JMIR FORMATIVE RESEARCH

Muehlensiepen et al

Original Paper

mHealth Apps for Hypertension Self-Management: Interview Study
Among Patient-Users
Felix Muehlensiepen1,2,3, Dr rer medic; Dunja Bruch2, MSc; Frances Seifert1,2, MSc; Eileen Wengemuth1,2, Dr rer nat;
Martin Heinze1,4, Prof Dr Med; Sebastian Spethmann5,6, Prof Dr Med; Susann May1,2, MPH
1Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany

2

Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Bernau,
Germany
3

AGEIS laboratory, Université Grenoble-Alpes, Grenoble, France

4

University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany

5

Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany

6

Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Corresponding Author:
Felix Muehlensiepen, Dr rer medic
Center for Health Services Research
Faculty of Health Sciences
Brandenburg Medical School Theodor Fontane
Seebad 82/83
Rüdersdorf, 15562
Germany
Phone: 49 151 191260 24
Email: Felix.Muehlensiepen@mhb-fontane.de

Abstract
Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile
health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring bloodpressure, fostering lifestyle changes, and improving treatment adherence.
Objective: This study aimed to explore patient-users’ perspectives on the hypertension care mHealth app Hypertension.APP,
focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany.
Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension caremHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim
transcripts were analyzed using qualitative content analysis.
Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient
information from health care professionals regarding effective self-management strategies for their blood pressure. They valued
the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyleadjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app
became integral to patient-users’ hypertension management by offering consistent information and support. The integration into
formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might
have even felt intimidated to use it.
Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoringand educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective
hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better
integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample ofthis qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate thesefindings.
Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s(JMIR Form Res 2024;8:e56162) doi: 10.2196/56162
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KEYWORDS
hypertension; mobile health; mHealth apps; digital health; patient perspective; qualitative study; cardiology

Introduction
Despite effective guideline-based prevention and treatment
options, cardiovascular diseases remain the leading cause ofdeath worldwide [1]. Arterial hypertension is one of the mostimportant risk factors for cardiovascular disease, affecting over1 billion people worldwide [2]. In addition to genetic
predisposition, the development of high blood pressure and theresulting cardiovascular outcomes are strongly influenced byindividual factors, such as lifestyle and health literacy [3], as
well as by local access to health care and its quality [4].
The recent increase in digital health technologies has opened
new possibilities for the prevention and management ofhypertension [5]. This surge includes mobile health (mHealth)applications, wearable devices, and other digital tools thatempower individuals to monitor their blood pressure, track
lifestyle changes, and set health goals. These developments
offer health care professionals (HCPs) innovative methods toimprove patient care and foster healthier living habits [6].
Among these, mHealth apps have shown particular effectivenessin treating hypertension [7].
Despite the significant potential of mHealth apps in hypertensioncare, their integration into routine hypertension care in Germanyis sporadic. This hesitance can be attributed to factors that are
well-recognized in other medical fields. These include a lackof awareness of the benefits of mHealth apps [8], an absenceof reimbursement models for their integration into health careservices [9], and interoperability difficulties with existing
systems [10].
However, this study did not focus on these barriers. Instead, wesought to understand the perspectives and experiences ofindividuals with hypertension who actively use mHealth,specifically, Hypertension.APP, to manage their condition. This

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user-centered approach could provide insights into thepracticalities, determinants, and challenges faced by patients,
thereby informing strategies to optimize mHealth app usage inhypertension care.
Thus, the aim of this qualitative study was to explore user
experiences with an mHealth app in hypertension care, focusing
on app accessibility, expected benefits and perceived risks, andits role in hypertension care in Germany.

Methods
Study Design
We conducted a qualitative interview study on the perspectivesof patient-users of an mHealth app for hypertension care. This
study is part of the digital preventive measures for arterial
hypertension (DiPaH) - project [11], which examines the
structural and individual factors of patients and stakeholders in
the use of digital preventive measures in patients with arterial
hypertension in Germany.

mHealth App: Hypertension.APP
The app (Hypertension.APP) which patient-users wereinterviewed in this study was selected as an example according
to expert recommendations (Prof Dr Martin Middeke and Prof
Dr med Miklós Illyés). The Hypertension.APP is developed
and maintained by the Hypertension Care UG (Ingolstadt) [12].
The application has been downloaded in app stores nearly
10,000 times as of May 2024. It includes a diary function to
document blood pressure data, a personalized guide that provides
information based on the user’s health profile, an export function
to generate reports for medical consultation, a reminder function,and interactive exercises. The Hypertension.APP and its
functions are shown in Figure 1 [12]. The app is freely
accessible in various app stores. There is also a purchasable
premium version which includes additional features.

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Figure 1. Visualization of the Hypertension.APP and its functions [12].

Recruitment
Patient-users were invited to participate in the study throughthe Hypertension.APP. A study invitation for the DiPaH study
was placed in the app which led users to an online questionnaire
survey and an online form for entering contact details for theinterviews. The study team contacted people who had entered
their contact details within 14 days and an interview appointment
was arranged. Participants were selected using purposive
sampling with the aim to include heterogeneous app users [13].
The inclusion criteria were age 18 years or more, use of the app
in the last 2 years, and arterial hypertension. A further inclusion
criterion was interest in and willingness to participate in theinterviews. We chose to conduct 20 interviews as this number
has proven to be adequate in previous studies to reach theoreticalsaturation in the exploration of digital approaches [14-16].

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Data Collection
A preliminary semistructured interview guide was drafted by amultiprofessional team (FM, SM, EW, DB, and SS). The
semistructured interview guide consisted of open-ended
questions that explored participants’ motifs to use theHypertension.APP, its usability, and the advantages anddisadvantages of the app, as well as its impact on personal
hypertension care. Sample interview questions included: (1)“Please remember. How did you come to use this app?” (2)“Please tell me, what do you think of the app?” (3) “What role
does the app play in your hypertension care?” In addition,sociodemographics and health-related data were collected,
including profession, sex, age, location (rural or urban), federal
state, education, technical devices, blood pressure values,
antihypertensive drugs, time since diagnosis, comorbidities,
and tobacco use. To test the applicability of this guide, we
conducted 3 pilot interviews (1 to 3). The interview guide
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JMIR FORMATIVE RESEARCH(Multimedia Appendix 1) proved to be appropriate, so the 3pilot interviews were included in the analysis. All interviews
were conducted by an experienced qualitative researcher (FM)by telephone, between January and June 2023. The interviews
were recorded and transcribed. Data collection was continued
until the aim of 20 interviews was achieved. Consistent withthe planned number of interviews, no substantial new findings
emerged, and saturation of content was reached [17].

Data Analysis
Data were analyzed in parallel with the data collection by 2
experienced qualitative researchers (FM and SM). Analysis was
based on Kuckartz’s structured qualitative content analysis [18]using MAXQDA Analytics Pro 2022 (version 22.1.0; VerbiGmbH). After transcription of the audio material, the analysis
began with the screening of the interview texts, whereupon theinterviews were coded. Relevant text passages from theinterview materials were coded according to a
deductive-inductive procedure. The main categories weredeveloped deductively based on the research questions of the
DiPaH study and subcategories were formed inductively fromthe codes. Consensus discussions were held continuously in the
research group until a common understanding of all theemerging categories was achieved. After data collection was
concluded, the 2 researchers (FM and SM) separately applied
the established category system to analyze the complete dataset,
ensuring that the process could be traced and replicated. For thepresentation of the results, representative quotes from thetranscripts were selected, translated into English, and included
into the manuscript.

Ethical Considerations
The study was approved by the ethics committee of theBrandenburg
MedicalSchoolTheodor
Fontanehttps://formative.jmir.org/2024/1/e56162

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Muehlensiepen et al(E-02-20220620). The study was registered as part of the DiPaH
project at German Clinical Trials Register (DRKS00029761).
Primary data collection was conducted in compliance with thecurrent data protection regulations of the General Data
Protection Regulation and the Helsinki declaration. Participantsreceived extensive study information and provided written
informed consent. Data were pseudonymized before analysis.
No conclusions can be drawn about individuals in thepresentation of results. Participants received €30.00 (US $33.07)
as an incentive and compensation for their participation. Patientswere not involved in designing this study. The manuscript has
been compiled in accordance with the COREQ (ConsolidatedCriteria for Reporting Qualitative Research; Multimedia
Appendix 2) [19]. All methods were performed in accordancewith relevant guidelines and regulations.

Results
Participant Characteristics
A total of 20 interviews with 20 participants were conducted
and were included in the analysis. The mean duration of theinterviews was 26 (10-40) minutes. The mean age of theparticipants was 56 (range 29-80) years. In total, 10 females
and 10 males were interviewed. Out of 20, 13 participants werelocated in an urban area (>20,000 inhabitants), whereas 7 werelocated in a rural area (<20,000 inhabitants). The systolic bloodpressure level most frequently reported was 130-139 mm Hg
and diastolic blood pressure was <80 mm Hg. Most of theparticipants (16/20) were on blood pressure-lowering
medication. Half of the participants were diagnosed withhypertension 1-5 years ago. None of the participants werecurrently using tobacco, while 7 had used tobacco earlier. All
participants of this study used the free version of the app. Table
1 shows further information on participant characteristics.

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Table 1. Detailed characteristics of the study participants.
Number Age(years)Sex

Location

Education

Blood pressure (mm Hg)

Systolic

Diastolic

Antihypertensive
drugs

Diagnosis(years)Other Disease

Tobacco
use

1

80

Male

Rural

University

120-129

<80

Yes

>10

Cardiovascularsurgery

No

2

59

Male

Urban

University

130-139

90-99

Yes

5-10

Elevated cholesterol levels

No

3

69

Female

Urban

University140-159

<80

No

1-5

Cardiovascularsurgery

In the
past

4

42

Male

Urban

Intermediate 120-129

<80

Yes

1-5

None

No

5

65

Male

Rural

Highschool

140-159

90-99

Yes

1-5

None

No

6

29

Female

Rural

University140-159

80-84

Yes

1-5

None

No

7

64

FemaleRuralIntermediate 120-129

<80

No

1-5

Elevated cholesterol levels

In thepast

848

FemaleUrban

Highschool

<120

<80

Yes

>10

Heart attack or
In thestroke, elevatedpastcholesterol levels

948

Female

Urban

University

130-139

<80

Yes

<1

None

No

10

64

Female

Urban

University

120-129

<80

Yes

1-5

None

No

11

66

Female

Urban

University

130-139

80-84

No

1-5

Elevated cholesterol levels

No

12

53

Female

Rural

University

120-129

85-89

Yes

5-10

None

No

13

42

Male

Rural

University

130-139

80-84

Yes

>10

Elevated cholesterol levels

No

14

54

Female

Urban

University

130-139

85-89

Yes

<1

Heart attack or
In thestroke, cardiovas- pastcular surgery

15

35

Male

Urban

Highschool

140-159

100-109

No

1-5

None

In the
past

16

53

Male

Urban

Highschool130-139

80-84

Yes

1-5

None

No

17

58

Male

Urban

University

120-129

85-89

Yes

1-5

Heart attack orNostroke, cardiovascular surgery, elevated cholesterollevels

18

49

Male

Urban

Highschool

120-129

90-99

Yes

>10

Elevated cholesterol levels,
chronic kidneydiseaseIn the
past

19

80

Male

Rural

Highschool130-139

80-84

Yes

>10

None

In the
past

20

53

FemaleUrban

Highschool130-139

80-84

Yes

>10

None

No

Themes
A total of 4 key themes were explored in the analysis: (1) accessto mHealth apps in hypertension care, (2) expected benefits ofhttps://formative.jmir.org/2024/1/e56162

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using mHealth apps in hypertension care, (3) potential risks ofusing apps in hypertension care, and (4) role of the app in
hypertension care routines. Table 2 contains the details of the
final coding tree.

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Table 2. Coding tree of the qualitative content analysis.
Themes and categories

Code (examples)

Access to mHealtha apps in hypertension care
Discovery and adoption

Self-discovery, third-party sources, self-efficacy, and eHealth literacy

Motivation

Convenience, enhancing knowledge, aid in disease management, tackling the disease, control over the disease,and advantages over paper documentation

Downloading and installation

User experience, support, technical challenges, and ease of navigation

Expected benefits of using mHealth apps
Monitoring and documentation Long-term monitoring, detection of blood pressure trends, and comparison with analog documentation
Feedback and information

Immediate explanations and feedback, personalized health advice, and lifestyle adjustments based on app
feedback

Independence in illness manage- Self-management of health conditions, blood pressure control, enhanced self-awareness, and adherence
ment
Potential risks of mHealth in hypertension care
Data protection and privacy

Concerns about data misuse and security breach fears

App usage

Risks of over-reliance on the app and misinterpretation of data

Role of mHealth app in hypertension care routines
Integration in self-management Daily routine integration, personification of the app, and emotional supportaIntegration of mHealth app informal health care

Use of app information in medical consultations; reactions of medical staff to the app; health care provider
skepticism, and gap between app use and medical practiceUser trust and reliability

Confidence in the app’s information and the app as a decision support toolmHealth: mobile health.

Access to mHealth Apps in Hypertension Care
The participants reported that the diagnosis of high bloodpressure was the initial reason for using the app:
I actually came across it by chance. Because twoyears ago I was diagnosed with high blood pressure.
And the doctor said that I should always measure my
blood pressure and keep an eye on it. So I had a look
to see if there were any little aids available. In theapp store, right? Then I came across the app. It wasalso well-rated, right? And, yes, I downloaded it and,yes, it was also easy to use. And, I have actually beenusing the app ever since. And I always record myblood pressure. Regularly, right? The measurements.
So that I can keep an eye on how it's developing. Does
it go too high at first or is it too low? [Interview_4,
pos. 7]
The participants recounted that they had discovered the app
mostly on their own. They either searched directly for an app
on hypertension in the app store or they searched for further
information on hypertension and then became aware of the app
through relevant websites.
Interviewer: Do you remember how you came to use
the app?
Participant: I don't remember exactly. I looked atvarious apps in the app store and tried out which ones
I got on well with, and then at some point I found thehypertension app, because it not only records, butalso provides information about it.
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Interviewer: And you did it all on your own, without
any advice from a doctor or anything like that?
Participant: No, my doctor never said anything about
the app. I looked for it myself. [Interview_12, pos.
6-9]
The participants recalled their dissatisfaction with theinformation provided by their treating HCPs concerning
effective self-management strategies for blood pressure andundertook their own research endeavors. They independently
searched for information on their condition to positively
influence it through lifestyle changes. In doing so, theydifferentiated reliable sources from others.
I was recently diagnosed with high blood pressure at
the beginning of the year which is still relatively
recent, and I didn't really get any useful informationfrom my GP. I felt a bit ill-advised or in bad hands,
so I did some research on the Internet to find reliable
sources and then came across the German Heart
Foundation, where I ordered a magazine. It's called“Bluthochdruck, Herz und Gefäß schützen” [Engl.:
High blood pressure, protecting the heart and bloodvessels] and in this magazine this app was featured
or advertised and that's how I came across this app.”[Interview_9, pos. 11]
The patients experienced no problems in downloading or
installing the app. Overall, the methods by which the participants
accessed the app demonstrated high levels of self-efficacy which
was also reflected in the expected benefits of using the app.

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Expected Benefits of Using Apps in Hypertension Care
The main motivation for using the app was the desire to saveand continuously monitor blood pressure values on a long-termbasis and to provide a clear overview to organize one’s own
lifestyle and make adjustments to it. This was in contrast to theselective blood pressure recording during doctor visits.
(…) in order to monitor my values and then not only
to selectively obtain values at doctor’s visits and geta snapshot or a 24-hour recording, but to actually beable to read certain trends and then act accordingly
in everyday life. [Interview_16, pos. 77]
From the participants’ perspective, one advantage of
documentation through the app over other types of
documentation is that patient-users receive immediate
explanations and feedback on their values.
Yes, ultimately because I also get information anddon't just read, “This is this number”, but what itmeans and what I can do. [Interview_12, Pos. 17]
The app users relate this feedback directly to their lifestyle andadapt it if necessary. The app provides a basis for decisions
regarding behavioral changes.
And I look how it goes and how my blood pressurelevel developed and draw my conclusions from that.
For example, I realize that stress is actually a factor
that increases my blood pressure. I can see this quite
clearly because I know what I have done and when.
And yes, you cannot always avoid stress, but you cantry to limit it. So this feedback is really helpful.
[Interview_17, Pos. 61]
Compared with analog and paper-based documentation types,
the overview and convenience of documentation through theapp were emphasized by the participants.
Well, in the past it was important to me that I always
wrote everything down by hand. So at the very
beginning, yes, there was a little booklet from theblood pressure machine. But then the booklet was
full. I just didn’t enjoy writing everything down byhand. And that immediately convinced me to enter
this data. I do a lot on my smartphone. And yes, andthat I can also see immediately whether I havehypertension or whether it’s the same and so on. So
the values that I enter also give me immediate
information about the status of things. So thatconvinced me immediately. [Interview_11, pos. 20]
The participants emphasized the importance of managing theirillnesses independently. They reported that the app effectively
helped them achieve this objective, particularly by controlling
their blood pressure.
Because I consider it important to have my bloodpressure under control given my state of health.
[Interview_1, Pos. 105]
One app user also reported that the app enabled him to lead an
independent life and that independent app-supported monitoring
helped him visit the doctor less often.

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Because I lead a very unconventional life. It isimperative that I need as little medical help as
possible. That is why I have to get a tight grip on myincipient illnesses – after all, I am 80 years old. I haveto be in control of the situation. [Interview_19, Pos.
19]

Potential Risks of mHealth in Hypertension CareIn addition to the perceived benefits, participants were also
asked about potential risks of using the app. However, mostparticipants did not perceive any risk when using the app. Someparticipants addressed the general risk of misuse of data by third
parties:Well, I do see a risk that you enter health data here,of course. This is just the data protection risk. But
not specifically in this app, it’s a general story. I think
the app is relatively well-secured. And yes, the data
can sometimes be hacked, okay. That always raises
the question of who uses this data and for what?
[Interview_16, pos. 55]
Furthermore, the participants reported a risk of excessive useof the app.
Interviewer: Do you see any risks when using theapp?
Participant: Well, not for me. Maybe that you get too
attached to the app. But that’s always the case withthings like this. But I tend to forget that.
[Interview_10, pos. 72-73]

Role of an mHealth App in Hypertension Care
Routines
In the interviews, the participants described the app as an
essential element in the self-management of their own
hypertension care routines. In contrast to conventional
hypertension care, continuous availability of support andinformation was emphasized in the interviews. In some cases,
the app was even personified and its use was described as atreatment.
Well, all these things combined make for perfectprevention or even treatment. It is actually already aform of treatment, yes. Because look, how often do
you visit your doctor? To my general practitioner
maybe twice a year. So they always tell you the same.
And that’s it, yes. But I need this support on a daily
basis, yes. It [the app] is like a kind of companion,
like a sparring partner basically, yes. And exactly,
the app is my sparring partner because it also
communicates with me. [Interview_11, pos. 30]
The app provides information to understand one’s condition.
Participants described that the app supports communication
with the medical staff and enables patient-users to express theirneeds.
And as I said, the most important thing for me was tobe taken seriously by the doctor. And when you
engage more with your own illness, then you can,well, argue better. [Interview_5, Pos. 53]
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In addition, the interview participants reported that they had
confidence in the app and regarded the information presented
as reliable. Simultaneously, the significance that the user
attaches to the app’s information is not acknowledged in the
doctor’s office.
Well, I must say, I trust the app and have already readthe information, which is kept relatively concise, fromthe library. And yes, because I trust the app, as I havealready mentioned, I take seriously what it shows me,
to put it bluntly. And so, for me, that is trustworthy
information. (…) And with this mild or slight diastolichypertension, it then says, “Continue taking yourblood pressure medication and consult a doctor tofurther optimize the medication or something in that
direction.” Exactly, so I find it very valuable
information. But I had the impression which mightalso be due to the individual doctor that the lady
didn't take my concern to discuss the medication again
very seriously. [Interview_13, Pos. 50]
Similarly, another user suggested that the treating doctor mightfeel intimidated by the app or the information provided. The
app is currently not integrated into the user’s medical
hypertension care.
So, in the general practitioner's office, it seems likethe app has not really caught on there, I feel. If I werein the place of the general practitioner, I would reallytake it seriously. Of course, it is possible that thegeneral practitioner might feel threatened by it. I don't
know. (...) If I were in her shoes, I would have been
more interested. She did say, “Oh that's great. And
good that you're doing it.” But she didn't say, “Showme the app.” or anything like that... [Interview_11,
Pos. 34]

Discussion
Principal Findings
This qualitative study is the first to explore user experienceswith an mHealth app in hypertension care, focusing on app
accessibility, expected benefits, potential risks, and its role in
hypertension care in Germany. The study showed thatpatient-users of the Hypertension.APP typically discovered theapp independently, driven by a combination of a recent highblood pressure diagnosis and a lack of satisfactory informationfrom their HCP. These patient-users particularly appreciatedthe app’s capabilities for continuous monitoring anddocumentation of blood pressure, as it offered valuable feedback
and explanations, aiding them in understanding their condition
and making informed lifestyle adjustments. Whileacknowledging these benefits, patient-users also noted potential
risks concerning data privacy and the possibility of becoming
overly reliant on the app, although they assigned relatively low
importance to these concerns. The app has become an essential
part of users’ disease management routines, providing consistent
support and information that contrasts with low-frequency
traditional doctor visits. Regarding the disappointment of app
users, the integration of the app into formal health care settings
was limited, with some patient-users sensing a lack ofhttps://formative.jmir.org/2024/1/e56162

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acceptance or even intimidation from the HCP toward thetechnology.

Comparison With Previous Work
Our results clearly indicate that mHealth can be a valuable tool
for self-management of arterial hypertension. This finding is inconcordance with existing research, underscoring the substantial
potential and effectiveness of digital health [5,6], particularly
mHealth [7], not only in hypertension care but also in othermedical areas [14-16].
While in other medical domains the use of digital technologies
is associated with depersonalization or dehumanization of healthcare [14,20], in this study, participants personified the app orconsidered it a “sparring partner.” We hypothesize that providing
personalized information enhances user motivation andcommitment to app usage, and therefore recommend this forthe development of digital health applications.
From a socio-technological perspective, our findings resonate
with Bruno Latour's actor-network theory [21]. This theory
characterizes an “actant” as an entity that either acts or is granted
action by others, without necessarily attributing specificmotivations to human actors or humans in general. In thisframework, any entity can be an actant as long as it isacknowledged as the origin of an action. In the realm ofhypertension management, our data position the app as a pivotal
actant within the actor network. Remarkably, for somepatient-users, the app assumed a more influential role than thatof the health care professionals involved, underscoring its
significance in this domain.
Notably, the participants expressed dissatisfaction with the lackof integration of mHealth into standard hypertension care. They
advocated its inclusion in formal hypertension practices,
stressing the need for HCPs to recognize and leverage these
digital health tools. Why do German HCPs have reservations
about mHealth in hypertension care? The reluctance of German
HCPs toward mHealth in hypertension management is amultifaceted issue, as explored in a separate module of the
DiPaH study [11]. HCPs reported doubts regarding the validityof patient-generated data, data privacy concerns, and additional
efforts including training and interoperability. These factors,
along with the absence of incentives and insufficientincorporation into the health care system’s reimbursement
frameworks, are major hindrances to the full exploitation ofmHealth capabilities, despite the advantages acknowledged bypatients. This contrasts with other chronic conditions, such as
rheumatoid arthritis, where HCPs acknowledge the value of
mHealth in facilitating shared decision-making and adopting atreat-to-target approach [15].

Implications
It appears critical that patient-users of mHealth applications,especially those managing chronic diseases, receive serious
attention and support from their HCPs. Therefore, potential
users and stakeholders should be involved in the development
of digital health applications. This was the case for thedevelopment of Hypertension.APP. However, there is currently
a significant shortfall in the information resources available to
HCPs which is crucial as there is evidence that HCPs’
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knowledge of telemedicine is closely intertwined with theiractual use of telemedicine services [22]. Low-threshold training
opportunities for HCP are highly needed and should be
supported by professional organizations involved in
hypertension care.
Looking ahead, the narratives from our interview participantssuggest that they possessed a high level of self-efficacy andeHealth literacy, as well as a higher income and educational
background. This observation raises critical questions about
accessibility and equity: who is able to use these mHealthservices effectively, and who is not? Based on interviews alone,
we can only speculate; however, a more comprehensive analysis
combining interview and questionnaire data would offer valuable
insight into these dynamics. It could provide a clearer pictureof the demographic profile of current patient-users of mHealthin hypertension care, and potentially identify groups that are
currently underserved or unable to benefit from this digital
health technology.
This knowledge would be instrumental in developing strategies
to make mHealth more accessible and effective for a broader
range of patients, particularly those with chronic conditions,such as hypertension.

Strengths and Limitations
While our study offers valuable insights, it is essential toacknowledge its limitations. First, the inclusion of solely
patient-users, particularly limited to one specific app may
introduce selection bias, potentially limiting the generalizabilityof our findings. In addition, the perspectives of treating HCP,
particularly GPs and cardiologists, warrant exploration in a
separate study to provide a comprehensive understanding of
hypertension management. Specifically, investigating the
optimal integration of app data into the local electronic medical
record and the workflow for HCPs is imperative, as this aspect
could significantly influence their acceptance of digital
hypertension care.
In addition, our study may be susceptible to self-selection bias
and social desirability bias, exacerbated by the provision of
study incentives. Furthermore, the demographic composition

Muehlensiepen et alof interview participants, predominantly consisting of highly
educated nonsmokers, fails to fully represent the diverse
population living with hypertension. The absence of reported
issues during the download and installation of the app suggeststhat our sample might also possess higher levels of self-efficacy,
eHealth literacy, and technical skills compared with the general
population. This indicates a potential overestimation of these
attributes in the broader community of hypertensive patients.
Most participants had controlled blood pressure levels, with
only a minority having systolic blood pressure >139 mm Hg
and some not on medication. This may also have influenced the
HCPs perceived need for mHealth based blood pressure
monitoring.
Furthermore, it is crucial to acknowledge that the app used inour study lacks certification as a digital therapeutic (“Digitale
Gesundheitsanwendung” or DiGA), limiting its integration into
standard health care systems and reimbursement schemes.
However, despite these limitations, our study stands as the first
exploration of user experiences with an mHealth app for
hypertension care in Germany. By closely examining therealities of care and patient perspectives, our findings offer
valuable insights into the potential of digital self-management
in hypertension care and highlight areas where further
improvement is needed.

Conclusion
Among the sample studied, mHealth apps like
Hypertension.APP were highly valued for their continuous
monitoring and educational content, which aids in hypertension
management. The findings highlight the potential of mHealthapps for effective hypertension care among patients who arehealth- and digitally-literate, as well as self-effective. However,there is a critical need for better integration of these apps into
routine health care practices, as perceived by the users. This
includes addressing the skepticism and lack of acceptanceamong HCP, ensuring that they receive the necessary training
and resources to effectively use these tools. Further researchshould also focus on the accessibility and effectiveness of
mHealth apps across diverse patient populations to promote
equitable health benefits.

Acknowledgments
The authors thank all interview partners and participants for their valuable contributions and time. We would also like to express
our gratitude to Olen Johannsen from Hypertension Care UG and Prof Dr med Martin Middeke from the Hypertension Centre
Munich for their collaboration in the investigation of the Hypertension.APP. This study was supported by the Innovation Committeeof the Federal Joint Committee (Innovation Fund; grant 01VSF18014).

Data Availability and Disclaimer
All data relevant to the study are included in the article or are uploaded as supplementary information. For further questions
regarding the reuse of data, please contact the corresponding author (felix.muehlensiepen@mhb-fontane.de). During the preparationof this work, the authors used ChatGPT version 4.0 to improve language and readability. After using this tool or service, theauthors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Authors' Contributions
FM made substantial contributions to the design of the work, obtaining funding, the data acquisition and analysis, the interpretationof data, drafted the manuscript and had full access to all the data in the study and takes responsibility for the integrity of the data
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Muehlensiepen et al

and the accuracy of the data analysis. FS made substantial contributions to the data analysis and substantively revised themanuscript. EW made substantial contributions to the data analysis and substantively revised the manuscript. MH made substantial
contributions to the design of the work, obtained funding, and substantively revised the manuscript. DB made substantial
contributions to the design of the work, obtaining funding, the data acquisition and analysis, and substantively revised themanuscript. SS made substantial contributions to the design of the work, obtaining funding, data acquisition and analysis andsubstantively revised the manuscript. SM made substantial contributions to the design of the work, the data analysis, the datainterpretation and substantially revised the manuscript.
All authors have approved the submitted manuscript. In addition, the authors have agreed both to be personally accountable forthe author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even onesin which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in theliterature.

Conflicts of Interest
None declared.

Multimedia Appendix 1
Interview guide.
[PDF File (Adobe PDF File), 699 KB-Multimedia Appendix 1]

Multimedia Appendix 2
COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist.
[PDF File (Adobe PDF File), 481 KB-Multimedia Appendix 2]

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Abbreviations
COREQ: Consolidated Criteria for Reporting Qualitative Research
DiPaH: digital preventive measures for arterial hypertension
HCP: health care professional
mHealth: mobile health

Edited by A Mavragani; submitted 09.01.24; peer-reviewed by RJ Katz, J Edwards, E van der Velde; comments to author 18.03.24;
revised version received 09.05.24; accepted 15.06.24; published 27.09.24
Please cite as:
Muehlensiepen F, Bruch D, Seifert F, Wengemuth E, Heinze M, Spethmann S, May S
mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-UsersJMIR Form Res 2024;8:e56162
URL: https://formative.jmir.org/2024/1/e56162
doi: 10.2196/56162
PMID:©Felix Muehlensiepen, Dunja Bruch, Frances Seifert, Eileen Wengemuth, Martin Heinze, Sebastian Spethmann, Susann May.
Originally published in JMIR Formative Research (https://formative.jmir.org), 27.09.2024. 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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