOICES) study [20]. This large-scale study demonstrated
that an interactive website focused on health promotion had thepotential to reduce obesity among young adults over the longterm [20].
Developing early interventions to prevent the onset of high BP
at earlier ages could significantly reduce both the onset andeconomic burden of medical costs related to CVD. Findings on
the receptivity of health and technology indicate that the use ofmHealth apps has the potential to assist with behavioral
modification for young adults if the apps are simple andstreamlined, minimizing the amount of effort on the part of theindividual to access the information [16]. As a result, mobile
health care and communication methods may be used to aid inpromoting BP reduction interventions for at-risk college-aged
individuals and may also be effective at promoting behavioral
and dietary changes. Therefore, the purpose of this pilot,
feasibility study was to understand the implications and impactof using mobile smartphone delivery messages tailored to theparticipant’s daily self-measured BP values using the Food andDrug Administration–approved Withings BP machine and app.
The long-term goal of this pilot study was to develop tailoredinterventions to increase awareness of elevated BP in college
students in a larger study.

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Methods
Study Design
This was a single-arm intervention, pilot study to evaluate thefeasibility of the mHealth to Optimize BP Improvement(MOBILE) intervention focused on elevated BP. Recruitment
was conducted at a large university in the southwest region of
the United States. Research flyers were posted around theuniversity campus, and face-to-face recruitment was completed
at the student union by 2 research assistants on a weekly basis
between March 2019 and September 2019.
An approach script was used to provide a standard set of
information to potential participants. Individuals who showedinterest were then screened for inclusion and exclusion criteria.
The inclusion criteria for this MOBILE feasibility study included
being a college student (full-time or part-time) at the recruited
university, aged 18 years to 39 years, who had regular accessto a mobile smartphone with unlimited text messaging, and with
SBP >120 mm Hg and DBP ≥80 mm Hg. Students were
excluded from the study if they were currently on
antihypertensive medications, pregnant, lactating, or planningto become pregnant during study duration or thought they might
be pregnant, or if they reported they had a life-threatening illness
or condition.

Recruitment and Participants
During the recruitment process, if any student expressed interestin participating, the research assistants met with the student;
completed the initial screening for the inclusion and exclusion
criteria, which involved taking at least 2 BP readings; verified
they were not on antihypertensive medication; and confirmed
they had access to unlimited text messages on their smartphone.

Initial screening was completed in a private area to provide
confidentiality to the potential participants at the designatedrecruitment site. If the potential participant met the inclusion
criteria, they were invited to participate in the study, andinformed consent was obtained. Those who agreed to participate
completed a sociodemographic questionnaire and scheduled abrief education session within the following 2 weeks. The
education sessions were limited to 1 to 3 participants to ensure
appropriate time was given to each participant. Each educationalsession took approximately 30 minutes, and during this time,
the research assistants delivered a brief educational presentation
on high BP and explained what the intervention entailed. Twomore BP readings were completed at the start of the educationalsession, before the presentation. After the presentation wascompleted, participants were instructed on how to use the BP
cuff, created a username and log-in information, and were taught
how to share their BP daily with the research team. A returndemonstration on the BP cuff usage was required. At the endof the educational demonstration, participants scheduled anothermeeting with one of the research assistants after 28 days for thelast assessment.

Intervention
The MOBILE intervention consisted of having each participant
take their BP using the BP cuff that was provided during the
educational session by the research assistants. They were
instructed to take at least 2 readings (1 on each arm) at theirconvenience and to send the BP value to the research assistantonce completed. The research assistants would then send preset
text messages corresponding to their BP value related toencouraging healthy lifestyle modifications. Table 1 shows anexample of the intervention text messages. Each participant was
required to take his or her BP daily for 28 days.

Table 1. Examples of the tailored text messages for the intervention.
Message type and trigger

Example message

SMBPa monitoring measurement
SBPb <120 mm Hg or DBPc <80 mm Hg Your BPd is right on target, within normal range. Keep up the good work!
SBP 120-129 mm Hg or DBP <80 mm Hg Your BP is slight highly today, remember to increase your physical activity (30 minutes walking),
eat less than 2300 mg of sodium a day, drink less alcohol, and consume more fruits and vegetables
SBP ≥130 mm Hg or DBP ≥81 mm Hg

Your BP is high today; we strongly encourage you to do the following: increase your physical activity (30 minutes walking), eat less than 2300 mg of sodium a day, and avoid any alcohol consumption.

Missing report message
Had not received any message from theparticipanta

We have not heard from you today. Do not forget to take your BP this week.

SMBP: self-measured blood pressure.

b

SBP: systolic blood pressure.

c

DBP: diastolic blood pressure.

d

BP: blood pressure.

Data Collection
Daily BP was collected from each participant, and a text
message (intervention) was sent to the participant when his or
her BP was received for the day. Participation was measured
by receiving 1 BP value from the participant and sending 1 text
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message a day for 28 days. At the conclusion of the intervention,
participants completed a survey regarding the usability andeffectiveness of the intervention. The researcher-developed,
8-question survey focused on determining the effect of theintervention on BP awareness; reported lifestyle changes (2questions); and usability issues such as frequency, content, andJMIR Form Res 2024 | vol. 8 | e48520 | p. 3
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helpfulness of text messages (4 questions). In addition,
participants were asked to provide feedback on any potentialchanges to the intervention and any other suggestions (2questions). Survey data were collected within 1 week ofcompletion of the intervention and completed in person at the
final assessment visit.

Data Analysis
Descriptive statistics were used to describe the demographicsof the participants and the type of intervention text messages
delivered to each participant. A control chart (p chart) was
generated to track the participation rate by day. A mixed
regression model was used to evaluate the changes inparticipants’ BP over the study period, with covariates of age,
BMI, and gender. Analyses were performed using SPSS version
24 (IBM Corp). Data are reported as mean (SD), with a P<.05
considered significant.
The postintervention survey data were analyzed based onparticipants’ responses to the specific questions using principles
of quantitative content analysis. The research team read andreread the survey responses in order to quantify and analyze thepresence of recurring words and phrases. As each survey was
analyzed, specific words and phrases were coded, andsubsequent surveys were reviewed for the presence of thesecodes. In addition, as new words and phrases were discoveredin the survey answers, they were identified as additional codes.
These were then examined for patterns and frequency acrossthe questions and subsequently clustered as code categories.
Once the survey answer text was clustered into categories, theresearch team was able to focus on and code for the specificwords or patterns that addressed the questions. For example,
the analysis revealed themes such as “awareness of BP,” “riskreduction,” and “changes in diet.” The results were thendelineated by each of the 8 survey questions.

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Ethical Considerations
The study received exempt approval from the University of
Nevada Las Vegas Institutional Review Board (IRB number
1207565) where all recruitment and study procedures wereconducted. Written informed consent was obtained from allparticipants prior to initiation of data collection. Research
assistants explained the informed consent in detail and provided
opportunities for the potential participants to ask questions andreceive clarification. All study data were deidentified, and eachparticipant was given an anonymous numeric identifier. Data
were maintained on a password-protected computer in an
encrypted file, and only the research team members who weredirectly involved in the study had access to the files. The
participants received a total of US $50 as compensation for their
participation.

Results
Participant Characteristics
A total of 11 participants were recruited at baseline, and 2
participants were excluded from the analysis because 1 of themwithdrew after day one and another did not participate in the
educational session. Among the 9 participants, 56% (5/9) were
Asian American, followed by 22% (2/9) who were African
American, 11% (1/9) who were Hispanic, and 11% (1/9) who
were mixed race. The majority were male (6/9, 67%) and used
an iPhone smartphone device (7/9, 78%). The participants’ ages
ranged from 18 years to 33 years, with a mean age of 22.64 (SD4.54) years, and the majority (5/9, 56%) were between 21 years
and 29 years old (Table 2). Among the 9 participants, 56% (5/9)
were overweight (BMI=25-29.9 kg/m2), and 1 (11%) was obese.

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Table 2. Demographics, type of phone used during the intervention, and baseline BMI of the 9 participating college students in Las Vegas, NV who
had elevated blood pressure over 28 days.
Characteristics

Results

Age (years), mean (SD)22.64 (4.54)

Age (years), n (%)≤20

2 (22)

21-29

5 (56)≥30

2 (22)

Race/ethnicity, n (%)
Asian

5 (56)

African American

2 (22)

Hispanic

1 (11)Mixed

1 (11)

Gender (male), n (%)

6 (67)

Phone type, n (%)
iPhone7 (78)

Android

2 (22)BMI (kg/m2), n (%)<25

3 (33)

25-30

5 (56)>30

1 (11)Engagement and Participation Rate
The average daily participation rate was 86.1% (Figure 1).
“Participation” was operationalized as the percentage of students
who submitted their BP reading to the mobile app on a given
day, which varied over the course of the study. For example,
during the 28-day study period, the daily participation rate
(percent of study participants who reported their BP) ranged
from 5 (56%) to 9 (100%) of the 9 participants. The participation

rate approached 90% on 17 of the 28 days, as 8 of the 9 study
participants (89%) reported their BP. Additionally, we had 100%(9/9) participation on 4 of the 28 days. A total of 218 text
messages were sent over the 28-day course of the study. “YourBP is right on target, within normal range. Keep up the goodwork!” was the leading text message sent (n=40), followed by“Your BP is within the normal range. You are doing amazing.”(n=32). However, 2 of the participants received 16 and 10,
respectively, of these messages.

Figure 1. The average daily participation rate over 28 days (N=9) of college students with elevated blood pressure in Las Vegas, NV. LCL: lower
confidence limit; UCL: upper confidence limit.

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We measured BP at least twice before the start of theintervention, and the participants were tasked with measuring
their BP daily for 28 days. Figure 2 depicts the BP for eachparticipant during the study period. Based on the mixed

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regression test outputs, there were no significant changes in BP
over the 28 days. However, we did find that male participants
with higher BMIs had significantly higher SBP and DBP.

Figure 2. The (A) systolic blood pressure (BP) and (B) diastolic BP level for each participant during the 28-day study period in Las Vegas, NV.

Participant Perspectives on the Intervention
Of the 9 participants, 8 completed 100% of the survey’s
questions that focused on their perspective of the usability andeffectiveness of the MOBILE intervention (Table 3).
All participants (n=8) responded affirmatively that theintervention was successful at increasing their awareness of
their individual BP levels and found the text messages to be
helpful. When asked for more detail regarding why they foundthe messages helpful, 4 comments aligned with the first question
and indicated the texts helped remind them to measure their BP,

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understand the category of their BP, and understand the potential
outcomes:
Yes they gave me guidance to assist with decreasing
and maintaining a more favorable blood pressure.
[P201]In addition, 50% (4/8) specifically mentioned they found themessages related to risk reduction, such as diet and exercise andphysical activity, to be helpful:Yes, help to remind me to be conscious of what I eat
and to be physically active. [P209]

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Table 3. Feasibility questionnaire after the participants completed the intervention at 28 days (n=8).
Question and response options

Results, n

1. Did the intervention increases your awareness of your blood pressure levels?
Yes

8

2. Did you find the text messages helpful?
Yes

8

Why or why not?
Awareness

4

Risk reduction

4

Negative2

3. Do you think the frequency of the text messages being sent was appropriate?
Yes

8

If not, how often would you prefer to receive the text messages?
Positive

2

Inconsistent2

Wanted more

1

Constant feedback desire

1

4. What are your thoughts regarding the length of the intervention (4 weeks)? Too short, too long, just right
Just right

6

Preferred longer

2

5. Have you made any changes to your lifestyle?
Yes

8

If yes, what?
Diet and exercise

3

Changes in exercise

3

Changes in diet2

6. What would you like to see differently with the intervention to increase your engagement and participation?
More resources

7

Exercise plan

2

Nutrition suggestions

4

More personalized3

No suggestions

1

7. What was the ease of use regarding the blood pressure machine? Any technical difficulty?
Accessibility

1Portability

1Ease of use

5

Not compact

1

Connectivity problems

2

Failure to work2

8. Anything you would like to share with the researchers regarding your participation.
Good experience

3

Share more data/analysis

2More variety in messages

1

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All participants (n=8) reported making lifestyle changes during
their participation in the intervention: 3 indicated they changed
their exercise patterns, 2 made improvements in their diet, and3 made positive changes to both their diet and exercise:
I changed my diet and amount of exercise by working
out at least four times a week. [P201]
I actually started exercising more towards the end of
the study after seeing my B/P was constantly elevated.
[P205]
A number of questions focused on the ease of use of theintervention. All (n=8) participants indicated they found thefrequency of the text messages to be appropriate:
The daily texts were enough. [P201]
Two participants wanted more text messages that included moredetail, such as meal plans and more constant individual
feedback:
Some more resources would be nice, such as mealsuggestions or other educational resources. [P202]
Regarding the length of the intervention, 6 of the 8 participants
indicated the 4-week span of the intervention was just right.
However, 2 participants preferred a longer intervention and felt
4 weeks was not quite enough time.
I think the length of the intervention was just rightbecause you could see the improvements and changes.
[P206]
I think three months would have been better...longer
length in time for the study would have helped see
either a change in B/P or stagnation. [P207]
Feedback regarding the ease of use of the BP machine was
mixed. Participants (n=5) had positive experiences, as theyreported it was easy to use and did not encounter any technicaldifficulties:
BP cuff was easy to use...user friendly. [P204]
However, others indicated they had connectivity problems andthat the cuff did not work. One participant reported the cuff was
not compact enough.
50% of the time it worked/failed. Sometimes it would
not connect... [P207]
Participants were also asked what they would like to change or
add to the intervention to increase their engagement andparticipation. The responses indicated they wanted moreguidance regarding lifestyle changes such as exercise plans(n=2) and diet or meal suggestions (n=4).
I would like to see examples of exercises and the time
(durations) of the workout... [P201]
Some more resources would be nice, such as mealsuggestions or other educational resources. [P203]
In addition, they indicated more personalized and individualized
information would be helpful (n=3):
Receiving more personalized messages because they
seemed premade. [P207]

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Weekly or biweekly progress notes would seemappropriate and may even motivate me to keep going.
[P205]
Finally, the students indicated they found participating in the
study to be a positive experience:
I found this research study participation to be a goodexperience and a great teaching tool for healthpromotion. [P204]
They provided additional suggestions such as using an online
database for results and providing variation in the text messages.

Discussion
Principal Findings
Based on our findings, the mHealth-supported MOBILE
intervention for BP monitoring and tailored text messaging was
feasible to implement, as our study indicated high rates ofengagement among the college student sample. During the study
time frame, 9 participants used MOBILE to obtain and reporttheir BP over the course of the 28-day intervention from 56%
to 100% of the time, averaging an 86% participation rate. Our
feasibility study found a high daily participation rate, which ispromising given the 4 weeks required for daily data collection.
Among the 28 days, the majority of the participants reported
their BP on 17 of 28 days (89%), and there was 100%
compliance of BP reporting 4 of 28 days. This can be interpretedas, on 21 of 28 days, the participation rate was >90%. This ishigh for a daily intervention. These results also reflected theparticipants’ perspectives regarding the intervention.
Specifically, 6 of the 8 participants stated that the 4-weekintervention was sufficient, yet surprisingly, some of theparticipants actually preferred a longer intervention.
Understanding the participants’ perspectives related to the lengthof time for the intervention is useful and can help inform future
testing of the intervention with a larger randomized controlled
trial to determine effectiveness and efficacy in this population
with elevated BP.
The study results also supported the importance of anindividualized, tailored approach. Although the intervention
was successful at increasing participants’ awareness of theirindividual BP levels and all found the text messages to be
helpful, the majority of the participants reported wanting moreresources to make the lifestyle changes to reduce their high BP
as well as variation and individualization of the messaging.
Participants recommended providing more guidance regarding
lifestyle changes related to nutrition and physical activity. Theysuggested adding exercise plans and meal suggestions that would
be delivered through text messaging. Their feedback is
informative for future implementation of a large randomized
controlled trial and emphasizes the importance of an initialassessment regarding the extent of information appropriate toeach participant based on their needs (ie, nutrition, physicalactivity, knowledge). This implementation will keep some ofthe standardized baseline intervention but also address
individualization that would benefit the participants during andafter the intervention.

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Our study aligns with other studies involving mHealthinterventions resulting in similar levels of high engagement andacceptability. A recent study by Quintiliani and colleagues [21]found an mHealth intervention feasible and useful for weight
management and counseling among breast cancer survivors.
Similarly, mHealth approaches were used successfully to addressor prevent excessive drinking in college students [22]. Likewise,
Kaplan et al [23] recognized that mHealth enables individuals
to achieve a significant BP reduction through in-depth
interactions that encouraged behavioral changes and participant
engagement with treating their condition. Similarly, Cianflone
et al [24] demonstrated that their participants were able toachieve reduction in both SBP and DBP, by 4.7 (SD 1.2) mm
Hg and 3.1 (SD 0.8) mm Hg on average, respectively, using an
mHealth-delivered lifestyle change program. In contrast, asystematic review conducted by Jamshidnezhad and colleagues[25] indicated that existing research regarding mHealth for
hypertension intervention lacks consistency in its impact on
self-care behavior of patients with hypertension. This review
suggests the need for further investigation into the potential
issues in the study designs and interventions and a focus on
rigorous intervention implementation.
Although there was no significant reduction in BP over the 28
days, all participants who responded to the postintervention
questionnaire (n=8) reported making positive lifestyle changes
in diet or exercise during their participation in the intervention.
Our study did reveal that male participants with higher BMIs
had significantly higher SBP and DBP. This is of concern andshould be further assessed to intervene appropriately given
young men are at higher risk of CVD than young women[26,27]. Potential reasons we did not find a BP reduction include
the variations in BP levels resulting from multiple factors suchas time of day, food consumption, physical activity, andemotional state. Furthermore, we had a small sample size andonly assessed 4 weeks of BP, which, according to the literature,
is sufficient to determine if there was a significant reduction
but may not be enough to find a relationship [28]. Additionally,
despite clear instructions during the educational session on how
and when to take their BP, we cannot fully validate if there wereadherence issues since the participants were self-monitored.
Despite our small sample size, we were able to recruit raciallyand ethnically diverse participants. A significant portion of ourstudy sample reflects segments of the general population who
experience health disparities, particularly related to conditions
such as CVD and hypertension, and decreased access to care.
Further efforts to include a diverse sample are likely to be
successful given the overall diversity of the campus used forrecruitment for this pilot study.

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Implications for PracticeThis pilot study lays the groundwork of mHealth as an effective
medium to increase awareness and guide participants to modify
their lifestyles to improve BP in college-aged adults. High BP
requires lifetime management with lifestyle modifications, andmonitoring BP daily (as in this intervention) enables individuals
to understand their daily BP levels and trends and may
encourage behavioral changes. Health care professionals playa fundamental role in educating individuals and providing
optimal feedback for adjustment when necessary. The MOBILE
intervention with mHealth can be used as a primary lifestylemodification tool in both outpatient and inpatient settings for
those who have elevated BP and are initially diagnosed withhypertension, providing the feedback they need to build a strong
heart-healthy foundation.

Limitations
This study was not without limitations. The study involved asmall sample size and lacked a control group; however, given
this is a feasibility study, this was appropriate. There wereinternet connectivity issues reported by some of the participants
who used Android phones; however, one aspect of thisfeasibility study was to determine the technical issues thatparticipants may encounter to help us anticipate and improvein a larger randomized controlled trial. Additionally, allparticipants were required to have a smartphone device withunlimited text messaging to participate, which may have led tobias in our sample; however, given this is an mHealthintervention study, this was an appropriate inclusion criterion
due to our limited resources. All attempts will be made to avoid
bias related to resources that may expand our recruitment andtarget population in future studies. It is worth noting that we
acknowledge this as a potential bias; however, this was anonissue during recruitment because our target population,
namely college students, all had a smartphone device withunlimited text messages.

Conclusions
This pilot study provides support for the feasibility of anintervention with high participation rates and appropriate
approaches regarding the length of time and frequency of text
messages. Based on the suggestions and feedback fromparticipants, improvements and alterations will be made to themHealth BP reduction intervention that can inform successful
implementation when a future randomized controlled trial isconducted with a larger sample size. As a whole, this was apositive experience for the participants that made them awareof their BP and the potential steps to reduce their BP andlifestyle in its entirety.

Conflicts of Interest
None declared.

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Abbreviations
BP: blood pressure
CHOICES: Choosing Healthy Options in College Environments and Settings
CVD: cardiovascular disease
DBP: diastolic blood pressure
MOBILE: mHealth to Optimize BP Improvement
SBP: systolic blood pressure

Edited by A Mavragani; submitted 26.04.23; peer-reviewed by G Roux, S Li; comments to author 01.02.24; revised version received
30.03.24; accepted 03.04.24; published 07.06.24
Please cite as:Tran DM, Dingley C, Bonilla R
mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention StudyJMIR Form Res 2024;8:e48520
URL: https://formative.jmir.org/2024/1/e48520
doi: 10.2196/48520
PMID:©Dieu-My Tran, Catherine Dingley, Roger Bonilla. Originally published in JMIR Formative Research (https://formative.jmir.org),
07.06.2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information,a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

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