Telemonitoring Blood Pressure Education African Americans with Hypertension

For African Americans with Hypertension (P), Does Telemonitoring Blood Pressure Education (I), Compared to Usual Care (C), Improve Blood Pressure Control (O), Within Three Months (T)
Abstract
With the advent of technology, telemedicine has gained its popularity over the past few years. Various researches are now being conducted to see whether this emerging trend is effective in controlling diseases remotely. Patients need to be educated about technology, especially for the most common and most complicated chronic disease called hypertension. African Americans are believed to have higher rates of this disease, and data have been collected from numerous scholarly articles in this paper to support whether telemonitoring would be helpful for their hypertension control. A background and significance of the problem are mentioned, and then, an assessment of the phenomenon is provided. To highlight the societal perspective of the problem, details are added for further elaboration of the chosen clinical problem. Incidence and prevalence are explained for presenting a comprehensive understanding of the scholarly articles and the times when this problem was probed deeply.
Keywords: hypertension, African Americans, high blood pressure, telemonitoring, usual care, blood pressure control
For African Americans with Hypertension (P), Does Telemonitoring Blood Pressure Education (I), Compared to Usual Care (C), Improve Blood Pressure Control (O), Within Three Months (T)
Ethnicity or race is sometimes linked with the body reactions to hypertension since the levels of blood pressure response to the level of salt one ethnic person intakes and other similar factors too. Among African Americans, high levels of blood pressure, also known as hypertension, are observed. Non-Hispanic black adults experience hypertension more commonly than non-Hispanic Whites (54 percent and 46 percent, respectively) (Centers for Disease Control and Prevention, 2020). The reason for these high levels can be linked to ethnicity since there are environmental factors as well as eating habits, weights, and other health risk factors impacting hypertension. This paper would look into previous research articles providing background literature and theory on the current identified problem.
Background and Significance
African Americans are found to have the highest rates of blood pressure among all the other racial groups of the United States. It is stated that the blood pressure of Blacks in the American community is more likely to develop. Forty-three percent of African Americans are found to have high blood pressure compared to non-Hispanic Whites, which were 28 percent of the hypertensive population (Skolarus et al., 2018). Prevention is of paramount importance since if this disease is left untreated, it might lead to heart and cardiovascular diseases, leading to death. The middle ages of the same racial community are seen to have high rates of this disease compared to the middle ages of Whites. The racial disparities are seen for hypertension, and for this reason, hypertension remains uncontrolled.
Several factors that lead to such conditions at the middle ages of lives of African Americans, such as work, increasing demands to provide care to their families in racial disparity society, and young families who have to lead themselves in complex societal circles. A cardiovascular risk factor is observed when psychosocial, socio-economic, and other patient factors affect self-management of blood pressure rates and self-adherence to medication (Barton et al., 2018). Another risk factor is the inability to treat hypertension on time when it is detected. Medical appointments increase concerning hypertension, and the feasibility of maintaining face-to-face meetings with the health care providers becomes difficult.
There arises a definite need for these patients to be constantly monitored for keeping them on track so that their lifestyle changes can be made to control their blood pressures. The dietary approaches are set so that sodium intake is lessened, and physical activity is increased. Stress is a risk factor for hypertensive African Americans, and being overweight also leads to this chronic disease. Medication adherence is pivotal, and for that, mHealth approaches with the use of technology and mobile applications are becoming common. It is still in the introduction stage and needs to be made common for everyone with its ease of usage and user-friendly interfaces. Still, the option is there, so that blood pressure monitoring is made uncomplicated. It is also a low-cost and effective method for encouraging adherence among African Americans and reaching various geographical locations (Buis et al., 2017).
Connectivity to technology in mobile usage and blood pressure monitoring devices would be better since patients would monitor their blood pressure on their win. Their data would be transmitted too far away locations with the help of those apps. Patients need education in this regard, and for that, patients need to have smartphones, which are quite common these days. Older patients need special attention since they might not be familiar with these methods as such, and to change their lifestyle and behavioral patterns would be a challenge. African Americans utilize emergency department services for hypertension control of all the racial groups, and technological interventions have become compulsory (Buis et al., 2019).
Assessment of the Phenomenon
The current state of the problem needs to be changed, and several examples have been mentioned in the previous section. The examples include the need for technological intervention for control of hypertension among African Americans who are more exposed to this disease than all the other racial groups in America. There is a need for education on technological use for older patients since they might have smartphones. Still, they might not be able to use applications on their mobiles so that their blood pressure data and schedules for taking medications daily are communicated with their health care providers. Follow-ups then need to be scheduled so that weekly or monthly tracking is set for the control of this disease. If the patient has gone to a distant location and he seems to be experiencing bad blood pressure conditions, he might feel the need to contact his nurse caregiver or the physician so that they can help on time. Timely detection of the problem is necessary for accurate control. In this case, telecommunication in the form of video calls or text messages would greatly help. It is certain that there is no need for change in the monitoring of blood pressure of hypertensive patients, and telemonitoring would assist in better avoidance and control of this issue.
The gaps in the evidence emphasize the educational needs of the patients, especially the older ones, and increasing acceptance of telemonitoring for hypertensive patients in the said community. The selected articles do not provide comprehensive data on how the need for telemonitoring should be made important, and for that, perceptions of African Americans need to be changed. There is a further requirement for a deeper probe into changing perceptions towards the technological interventions for controlling hypertension among African Americans. The older population should remain inclusive in future studies of these types so that it should be investigated how old race people respond to new technology and whether they are ready to accept new interventions that would be helpful in medication adherence.
Historical Societal Perspective
The historical and societal perspectives of hypertension and the use of telemonitoring for controlling this disease in African Americans are integrating to study since various social, cultural, and emotional settings shape the behavior of these people towards hypertension and its control. For example, in the study where Church members were included for witnessing a reduction in blood pressure as compared to usual care methods, this specific community was not included before for such investigations, and the article holds significance in this regard. In historical and societal terms, the participants included were those who had access to mobile phones and who could be monitored for blood pressure control through text messages. The messages were tailored according to their social and health values; hence, a social perspective was present. In historical regards, there was no previous intervention faced by this faith-based group, but mobile phone usage was there.
There was another study in which the combination of monthly self-management for supporting medication adherence and quarterly medication management was provided to the patients to observe whether clinical inertia (the failure of health providers to initiate intensification of control therapy) (Barton et al., 2018). This provided the historical perspective of the health providers' perspective of the patient's true control over the blood pressure monitoring. It was discussed that for control of this disease, there is a need for reduction of uncertainty of true control and requires several measurements. Also, the health providers did not respond to many of the encounter communications where intensification was necessary. This was because they had other competing demands, and they put less emphasis on technological interventions. Societal perspectives include the familiarity with the nurse interventionists and high uncertainty of true data provided by the nurses to the health care providers. The health providers believed that the data might or might not be true since they were not familiar with the nurses and their backgrounds. Comfort with a prescription of intensification intervention was not provided in that case.
Incidence and Prevalence
The incidence and prevalence of the chosen problem are provided in a table (appendix 1). The table gave timelines when those studies took place, and the prevalence of the problem in those studies is identified side by side. The first study mentioned was conducted in 2017 for assessing the feasibility of BPMED, text messaging reminder intervention, in controlling blood pressure among African Americans. The problem was quite evident since African Americans showed greater signs of this disease than whites (42 percent versus 28 percent, respectively) (Buis et al., 2017). Medication adherence in this group was low, and only half adhered to their medicines. Forgetfulness was a major factor in this regard. Since 90 percent owned a cell phone and 81 percent used text messages in their daily lives, the feasibility of an automated text messaging system for medication reminders was present since African American "adults" (70 percent) had mobile phones and used the internet as their primary source.
The second study took place in the year 2018 that cited chronic diseases like type 2 diabetes and frequent hypertension causes for cardiovascular diseases, leading to deaths among African Americans. Two factors were deemed critical in CVD risk factors: treatment non-adherence, which might be affected by psychosocial, socio-economic, and other patient factors, the second being clinical inertia, which the health provider's failure to commence intensification of control therapy for hypertension prevention. They have doubts about the true data of control from the patients. For example, access to self-monitored blood glucose and clinic-based blood pressure not reflecting home B.P. monitoring can be the source of this uncertainty.
Another study was conducted in 2018 to assess the feasibility and acceptability of technological intervention for controlling hypertension among African Americans and the Church community. Eighty million adults, which are 30 percent of the American population, have hypertension. Hypertension is crucial in the middle years of life since midlife African Americans are more likely to have their hypertension controlled if they adhere to medications. Racial disparities were also clear since midlife African Americans were more prospective to this disease than midlife Whites.
The study conducted in 2019 was aimed at improving blood pressure among African Americans with the use of the mobile health approach, the MI-App. The study is still ongoing, and the expected results are likely to be in favor of the application of technological intervention for better control of hypertension. One hundred million Americans were mentioned to be suffering from hypertension, and only half of them receive blood pressure control with appropriate strategies. 15.9 percent of them continue to be ignorant of the problem. African Americans are again more likely to have higher rates of this chronic disease, which remains uncontrolled in later years if not treated early, triggering higher cardiovascular morbidity and mortality. Increased use of emergency departments by this ethnic population is witnessed, and this is because of a lack of access to primary care, less awareness of the disease and its preventive measures, and the inability to receive care and having less money for that.
The final chosen study conducted in 2020 was based on the economically disadvantaged community in Flint, majorly African Americans. Thirty percent of the U.S. adult population was affected by hypertension. Reasons for the prevalence of this problem in this community were non-adherence to the medication plan and following an improper lifestyle inducing increased hypertension. Health promotional messages were used to improve their diets, physical activities, medication adherence, and blood pressure monitoring.
Review of Health Care Costs of Problems
After a thorough review of the chosen studies, it has been deducted that with telemonitoring, the costs of health care for hypertension patients would be reduced. Text messaging is thought to be low-cost and an easy method for adoption when it comes to Telehealth. It allows lesser visits to the emergency departments, doctor visits, hospitalization costs, and the stay time within the hospital premises (Nguyen & Nguyen-Le, 2017). The direct costs were reported to be considerably lower than those of the usual care method, despite differences in the execution of the program, duration, and demographics. Even the research conducted by Skolarus et al. (2018) also mentioned that the text messaging telemedicine approach is appealing in its low costs.
Evidence of Support for APRN's Role in Solutions
The chosen research, which was conducted by Barton et al. (2018), revealed that two nurse-administered interventions were carried out to see the effectiveness of telemedicine in the control of type 2 diabetes and chronic diseases like hypertension. The nurses proved quite helpful in dispersing patient data to their respective doctors and transferring their health monitoring data to the physicians so that timely control of the diseases could be made possible. The nurses were responsible for communicating with patients as well as the primary care providers. Also, the nurses were required to provide training to the patients during phone meetings based on a monthly schedule. Then the nurses gave the patient data on his progress in blood pressure monitoring but did not prescribe the medicines to patients by themselves; rather, the nurses contacted PCPs and asked for medication adjustments if any were needed. The follow up between the doctors and patients were arranged by nurses too.
Foundation of PICOT
The foundation of PICOT with relevance to the chosen problem is important to understand since it would answer major questions of this study. The population of the problem were African Americans, intervention is the application of telemonitoring, a comparison was made with the usual care methods for controlling hypertension in the said population, the outcome would be sought to see whether with the intervention of telemonitoring hypertension is controlled or not, and time frame would be within three months. Most of the chosen studies indicate that telemonitoring has reaped positive effects on the health of African Americans since they were able to better adhere to their medication plans, and their hypertension was, therefore, under control. They were reminded regularly through text messages that they had to take their medicines and health-improving messages that encouraged the patients to change their lifestyles to healthier ones.
References
Barton, A.B., Okorodudu, D.E., Bosworth, H.B. & Crowley, M.J. (2018). Clinical inertia in a randomized trial of telemedicine-based chronic disease management: Lessons learned. Telemedicine and e-Health, 24(10), 742-748. DOI: 10.1089/tmj.2017.0184
Buis, L.R., Dawood, K., Kadri, R., Dawood, R., Richardson, C.R., Djuric, Z., Sen, A., Plegue, M., Hutton, D., Brody, A., McNaughton, C.D., Brook, R.D. & Levy, P. (2019). Improving blood pressure among African Americans with hypertension using mobile health approach (the MI-BP app): Protocol for a randomized control trial. JMIR Research Protocols, 8(1), e12601. DOI: 10.2196/12601
Buis, L., Hirzel, L., Dawood, R.M., Dawood, K.L., Nichols, L.P., Artinian, N.T., Schwiebert, L., Yarandi, H.N., Roberson, D.N., Plegue, M.A., Mango, L.C. & Levy, P.D. (2017). Text messaging to improve hypertension medication adherence in African Americans from primary care and emergency department settings: Results from two randomized feasibility studies. JMIR mHealth and uHealth, 5(2), e9. DOI: 10.2196/mhealth.6630
Centers for Disease Control and Prevention. (2020, September 8). Facts about hypertension. Retrieved https://www.cdc.gov/bloodpressure/facts.htm
Champoux, E., Price, R., Cowdery, J.E., Dinh, M., Meurer, W.J., Rehman, N., Schille, C., Oliver, A., Brown, D.L., Killingsworth, J. & Skolarus, L.E. (2020). Reach out emergency department: Partnering with an economically disadvantaged community in the development of a text messaging intervention to address high blood pressure. Health Promotion Practice, 21(5), 791-801. https://doi.org/10.1177/1524839920913550
Skolarus, L.E., Cowdery, J., Bailey, S., Baek, J., Byrd, J.B., Hartley, S.E., Valley, S.C., Saberi, S., Wheeler, N.C., McDermott, M., Hughes, R., Shanmugasundaram, K., Morgenstern, L.B. & Brown, D.L. (2018). Reach out churches: A community based participatory research pilot trial to assess the feasibility of a mobile health technology intervention to reduce blood pressure among African Americans. Health Promotion Practice, 19(4), 495-505. DOI: 10.1177/1524839917710893
Appendix 1
Incidence and Prevalence Table
Years
Articles
Prevalence of data related to the chosen problem
2017
Buis, L., Hirzel, L., Dawood, R.M., Dawood, K.L., Nichols, L.P., Artinian, N.T., Schwiebert, L., Yarandi, H.N., Roberson, D.N., Plegue, M.A., Mango, L.C. & Levy, P.D. (2017). Text messaging to improve hypertension medication adherence in African Americans from primary care and emergency department settings: Results from two randomized feasibility studies. JMIR mHealth and uHealth, 5(2), e9. DOI: 10.2196/mhealth.6630
The problem was evident since African Americans showed greater signs of this disease than whites (42 percent versus 28 percent, respectively). Medication adherence in this group was low, and only half adhered to their medicines. Forgetfulness was a major factor in this regard. Since 90 percent owned a cell phone and 81 percent used text messages in their daily lives. American "adults" (70 percent) had mobile phones and used the internet as their primary source
2018
Barton, A.B., Okorodudu, D.E., Bosworth, H.B. & Crowley, M.J. (2018). Clinical inertia in a randomized trial of telemedicine-based chronic disease management: Lessons learned. Telemedicine and e-Health, 24(10), 742-748. DOI: 10.1089/tmj.2017.0184
Two factors were deemed critical in CVD risk factors: treatment non-adherence, which might be affected by psychosocial, socio-economic, and other patient factors, the second being clinical inertia, which the health provider's failure to commence intensification of control therapy for hypertension prevention. They have doubts about the true data of control from the patients. For example, access to self-monitored blood glucose and clinic-based blood pressure not reflecting home B.P. monitoring can be the source of this uncertainty.
2018
Skolarus, L.E., Cowdery, J., Bailey, S., Baek, J., Byrd, J.B., Hartley, S.E., Valley, S.C., Saberi, S., Wheeler, N.C., McDermott, M., Hughes, R., Shanmugasundaram, K., Morgenstern, L.B. & Brown, D.L. (2018). Reach out churches: A community based participatory research pilot trial to assess the feasibility of a mobile health technology intervention to reduce blood pressure among African Americans. Health Promotion Practice, 19(4), 495-505. DOI: 10.1177/1524839917710893
Eighty million adults, which are 30 percent of the American population, have hypertension. Hypertension is crucial in the middle years of life since midlife African Americans are more likely to have their hypertension controlled if they adhere to medications. Racial disparities were also clear since midlife African Americans were more prospective to this disease than midlife Whites.
2019
Buis, L.R., Dawood, K., Kadri, R., Dawood, R., Richardson, C.R., Djuric, Z., Sen, A., Plegue, M., Hutton, D., Brody, A., McNaughton, C.D., Brook, R.D. & Levy, P. (2019). Improving blood pressure among African Americans with hypertension using the mobile health approach (the MI-BP app): Protocol for a randomized control trial. JMIR Research Protocols, 8(1), e12601. DOI: 10.2196/12601
One hundred million Americans were mentioned to be suffering from hypertension, and only half of them receive blood pressure control with appropriate strategies. 15.9 percent of them continue to be ignorant of the problem. African Americans are again more likely to have higher rates of this chronic disease, which remains uncontrolled in later years if not treated early, triggering higher cardiovascular morbidity and mortality. Increased use of emergency departments by this ethnic population is witnessed. This is because of a lack of access to primary care, less awareness of the disease and its preventive measures, and the inability to receive care and having less money for that.
2020
Champoux, E., Price, R., Cowdery, J.E., Dinh, M., Meurer, W.J., Rehman, N., Schille, C., Oliver, A., Brown, D.L., Killingsworth, J. & Skolarus, L.E. (2020). Reach out emergency department: Partnering with an economically disadvantaged community in the development of a text messaging intervention to address high blood pressure. Health Promotion Practice, 21(5), 791-801. https://doi.org/10.1177/1524839920913550
Thirty percent of the U.S. adult population was affected by hypertension. Reasons for the prevalence of this problem in this community were non-adherence to the medication plan and following an improper lifestyle inducing increased hypertension. Health promotional messages were used to improve their diets, physical activities, medication adherence, and blood pressure monitoring.
Running head: AFRICAN AMERICAN HYPERTENSION 0
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Appendix 2
Matrix Table for Research Articles
Source Citation
Purpose/ Problem
Design/Sample
Instruments/Measures
(Include Reliability/Validity)
Results (Include actual data)
Strengths/weaknesses
Barton, A.B., Okorodudu, D.E., Bosworth, H.B. & Crowley, M.J. (2018). Clinical inertia in a randomized trial of telemedicine-based chronic disease management: Lessons learned. Telemedicine and e-Health, 24(10), 742-748. DOI: 10.1089/tmj.2017.0184
To study why improvements were not seen in treatment non-adherence and clinical inertia after telemedicine intervention and reduced CVD risks.
12-month telemedicine intervention in contrast to usual care, including two nurse management systems: monthly and quarterly. Two Durham clinics were included with participants over 18 years of age. African Americans with type 2 diabetes. Three hundred fifty-nine enrolled patients, 182 were randomized to receive CHANGE intervention.
Statistical mean and derivation for parameters linked with recommended intensifications and also non recommended ones. Microsoft Excel versions were used for computing CVD risk factors, diabetes, and systolic hypertension also.
Mean age: 56. The majority of patients were female, unmarried, and hypertensive—forty-eight percent with low literacy, 35 percent with income less than $10,000 per year. For diabetes, PCPs suggested following intensification 25.4 percent. For hypertension, the recommendation was 20.3 percent. Evidence of non-adherence was present at 7.2 percent. For each CVD risk factor, PCPs were more likely to suggest intensification. THE mean S.D. intensification recommendation was 9.7 percent.
Strength includes a comprehensive analysis of non- adherence factors.
Limitations include a lack of impact of CHANGE strategy even after treatment intensification recommendations.
Buis, L.R., Dawood, K., Kadri, R., Dawood, R., Richardson, C.R., Djuric, Z., Sen, A., Plegue, M., Hutton, D., Brody, A., McNaughton, C.D., Brook, R.D. & Levy, P. (2019). Improving blood pressure among African Americans with hypertension using the mobile health approach (the MI-BP app): Protocol for a randomized control trial. JMIR Research Protocols, 8(1), e12601. DOI: 10.2196/12601
Reducing health disparities related to hypertension in the African American community with the use of mobile health app.
One year control trial on a randomized basis from two emergency departments of Detroit. The sample size was 396, age 25 to 70 years, smartphone, and uncontrolled hypertension.
Two arms were categorized, naming the usual care arm and MI-BP app arm. The comparative analysis would be run using logistic regression with B.P. control as an outcome and study arms counted as primary factors. Mean SBP was compared with the intervention group with the usual care group. Secondary outcomes are determined with the help of linear mixed-effects regression models.
Final statistical results still to be presented since the study is ongoing until 2021.
Strength includes the study's use of a mobile app, which was absent in previous studies, as the prior ones only made use of text messaging.
Limitations include a lack of truly interested participants, and aggressive participant enrollment is missing.
Buis, L., Hirzel, L., Dawood, R.M., Dawood, K.L., Nichols, L.P., Artinian, N.T., Schwiebert, L., Yarandi, H.N., Roberson, D.N., Plegue, M.A., Mango, L.C. & Levy, P.D. (2017). Text messaging to improve hypertension medication adherence in African Americans from primary care and emergency department settings: Results from two randomized feasibility studies. JMIR mHealth and uHealth, 5(2), e9. DOI: 10.2196/mhealth.6630
Discovering the viability, suitability, and clinical effectiveness of BPMED, text messaging service in controlling blood pressure in uncontrolled patients like African Americans.
Two randomized controlled pilot studies were conducted in primary care and emergency departments with usual or intervention care. One hundred twenty-three participants between 2012 and 2014 were taken. 58 primary care and 65 emergency department participants took part. Ages: 18 years and older, English speaking, having cell phones in Detroit. MMAS adherence scale was used to check medication adherence after receiving text messages.
Independent and pooled analyses were made. In the pooled analysis, regression analysis was used.
The results for the two studies were conducted separately, but the combined results were discussed in a shared manner.
Mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5; P=.26). Both control and BPMED participants experienced better SBP (mean 140.4, SD 22.0 mm Hg and mean 140.2, SD 21.6 mm Hg, respectively) and DBP (mean 90.4, SD 11.8 mm Hg and mean 90.2, SD 13.6 mm Hg, respectively) noticed on follow-up, but BPMED members had greater, yet non-significant, meaningful progress in B.P. compared to usual care
Strengths include a depiction of the need for stronger trials in mHealth patients.
Weakness includes only one factor of mHeath, text messaging, out of all the others for monitoring health factors, and improving blood pressure control in hypertensive patients.
Champoux, E., Price, R., Cowdery, J.E., Dinh, M., Meurer, W.J., Rehman, N., Schille, C., Oliver, A., Brown, D.L., Killingsworth, J. & Skolarus, L.E. (2020). Reach out emergency department: Partnering with an economically disadvantaged community in the development of a text messaging intervention to address high blood pressure. Health Promotion Practice, 21(5), 791-801. https://doi.org/10.1177/1524839920913550
To define the procedure of planning and modifying text messages currently being implemented in the Reach Out controlled randomized trial.
The 5-step framework used in the Reach Out program, including literature review, theoretical concepts, community-centered behavioral framework, and community feedback.
Three hundred thirty-three generic and segmented messages were created, addressing diet, physical activity, hypertension, medication adherence, and B.P. monitoring. Pilot community interview feedback was integrated into the study. Fifty-three people were interviewed over the age of 30 years.
A text messaging road map was formulated for each random group. Community interview feedback was shown in the form of a colored graph for each text message response. Positive results in medication adherence and improved B.P. control were seen.
The strength of the study is the five framework analysis that observes the effects of telemonitoring from all angles.
Weakness includes the lack of a second community review since mobile technology is a developing area of health.
Skolarus, L.E., Cowdery, J., Bailey, S., Baek, J., Byrd, J.B., Hartley, S.E., Valley, S.C., Saberi, S., Wheeler, N.C., McDermott, M., Hughes, R., Shanmugasundaram, K., Morgenstern, L.B. & Brown, D.L. (2018). Reach out churches: A community based participatory research pilot trial to assess the feasibility of a mobile health technology intervention to reduce blood pressure among African Americans. Health Promotion Practice, 19(4), 495-505. DOI: 10.1177/1524839917710893
To measure the feasibility of Reach Out intervention with mobile intervention for African American church members.
Four hundred twenty-five church members went through B.P. screening, 94 enrolled (N =94, usual care n = 46, intervention n = 48), and 73 completed six month trial period in Flint. Adults of 18 years and above were included through blocked randomization in ratio 1:1. Feasibility was measured through assessment of willingness. Focus groups were analyzed with the inclusion of church members and studied by a social worker.
Ninety-seven percent of participants were African Americans, and 79 percent were women. The mean age was 58. The participants texted back their B.P. readings, and S.D.'s response was 10.7. Clinical outcomes were assessed through statistical analysis for change in pressures for focus group intervention and usual care ones.
People who responded, 100 percent of them were satisfied with the intervention. Eighty-four percent chose to have interventions in the future. Thirty percent said weekly texts are better, 21 percent referred daily ones, and 81 percent mentioned the duration of the program was perfect. Clinical outcomes stated systolic B.P. was -11.3 mmHg; diastolic B.P. was -8.6. No change in medication adherence with between-group non-significant confidence interval 95 percent.
The strength of this study was that it reached the most underserved community of African Americans, the church members, who are not targeted in other studies for blood pressure control.
Weakness includes low and technical difficulties that deterred the participants from responding with their B.P. measures.
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