The effects of a smartphone-enhanced nurse-facilitated self-care intervention for Chinese hypertensive patients: A randomised controlled trial

For hypertensive patients, self-care is of the utmost importance in disease management and health maintenance. However, due to inadequate motivation and self-efficacy in performing self-care behaviours, satisfactory self-care is difficult to initiate and maintain. Smartphone-based interventions with support from nurses may be an alternative way to improve self-care behaviours and blood pressure control. Therefore, a randomised controlled trial was conducted to test the effects of a smartphone-enhanced nurse-facilitated self-care intervention for hypertensive people.To examine the effects of a smartphone-enhanced nurse-facilitated self-care intervention on improving blood pressure control, anthropometric parameters, and self-care amongst Chinese hypertensive patients from two community health service centres.This study was a single-blinded, two-arm randomised controlled trial with a repeated-measures design.Participants were recruited from two community health service centres in China from March 2018 to June 2018.A total of 210 patients with hypertension were randomly allocated to either the intervention or control group (n = 105 per group).Participants in the intervention group received six individual weekly education and consultation sessions provided by a nurse in the first 6 weeks and a researcher-developed smartphone application for 12 weeks. The sessions consisted of health education, individual self-care planning, daily records of physical health status and lifestyle behaviour, and an automated weekly health report. Data on systolic blood pressure, diastolic blood pressure, body weight, waist circumference, and self-care (behaviour, motivation, and self-efficacy) were collected at baseline, the 6th week, and 12th week after joining the study. A generalised estimating equation model was used to analyse the outcome.A total of 191 patients (91%) completed outcome measurements at the three time points. Compared with the control group at the 6th and 12th week follow-ups, the intervention group exhibited significant reductions in systolic blood pressure (T1: β = -7.29, T2: β = -11.07), diastolic blood pressure (T1: β = -4.80, T2: β = -7.50), body weight, body mass index, and waist circumference, and a significant improvement in self-care (behaviour, motivation, and self-efficacy). At the 12th week follow-up, the proportion of participants with BP < 140/90 mmHg in the intervention group (31%) was significantly higher than that in the control group (9%, p = 0.003).The smartphone-enhanced nurse-facilitated self-care intervention could improve blood pressure, anthropometric parameters, and self-care amongst Chinese hypertensive people in two communities. Its long-term effects amongst diverse hypertensive patient populations can be examined in a future study.The smartphone-enhanced nurse-facilitated self-care intervention improved BP control and self-care, which is an effective alternative to hypertension management.This study was registered at the Chinese Clinical Trial Registry (ChiCTR-IOR-17014227).