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Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study

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机构: [1]Global Health Research Center, Duke Kunshan University, Kunshan, China [2]Department of Medicine (Cardiology), University of California, San Francisco, San Francisco, CA, United States [3]Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States [4]Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States [5]Exercise Works Ltd., Derby, United Kingdom [6]National Clinical Research Center for Cardiovascular Diseases, Beijing, China [7]Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China [8]School of Public Health, Fudan University, Shanghai, China [9]Global Health Research Center, Duke Kunshan University, Kunshan, China [10]Department of Cardiology, Hainan Provincial Nongken General Hospital, Haikou, China [11]Department of Neurology, Hainan Provincial Nongken General Hospital, Haikou, China [12]Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, Centre d’Investigations Cliniques, Centre Hospitalier Universitaire de Nancy, Nancy, France [13]Cardiovascular and Renal Clinical Trialists, French Clinical Research Infrastructure Network, Nancy, France [14]Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria [15]Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia [16]Duke Global Health Institute, Duke University, Durham, NC, United States [17]Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada [18]McMaster University, Hamilton, ON, Canada
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关键词: coronary heart disease secondary prevention medication adherence mobile applications text messaging

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Background: Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, yet implementation of evidence-based strategies for secondary prevention remains suboptimal Objective: This study aimed to evaluate the feasibility, specifically the usability and acceptability, and estimate the preliminary effectiveness of a mobile health (mHealth) intervention targeting both physicians and patients to improve adherence to evidence-based medications and lifestyle modifications. Methods: We conducted a 12-week pre-post interventional pilot study at two sites in Shanghai and Hainan, China Physicians used the app designed in this study to prescribe evidence-based medicines and record patient information. Eligible and consenting patients received automatic text messages or voice calls 4 to 5 times per week for 12 weeks on medication adherence and healthy behaviors. Interviews were conducted among 10 physicians and 24 patients at the two sites for their thoughts on medication adherence and feedback on the usability and acceptability. Questions on usability and acceptability were also asked in a patient follow-up survey. With regard to estimating effectiveness, the primary outcome was medication adherence (as estimated by the Morisky Green Levine Scale) at 12 weeks. Secondary outcomes included physical activity, smoking status, fruits and vegetables consumption, and facility visit frequency. Results: Interview findings and patient survey showed the good usability and acceptability of the intervention. Among 190 patients who completed the intervention, there was a significant increase in medication adherence (odds ratio [OR] 1.80, 95% CI 1.14-2.85). The study also showed decrease of smokers' percentage (-5%, P=.05), increase of daily vegetables consumption frequency (+0.3/day, P=.01), and community health care center visit frequency (+3 in 3 months, P=.04). The following site-specific differences were noted: medication adherence appeared to increase in Hainan (OR 14.68, 95% CI 5.20-41.45) but not in Shanghai (OR 0.61, 95% CI 0.33-1.12). Conclusions: Our study demonstrated that the intervention was feasible in both a tertiary care center and an urban community health center in China Preliminary results from pre-post comparison suggest the possibility that provider and patient-linked mHealth interventions may improve medication adherence and lifestyle modifications among CHD patients, especially in resource-scarce settings. Randomized controlled trials are needed to verify the findings.

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出版当年[2017]版:
大类 | 2 区 医学
小类 | 1 区 卫生保健与服务 1 区 医学:信息
最新[2023]版:
大类 | 2 区 医学
小类 | 2 区 卫生保健与服务 2 区 医学:信息
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出版当年[2016]版:
Q1 HEALTH CARE SCIENCES & SERVICES Q1 MEDICAL INFORMATICS
最新[2023]版:
Q1 HEALTH CARE SCIENCES & SERVICES Q1 MEDICAL INFORMATICS

影响因子: 最新[2023版] 最新五年平均 出版当年[2016版] 出版当年五年平均 出版前一年[2015版] 出版后一年[2017版]

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第一作者机构: [1]Global Health Research Center, Duke Kunshan University, Kunshan, China
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通讯机构: [1]Global Health Research Center, Duke Kunshan University, Kunshan, China [16]Duke Global Health Institute, Duke University, Durham, NC, United States [*1]Global Health Research Center, Duke Kunshan University, No 8 Duke Avenue, Duke Kunshan University, Kunshan, Jiangsu, China, Kunshan, 215316 China
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