Mobile Health for Enhanced Hypertension Self-Management in Underserved Urban Residents

Hypertension (HTN) is a highly prevalent, chronic condition which disproportionately affects socioeconomically disadvantaged individuals and their communities. Individual- and neighborhood-level social risk factors influence the self-management and access to care essential for HTN control. Mobile health (mHealth) strategies may contribute to behavioral changes but are largely understudied in disadvantaged communities. Further, the engagement of the residents of such communities is critical for the successful development and implementation of contemporary mHealth interventions. This Mentored Patient-Oriented Research Career Development (K23) Award will investigate and develop a participant-informed, mHealth behavioral approach to individuals living in disadvantaged communities at high risk for adverse cardiovascular outcomes. Specific aims: (1) Use qualitative assessments to determine how neighborhood deprivation affects HTN control; (2) Adapt a mHealth intervention to incorporate lifestyle modifications and self-management for individuals living in adverse community settings using a validated, human-centered design (HCD) approach to adapt the intervention until we reach participant consensus; (3) Assess the adapted mHealth intervention for feasibility, as defined by acceptance, usability, and practicality in a randomized-controlled pilot study. The investigations build on and leverage the core infrastructure of an active, funded health services research program; the resources of a large, regional health care system; and expert mentorship in qualitative methods, community engagement, systems science, and clinical trials. Training goals: (1) Integrate the candidate’s prior training with new methodological tools to examine neighborhood-level social determinants of cardiovascular health; (2) Cultivate skills in community-informed cohort development; (3) Develop the methodological skills to conduct rigorous research in chronic disease behavior change; (4) Enhance grant writing, presentation, team science, and leadership skills to support the candidate’s transition to an independent investigator. As such, the career development agenda will include synergistic efforts between the candidate’s strengths and future goals. The proposal advances key objectives of the NHLBI Strategic Vision to address health disparities in disadvantaged communities and the career development of a physician-scientist. Expected results: The project will: (1) Develop and test an innovative, practical, and scalable mHealth intervention program grounded in behavioral theory and tailored for underserved communities; (2) Develop and refine a model to improve engagement and satisfaction for mHealth intervention programs using an iterative process; and (3) Collect preliminary data to inform the design of an R01 application to expand a behavioral intervention tailored for individuals residing in disadvantaged communities. The research and career development activities outlined in this proposal will enable the candidate to launch and conduct an independent research career as a future expert in community-engaged, clinically meaningful interventions to promote cardiovascular health.