# title
Investigating the Effect of an mHealth Intervention on Health Beliefs, Adherence, and Clinical Outcomes of Patients with Hypertension: Case-Control Study (Preprint)

# abstract
BACKGROUND

Mobile health technologies have shown promise as delivery platforms for digital health coaching to improve self-management of chronic conditions such as hypertension. However, more longitudinal research is required to assess the impacts of such strategies on users health beliefs, intentions, and ultimately clinical outcomes.

OBJECTIVE

This study has two main objectives: First, to evaluate the effects of a digital health coaching intervention on participants beliefs constructs; and second, to assess the relationships between these belief constructs and intentions to utilize the technological intervention, actual adherence metrics, and clinical outcomes related to hypertension.

METHODS

Thirty-four patients with hypertension were recruited from a large university community from January to May, 2021. They performed self-measurement of weight and blood pressure for 30 days followed by digital coaching delivered via a mobile application for another period of 30 days. Surveys assessed constructs from the Health Belief Model and Technology Acceptance Model, compared to intention, health belief, blood pressure (BP) self-monitoring adherence, and BP outcomes. A path analysis model was used to assess the relationships between constructs and intention, adherence metrics, and clinical outcomes. A Kruskal-Wallis test was used to identify significant changes in beliefs over the course of the intervention.

RESULTS

Participant health beliefs significantly improved as a result of coaching. Namely constructs such as self-efficacy increased (H(1)=15.12, P<.001) from (Mdn=4.75) to (Mdn=6.5), and Cues to Action increased (H(1)=5.33, P=.02) from (Mdn=5.25) to (Mdn=6). Attitude increased (H(1)=10.35, P=.002) from (Mdn=5.95) to (Mdn=6.5). Perceived Usefulness increased (H(1)=15.02, P<.001) from (Mdn=6) to (Mdn=6.5). Resistance to Change decreased significantly (H(1)=4.05, P=.04) from (Mdn=2) to (Mdn=1.25). Adherence to BP measurements positively correlated with perceived health threat (=.033, P=.007) and perceived ease of use (=.0277, P<.001). While, Self-efficacy ( =2.92, P=.02) and perceived usefulness ( =3.75, P=.01) were linked with a decrease in diastolic BP.

CONCLUSIONS

A digital mobile health coaching intervention may be effective at helping patients with hypertension improve their beliefs regarding the self-management of hypertension. Findings show that there is a significant correlation between self-efficacy and diastolic BP, and higher perceived health threat and perceived ease of use among participants who engaged more with the app.

# authors[].organizations[].label
Center for Health Organization Transformation

# authors[].organizations[].label
Institute for Engineering Education and Innovation

# authors[].organizations[].label
Institute for Science, Technology, and Public Policy

# authors[].organizations[].label
Center for Remote Health Technologies and Systems

# authors[].organizations[].label
Texas A&M Engineering Experiment Station (TEES)

# authors[].organizations[].label
Bush School of Government and Public Service

# keywords[]
Networking And Information Technology R&d (nitrd)

# authorList[]
Zahed, K., Markert, C., & Sasangohar, F.