Smartphones apps to support the self-management of hypertension: effectiveness and user satisfaction
By Emma Norris, on 10 October 2018
By Tourkiah Alessa, Prof. Mark Hawley and Prof. Luc de Witte – University of Sheffield, UK
Hypertension, which is among the most common chronic diseases in adults, is a major cause of stroke, heart disease and renal failure. About one billion people live with hypertension worldwide, many of whom do not control their blood pressure (BP) well, despite the fact that lowering BP lessens the risk of renal and cardiovascular disease. One of the most effective ways of coping with hypertension is through self-management, making patients more responsible for their own care. Smartphone apps offer great potential to play a role in self-management, clearly demonstrated by the large number of apps that have become available over the past few years. However, the rapid growth in the use of these apps raises questions about what evidence there is for their effectiveness, their usability and patients’ satisfaction. Do they really work, what do patients think about their usability and how satisfied are they with their use?
To answer these questions we conducted a systematic literature review, funded by the Saudi Culture Bureau. This review examined 14 apps that were evaluated in 21 different studies. We found that people with hypertension and their health professionals generally accept the use of apps to support the self-management of hypertension. Participants found that all the studied apps were easy to use, convenient and helpful in self-managing hypertension and encouraging active involvement in their own healthcare.
To evaluate the effectiveness of the apps, app functionalities were categorized into behavior change techniques, including self-monitoring, goal setting, the use of prompts or cues (reminders), automatic feedback and educational information. We found apps that had similar functionalities, but they were different in the number of their combined functionalities. Most studies indicated positive effects of using the apps. Due to the variety of quality and design of the studies there is no conclusive evidence about which of the functionality combinations are most effective. However, apps with more comprehensive functionalities were likely to be more effective. These functionalities should include but not be limited to self-monitoring and reminders, with educational information or automatic feedback or both. To fully understand the mechanisms of effectiveness of the apps we need well-designed, large-scale studies.
The majority of the apps in this review were study-specific, that is developed for the aims of the study alone. This is in contrast to the hundreds of commercially available apps in app stores. This raises important questions about the extent to which these apps in app stores are evidence- based, and how the results of evaluation research translate to the work of app developers. This is an area that clearly requires further research to distinguish apps that really work and help people to manage their BP from those that do not work.
- What differences might we find between commercially developed apps and apps designed for research purposes in terms of usability and effectiveness?
- If commercial apps are not evidence-based, how should we assess their effectiveness and usability? Are there limitations that we should keep in mind when evaluating them?
- What possible criteria could be used to assess whether commercially developed apps really do work?
Tourkiah Alessa is a teaching assistant at King Saud University (KSU) in KSA and a PhD candidate at Sheffield University, UK. She is supervised by Professor Luc de Witte and Professor Mark Hawley in the Center of Assistive Technology (CATCH), which is located in the School of Health and Related Research (ScHARR). Her research revolves around using technology in health care settings, including Electric Health Record implementation and current technology in self-managing chronic diseases. Her current focus is on using apps to support the self-management of chronic diseases, especially hypertension.
Mark Hawley is Professor of Health Services Research at the University of Sheffield, and Honorary Consultant Clinical Scientist at Barnsley Hospital. Over the last 30 years, he has worked as a clinician and researcher – providing, researching, developing and evaluating assistive technology, telehealth and telecare products and services for people with disabilities, older people and people with long-term conditions.
Mark is Director of the Centre for Assistive Technology and Connected Healthcare (CATCH) at the university. He leads a number of projects funded by the NIHR and Innovate UK, and leads the Assistive Technology theme of the Devices for Dignity MedTech Cooperative. @Mark_S_Hawley
Luc de Witte is a professor of Health Services Research in the School of Health and Related Research (ScHARR) at the University of Sheffield. His research is on healthcare innovations using technology, with a focus on long term care. He worked as a Professor of care technology at two universities in the Netherlands, and Director of a large innovation network with about 35 partners in health and social care, industry and academia. He also chaired the management board of the National Centre for Care Technology Research – a collaboration of four large institutions in the Netherlands. As well as this, he initiated a research and development programme called ‘Health in Slums’ that focuses on improving the living circumstances in India. He is President of and active governor member of a number of other programmes and organisations across 25 locations. @luc_witte