Frontiers in Public Health · 10 authors, 5 centres
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This paper describes the theory-driven design and development of a smartphone app integrated with a wearable cuffless blood pressure device for hypertension self-management, using an Intervention Mapping approach. The app includes features for real-time BP monitoring, physical activity tracking, medication adherence, education, and a clinician portal for remote patient management. The intervention will be evaluated in future studies to determine its clinical effectiveness and usability.
**Background:** Hypertension is a leading modifiable risk factor for cardiovascular disease, affecting 4.1 million Australian adults with an annual healthcare expenditure of approximately AUD$941 million. Despite available treatments, only 21.6% of Australians with hypertension are treated and controlled, 17% are treated but uncontrolled, and 61.4% remain untreated. Mobile health apps have shown potential to improve hypertension management by enabling self-monitoring, feedback, tailored information, and reminders. However, the design and development processes of these apps are rarely described in detail, and few apps integrate wearable devices with a clinician portal for remote management.
**Methods:** The authors used an Intervention Mapping approach, a six-step framework for developing theory- and evidence-based interventions. Step 1 (Needs Assessment) involved a literature review of qualitative and quantitative studies on the self-management needs and preferences of people with hypertension. Needs were prioritized using the MoSCoW (Must have, Should have, Could have, Won't have) model. Step 2 (Outcomes, Performance and Change Objectives) identified intervention objectives based on stakeholder perspectives, focusing on promoting self-management behaviors. Step 3 (Theoretical Methods and Practical Strategies) involved brainstorming sessions to select appropriate behavior change strategies, incorporating the Information-Motivation-Behavioral Skills (IMB) model and the Patient Health Engagement (PHE) model. Step 4 (Program Design) included wireframing using Adobe XD and app development using the IONIC cross-platform framework. The app communicates with a validated Bluetooth smartwatch via GATT protocol and with a remote server via HTTP. The technical architecture comprises five layers: application, control, security, data linking, and data storage. The security layer implements OAuth2 authentication, a Confluent Kafka REST proxy for gateway control, and audit trail logging. Data is stored in a MySQL database across five groups: personal information, healthcare data, care plan, medications, and notifications. Steps 5 (Adoption and Implementation Plan) and 6 (Monitoring and Evaluation Plan) are described but will be executed in future studies.
**Key Results:** The needs assessment identified six key self-management requirements: education, medication/treatment adherence, lifestyle modification, alcohol and smoking cessation, and blood pressure monitoring support. Using MoSCoW prioritization, the 'Must have' features included: providing disease information, enabling BP monitoring, enabling physical activity monitoring, and enabling medication management. 'Should have' features included clinician health input and connection to validated devices. 'Could have' features included clinician communication, push notifications, personalized support, real-time feedback, and data sharing. 'Won't have' features included alcohol management, smoking cessation, and social support (though information on these topics would be included in educational content). The intervention outcomes were mapped to three objectives: improving disease knowledge, promoting patient empowerment (including BP control, physical activity, and medication management), and improving self-efficacy. The IMB model was applied such that information includes hypertension knowledge, motivation includes personal and social factors, and behavior focuses on self-management skills. The PHE model's behavioral, cognitive, and emotional domains were mapped to techniques including goal setting, psycho-education, daily diaries, and healthcare provider support. The developed app includes six main features: real-time health monitoring via Bluetooth smartwatch, BP and physical activity assessment with automated alerts, education content, medication lists with reminders, data presentation as text and graphs, and clinician communication via messaging. The clinician portal allows remote medication list modification and care plan rule setting.
**Clinical Implications:** This is the first study to describe the design and development of an mHealth app that integrates a wearable cuffless BP device with lifestyle support and a clinician portal for hypertension management using a systematic Intervention Mapping approach. The theory-driven design addresses the critical needs of people with hypertension, including treatment adherence, medication review and titration by clinicians, and remote patient monitoring. The app's security and privacy considerations (OAuth2, audit trails, data de-identification) aim to improve patient trust and engagement. The authors note that a recent systematic review of 24 studies reported that mHealth apps reduced systolic BP by −3.78 mmHg and diastolic BP by −1.57 mmHg in intervention groups compared to controls, with improved medication adherence in 16 studies. However, the current app requires rigorous evaluation in future pilot trials to determine its effectiveness, usability, and feasibility in real-world settings.