Mobile health technology for hypertension management with Hmong and Latino adults: mixed-methods community-based participatory research

ABSTRACT

Objective

To identify Hmong and Latino adults’ perspectives about a mHealth-based care model for hypertension (HTN) management involving blood pressure (BP) self-monitoring, electronic transmission of BP readings, and responsive HTN medication adjustment by a provider team.

Design

We conducted a mixed-methods formative study with 25 Hmong and 25 Latino participants with HTN at an urban federally-qualified health center. We used a tool to assess HTN knowledge and conducted open-ended interviews to identify perspectives about mHealth-based care model.

Results

While most participants 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 about 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, especially 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, and the sense of increased surveillance could feel entrapping. Some people may feel empowered 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 HTN. However, some people may feel entrapped as it could breach patient privacy, interfere with patients’ lifestyle choices, and curtail patient autonomy.

Conclusions

In general, Hmong and Latino adults responded positively to the empowering aspects of the mHealth-based care model, but expressed caution for those who had limited technological knowledge, who did not agree with the medical model and who may feel entrapped. In a shared decision-making approach with patients and possibly their family members, health care systems and clinicians should explore barriers and potential issues of empowerment and entrapment when offering a mHealth care model in practice.

KEYWORDS:

• mHealth
• hypertension
• blood pressure monitoring
• Hmong
• Latino
• community-based participatory action research
• mixed-methods

Acknowledgements

We want to thank our 50 participants who graciously shared their thoughts and experiences with us, our federally-qualified health center partner Minnesota Community Care, and Shannon L Pergament MPH MSW.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by NIH grant R01 HL138332 to KL and a J.B. Hawley Award from the University of Minnesota, Division of Epidemiology and Community Health to KL. CAN was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number T32HL007779.