Using apps to support the self-management of hypertension in Saudi Arabia

Abstract

Background: Hypertension is a chronic condition that affects one billion adults globally will affect an estimated 1.56 billion by 2025. Its prevalence in Saudi Arabia is particularly high and is the main risk factor for death. Hypertension can be greatly improved by effective self-management. Smartphone apps offer potential solutions to aid self-management, and their availability has hugely increased recent years. An increasing number of studies have advocated their use in clinical settings. This increase in commercial hypertension apps, and the growing enthusiasm for their use in patient care urgently necessitates research to identify those that are most suited to facilitating the self-management of hypertension in Saudi Arabia. Purpose: The aim of this PhD research was to review available apps for the self-management of hypertension based on their effectiveness, privacy and security, and their theoretical underpinning, to identify the most suitable apps for use in the Saudi context, and to evaluate the usability and acceptance of the most suitable app among Saudi patients. Methods: This PhD consists of four studies. A systematic review explored the usability and effectiveness of apps in supporting self-management of hypertension (Study 1). An app store review was carried out to review available hypertension self-management apps in the most common app stores, and identify their functionalities, privacy and security characteristics, and theoretical backgrounds (Study 2). A systematic selection approach was used to identify the most suitable, effective and secure apps, which were then explored via a qualitative study to identify the most suitable app for the Saudi context (Study 3). Finally, a mixed methods study amongst Saudi hypertension sufferers evaluated the acceptance and usability of the selected app in both a real-life context and a controlled setting (Study 4). Results: Study 1 identified apps with the potential to be effective in supporting hypertension self-management, and found that apps are more likely to be effective if they have more comprehensive functionalities. Study 2 found 186 such apps, but few of them (n=30) are likely to be effective, and most of them did not meet current standards of privacy and security, and were lacking a sound theoretical bases. In Study 3, the systematic selection approach, identified 5 apps that are likely to be effective, and that have adequate privacy and security measures. These 5 apps were assessed in a qualitative study with patients and doctors, who identified three apps as more suitable, with Cora health app rated highest in participants’ ratings. Study 4 found that the Cora health app can be acceptable and usable in the self-management of hypertension, but there are some issues that could be improved. Conclusion: This PhD study demonstrates that the selected app is usable and acceptable in the self-management of hypertension and has the potential to be effective. Future research would be required to assess the app’s effectiveness in a larger study with longer follow up periods.