Mobile Health Technology for Hypertension Management in Hmong and Latino Adults: Qualitative Community-based Participatory Research (Preprint)
Authors: Culhane-Pera Kathleen A , Vang Ka Bao , Ortega Luis Enrique , Xiong Txia , Northuis Carin A , de la Parra Pilar , Lakshminarayan Kamakshi 
Published: October 2020

BACKGROUND

Hypertension (HTN) is a major risk factor for stroke and heart attack. Unfortunately, only 43.7% of US adults with HTN have adequate blood pressure control. Patients from minority groups, including Hmong and Latino communities, are disproportionally affected. Home blood pressure self-monitoring can improve hypertension control, particularly in times of restricted clinic visits during COVID-19 pandemic. Mobile health technology (mHealth) can facilitate this self-monitoring. However, it is unknown if mHealth will be accepted by minority patients.

OBJECTIVE

Identify Hmong and Latino adults’ perspectives about a mHealth based care model for high blood pressure management involving self-monitoring and responsive medication adjustment by a provider team.

METHODS

We enrolled 25 Hmong and 25 Latino participants with hypertension from an urban federally qualified health center serving low income patients. We obtained demographic data, collected responses about hypertension knowledge, and conducted open-ended interviews to identify participants’ perspectives about the mHealth based hypertension care model.

RESULTS

Participants were 56% female with a mean age of 56 years. Most (88%) were immigrants and most (96%) had lived in the United States (US) for 10 years or longer. Half (52%) spoke and read English and 100% of Latino and 76% of Hmong were literate in their own language. In addition to hypertension, participants reported comorbidities including diabetes mellitus (48%), elevated cholesterol (54%) and depression or anxiety (48%). While most participants (98%) agreed that lowering high blood pressure decreased the risk of strokes, heart attacks, and kidney failure, there were gaps in medical knowledge. Three major themes emerged from the interviews regarding the perception of the mHealth based care model: 1) Using mHealth technology could be useful especially if assistance was available to patients with technological challenges; 2) Knowing blood pressures could be helpful to patients who agreed with doctors’ medical diagnosis and prescribed treatment; 3) Transmitting blood pressures to the clinic and their responsive actions could feel empowering for patients; however, the sense of increased surveillance could feel entrapping to some patients.

CONCLUSIONS

In general, Hmong and Latino adults responded positively to the mHealth based hypertension care model and felt that it could be empowering since it could increase patient-provider communication without burden of clinic visits and could increase involvement in BP control for those who agree with the medical model of hypertension. Some participants expressed concern that the mHealth model could be entrapping as it could breach patient privacy, interfere with patients’ lifestyle choices, and curtail patient autonomy. In a shared decision-making approach with patients (and possibly their family members), health care systems and clinicians should explore potential issues of empowerment and entrapment when offering an mHealth care model in practice.

CLINICALTRIAL

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