Mobile health technology (WeChat) for the hierarchical management of community hypertension: protocol for a cluster randomized controlled trial

Figures & data

Figure 1 The eligibility criteria at screening and baseline.

Table 1 Summary of study measures at baseline and the end of follow-up

Measurement	Method	Contents
Questionnaire	self-administered	Social-demographic characteristics hypertension related health status (including course of disease, complications and daily BP) health knowledge about hypertension health-related behavior (including eating habits, alcohol drinking, HPSMBRS and IPAQ-S-C) self-efficacy: HSES medication adherence: CPAT
Physique^a	examined by the investigators	Height & weight (measured by height and weight scale) waist & abdomen circumference (measured by tapeline) BMI (calculated by height and weight)
Office blood pressure	examined by the investigators	Systolic pressure & diastolic pressure (measured by calibrated electronic sphygmomanometers, Omron HEM-8713) the heart rate (measured by calibrated electronic sphygmomanometers, Omron HEM-8713)

Notes: ^aPhysique: All measurements are accurate to one decimal place.

Abbreviations: BP, blood pressure; HPSMBRS, Hypertension Patients Self-Management Behavior Rating Scale; IPAQ-S-C, the Chinese version of short International Physical Activity Questionnaire; HSES, Hypertension Self-Efficacy Scale; CPAT, the compliance in patient with antihypertensive therapy.

Figure 2 The framework of self-efficacy theory in the study.

Table 2 Cardiovascular risk stratification of hypertension patients

Risk factors and medical history	Hypertension Stage 1 SBP 140~159/DBP 90~99	Hypertension Stage 2 SBP 160~179/DBP 100~109	Hypertension Stage 3 SBP≥180/DBP≥110
None	Low risk	Intermediate risk	High risk
1~2 risk factors^a	Intermediate risk	Intermediate risk	High risk
≥3 risk factors or complications^b	High risk	High risk	High risk

Notes: ^aRisk factors: male >55 years old, female >65 years old; smoking; dyslipidemia; family history of early onset of cardiovascular disease; obesity (BMI ≥28 kg/m²). ^bComplications: cerebrovascular disease, heart disease, kidney disease, peripheral vascular disease, retinopathy, diabetes.

Table 3 Content of mHealth intervention based on WeChat

Intervention	Duration	Forms	Frequency	Contents
Health education	3 months	deliver articles of health knowledge to participants via WeChat We-Media accounts	The prehypertension groups are delivered articles each two weeks; the low-intermediate risk groups are delivered articles once a week; the high-risk groups are delivered articles twice a week	Basic knowledge of hypertension; physical signs and target organ damage of hypertension; complications; drug treatment; health behaviors and lifestyle intervention
Health promotion	3 months	offer targeted health advices to participants; implement the punch-in system for fixed goals	The prehypertension groups punch in every two weeks; the low-intermediate risk groups punch in once a week; the high-risk groups punch in twice a week	Medication compliance; dietary guidance; exercise promotion; weight control; smoking cessation and alcohol limit; mental adjustment
Group chatting	6 months	encourage communication and disease management experience sharing in WeChat groups	The prehypertension groups chat every two weeks; the low-intermediate risk groups chat once a week; the high-risk groups chat twice a week	Individual experience of disease management; recent physical condition and live status
Tracking on BP	6 months	self-report HBPM and regular feedback	Everyone is asked for self-reporting BP three times a week at the time of inclusion; the report frequency is reduced to once a week if the BP is well controlled.	The self-reported SBP and DBP measured by patients at home; the monthly BP assessment report as regular feedback to patients by researchers

Abbreviations: BP, blood pressure; HBPM, home blood pressure monitoring; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 3 The WeChat app screenshots.

Notes: From left to night top to bottom, the screenshots of WeChat app are Notifications. Health consultation, group chat (1), group chat (2), health articles delivered by We-Media Accounts, and the punch-in questionnaire respectively.

Figure 4 Flowchart of the study procedures.

Notes: *30-month post-evaluabon: the evaluation of long-term effects of intervention, mainly assessed by the complication incidence (for patients with hypertension) and incidence of hypertension (for population with prehypertenson). **Data statistical analyses: including the economic evaluation.
Abbreviation: BP, blood pressure.