Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study

Shu Chen¹, Enying Gong¹, Dhruv S Kazi^{2

3

4}, Ann B Gates⁵, Rong Bai^{6

7}, Hua Fu⁸, Weixia Peng⁸, Ginny De La Cruz¹, Lei Chen⁹, Xianxia Liu⁹, Qingjie Su¹⁰, Nicolas Girerd^{11

12}, Kamilu M Karaye¹³, Khalid F Alhabib¹⁴, Lijing L Yan^#^{1

15}, J D Schwalm^{16

17}

Affiliations

¹ Global Health Research Center, Duke Kunshan University, Kunshan, China.
² Department of Medicine (Cardiology), University of California, San Francisco, San Francisco, CA, United States.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.
⁴ Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
⁵ Exercise Works Ltd., Derby, United Kingdom.
⁶ National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
⁷ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁸ School of Public Health, Fudan University, Shanghai, China.
⁹ Department of Cardiology, Hainan Provincial Nongken General Hospital, Haikou, China.
¹⁰ Department of Neurology, Hainan Provincial Nongken General Hospital, Haikou, China.
¹¹ Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, Centre d'Investigations Cliniques, Centre Hospitalier Universitaire de Nancy, Nancy, France.
¹² Cardiovascular and Renal Clinical Trialists, French Clinical Research Infrastructure Network, Nancy, France.
¹³ Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria.
¹⁴ Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁵ Duke Global Health Institute, Duke University, Durham, NC, United States.
¹⁶ Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁷ McMaster University, Hamilton, ON, Canada.

^# Contributed equally.

PMID: 29371178
PMCID: PMC5806005
DOI: 10.2196/mhealth.7849

Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study

Shu Chen et al. JMIR Mhealth Uhealth. 2018.

. 2018 Jan 25;6(1):e9.

doi: 10.2196/mhealth.7849.

Authors

Affiliations

¹ Global Health Research Center, Duke Kunshan University, Kunshan, China.
² Department of Medicine (Cardiology), University of California, San Francisco, San Francisco, CA, United States.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.
⁴ Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
⁵ Exercise Works Ltd., Derby, United Kingdom.
⁶ National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
⁷ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁸ School of Public Health, Fudan University, Shanghai, China.
⁹ Department of Cardiology, Hainan Provincial Nongken General Hospital, Haikou, China.
¹⁰ Department of Neurology, Hainan Provincial Nongken General Hospital, Haikou, China.
¹¹ Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, Centre d'Investigations Cliniques, Centre Hospitalier Universitaire de Nancy, Nancy, France.
¹² Cardiovascular and Renal Clinical Trialists, French Clinical Research Infrastructure Network, Nancy, France.
¹³ Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria.
¹⁴ Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁵ Duke Global Health Institute, Duke University, Durham, NC, United States.
¹⁶ Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁷ McMaster University, Hamilton, ON, Canada.

^# Contributed equally.

PMID: 29371178
PMCID: PMC5806005
DOI: 10.2196/mhealth.7849

Abstract

Background: Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, yet implementation of evidence-based strategies for secondary prevention remains suboptimal.

Objective: This study aimed to evaluate the feasibility, specifically the usability and acceptability, and estimate the preliminary effectiveness of a mobile health (mHealth) intervention targeting both physicians and patients to improve adherence to evidence-based medications and lifestyle modifications.

Methods: We conducted a 12-week pre-post interventional pilot study at two sites in Shanghai and Hainan, China. Physicians used the app designed in this study to prescribe evidence-based medicines and record patient information. Eligible and consenting patients received automatic text messages or voice calls 4 to 5 times per week for 12 weeks on medication adherence and healthy behaviors. Interviews were conducted among 10 physicians and 24 patients at the two sites for their thoughts on medication adherence and feedback on the usability and acceptability. Questions on usability and acceptability were also asked in a patient follow-up survey. With regard to estimating effectiveness, the primary outcome was medication adherence (as estimated by the Morisky Green Levine Scale) at 12 weeks. Secondary outcomes included physical activity, smoking status, fruits and vegetables consumption, and facility visit frequency.

Results: Interview findings and patient survey showed the good usability and acceptability of the intervention. Among 190 patients who completed the intervention, there was a significant increase in medication adherence (odds ratio [OR] 1.80, 95% CI 1.14-2.85). The study also showed decrease of smokers' percentage (-5%, P=.05), increase of daily vegetables consumption frequency (+0.3/day, P=.01), and community health care center visit frequency (+3 in 3 months, P=.04). The following site-specific differences were noted: medication adherence appeared to increase in Hainan (OR 14.68, 95% CI 5.20-41.45) but not in Shanghai (OR 0.61, 95% CI 0.33-1.12).

Conclusions: Our study demonstrated that the intervention was feasible in both a tertiary care center and an urban community health center in China. Preliminary results from pre-post comparison suggest the possibility that provider and patient-linked mHealth interventions may improve medication adherence and lifestyle modifications among CHD patients, especially in resource-scarce settings. Randomized controlled trials are needed to verify the findings.

Keywords: coronary heart disease; medication adherence; mobile applications; secondary prevention; text messaging.

©Shu Chen, Enying Gong, Dhruv S Kazi, Ann B Gates, Rong Bai, Hua Fu, Weixia Peng, Ginny De La Cruz, Lei Chen, Xianxia Liu, Qingjie Su, Nicolas Girerd, Kamilu M Karaye, Khalid F Alhabib, Lijing L. Yan, JD Schwalm. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 25.01.2018.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

**Figure 1**
The Adherence and Knowledge Exchange heart disease medicines (TAKEmeds) study flowchart.

**Figure 2**
Flowchart of the Adherence and Knowledge Exchange heart disease medicines (TAKEmeds) app operational procedures.

**Figure 3**
Examples of text messages developed and used in the Adherence and Knowledge Exchange heart disease medicines (TAKEmeds) study.

See this image and copyright information in PMC

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Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study

Affiliations

Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

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Medical