Using Goal-directed Design to Create a Mobile Health App for Improving Patient Compliance with Hypertension Self-management: Development and Deployment (Preprint)

Abstract

Hypertension is a lifestyle-induced chronic disease threatening lives of patients. The control of hypertension requires patients’ long-term self-management. Unfortunately, compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting their needs. Meanwhile, the use of mobile health is becoming popular in the self-management of chronic diseases. However, few mobile apps were specially designed to meet patients’ needs in hypertension self-management.

The aim of this study was to develop a mobile health app for improving patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance.

The study contained 4 stages. Stage 1 to 3 was the development process. Goal-directed Design method was applied to guide the development. In order to improve the applicability of Goal-directed Design method in chronic disease management, we extracted elements of user models concerned with patient compliance and defined the concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering method based on questionnaires were used to divide patients into different groups. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were defined based on the results from stage 1, in order to meet different groups’ needs. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the number of blood pressure measurement. Besides, qualitative interviews were conducted to learn reasons for the compliance results.

In stage 1, patients were divided into 3 groups based on 82 valid questionnaires. 18 patients from different groups (7, 5 and 6) were interviewed and the needs of the groups were summarized as: to improve self-management ability, to enhance self-management motivation and to receive self-management support. In stage 2 and 3, 6 functional modules were designed and implemented based on the personas, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months, the results showed that patient compliance improved as functional modules were added, and finally maintained at a high level (the rate of 0.73). Interview results from 32 patients showed that the design of the app met different needs of patients so that patients were more complied with it.

This study developed a mobile health app for hypertension self-management using Goal-directed Design method. The app proved to be effective in improving patient compliance with hypertension self-management.