Text Message Reminders for High Blood Pressure

No longer recruiting at 1 trial location

Overseen By Leah J Bauder, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: George Washington University

Disqualifiers: Pregnancy, Recent heart attack, Stroke, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how text message reminders can help manage high blood pressure in homeless individuals. The study tests whether messages focused on blood pressure control improve medication adherence and clinic visit attendance compared to general health tips. Participants will be randomly assigned to two groups to receive different types of messages over six months. It is suitable for those experiencing homelessness, who have high blood pressure, and are involved with Project Renewal shelter-clinics in New York City. The goal is to determine if focused text reminders can lead to better health outcomes for those with uncontrolled high blood pressure. As an unphased trial, this study allows participants to contribute to innovative research that could enhance health management strategies for vulnerable populations.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. It seems to focus on managing blood pressure through text message reminders, so you may continue your current treatment unless advised otherwise by your doctor.

What prior data suggests that this mHealth strategy is safe for hypertension management?

Research has shown that mobile health (mHealth) interventions, such as text messages, are generally safe and well-received. One study found these interventions acceptable to people experiencing homelessness, indicating no major safety concerns when using text messages to manage high blood pressure in this group.

In this trial, participants in the intervention group will receive text messages to help control blood pressure, remind them to take medication, and track appointments. While the study focuses on the effectiveness of these reminders, existing research supports the safety of using text messages for managing health conditions.

Overall, text messaging for health management is safe and widely accepted as a way to support people with health challenges. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the use of mobile health (mHealth) technology to manage hypertension in homeless individuals, a group that often faces barriers to traditional healthcare. Unlike current treatments that rely on regular doctor visits and medication adherence without additional support, this approach uses text message reminders to prompt medication adherence, appointment attendance, and provide hypertension-specific education. The trial also includes general health education via SMS, aiming to integrate healthcare engagement into the daily lives of participants. This method has the potential to improve blood pressure management by making healthcare more accessible and personalized for a vulnerable population.

What evidence suggests that this mHealth strategy is effective for managing hypertension in homeless persons?

Research has shown that text messaging can effectively help homeless people stay engaged with their health care and adhere to their medication regimens. This is crucial because nearly 40% of individuals with high blood pressure in New York City's homeless shelters do not have their condition under control. In this trial, participants will be assigned to different arms to evaluate the effectiveness of text message reminders. One arm will receive hypertension-specific education through SMS texts, including reminders for medication adherence and appointment attendance. Another arm will receive general health education via SMS texts. Text reminders have reduced hospital visits by keeping patients on track with their health needs. This method shows promise for managing high blood pressure by sending reminders to take medications and attend medical appointments. Overall, evidence suggests that these text message reminders could lead to better blood pressure control for homeless individuals. ^{1 6 7 8 9}

Who Is on the Research Team?

Ramin Asgary, MD, MPH

Principal Investigator

George Washington University

Are You a Good Fit for This Trial?

This trial is for homeless individuals over 21 with uncontrolled high blood pressure, who are not pregnant or post-partum, can consent, read/respond to texts, and haven't had recent severe cardiovascular events. They must be getting care at Project Renewal in NYC.

Inclusion Criteria

Your blood pressure was too high at your last doctor's visit.

You are currently homeless.

Currently presenting to Project Renewal shelter-clinics for medical care

Exclusion Criteria

I have not had a heart attack or stroke in the last 6 months.

Inability to read or respond to SMS texts

I have had an aortic aneurysm.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 6 months of mHealth HTN management support via SMS texts, including reminders for medication adherence, appointment attendance, and HTN-specific health education and support.

6 months

Regular visits at shelter-clinics for BP measurements and adherence assessments

Follow-up

Participants are monitored for changes in blood pressure, adherence to clinic visits, and adherence to medication.

6 months

BP measurements and adherence assessments at 0, 2, 4, and 6 months

Qualitative Interviews

Qualitative interviews with participants and providers to understand barriers and opportunities regarding BP control.

End of recruitment period

What Are the Treatments Tested in This Trial?

Interventions

• mHealth for Hypertension in Homeless Persons

Trial Overview The study tests a mobile health strategy using text messages to manage hypertension among the homeless. Participants will either receive standard care texts or additional messages aimed at controlling blood pressure to see if there's an improvement.

How Is the Trial Designed?

Group I: Hypertension-Specific Education Experimental Treatment 1 Intervention

6 months of mHealth HTN management support via SMS texts including reminders for medication adherence, appointment attendance, and HTN-specific health education and support. Texts will be delivered to support medication adherence and lifestyle changes, and participants will receive appointment reminders before each appointments with a follow-up text and robocall if the appointment is missed.

Group II: General Health Education Experimental Treatment 1 Intervention

6 months of mHealth including basic healthcare and general health promotion via SMS texts. Blood pressure measurements and adherence assessments will be collected at every shelter visit.

Who Is Running the Clinical Trial?

George Washington University

Lead Sponsor

Trials

263

Recruited

476,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

New York University

Collaborator

Trials

249

Recruited

229,000+

Published Research Related to This Trial

A study involving 50 homeless individuals in New York City revealed that most participants had mobile phones and were supportive of using text messaging for health care communication, such as appointment reminders and health education.

Participants preferred concise, positively framed text messages and believed that free cell phone plans could enhance their access to health care, suggesting that mobile health strategies could significantly improve health outcomes for the homeless population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceptions, Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters. Asgary, R., Sckell, B., Alcabes, A., et al.[2022]

Among 210 hypertensive patients studied in New York City shelters, 40.1% of homeless patients had uncontrolled blood pressure, which is significantly higher than the national average of 19.6% to 24.8%.

Lack of health insurance was identified as a key barrier to effective blood pressure control, while homeless patients with diabetes or multiple chronic conditions showed better management of their hypertension, suggesting that targeted health interventions could improve outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rates and Predictors of Uncontrolled Hypertension Among Hypertensive Homeless Adults Using New York City Shelter-Based Clinics. Asgary, R., Sckell, B., Alcabes, A., et al.[2022]

Among 97,366 homeless adults studied, the prevalence of self-reported hypertension was found to be 27.0%, and diabetes prevalence was 8.0%, indicating a significant burden of chronic diseases in this population.

Interestingly, the prevalence rates of hypertension and diabetes among homeless adults were similar to those in the general population, suggesting that homelessness does not necessarily increase the risk of these conditions, but highlights the need for improved healthcare and housing resources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis. Bernstein, RS., Meurer, LN., Plumb, EJ., et al.[2022]

Text messaging interventions for appointment reminders and medication adherence suggestions showed a trend towards reducing no-show rates and improving medication adherence among a homeless population, with no-show rates at 21.0% for the intervention group compared to 30.6% for the control group.

Although the results did not reach statistical significance, the intervention group reported a higher increase in self-reported medication adherence (from 8.27 to 9.84) compared to the control group (from 8.27 to 8.68), indicating potential effectiveness in enhancing patient engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study. Kershaw, K., Martelly, L., Stevens, C., et al.[2022]

This study will evaluate the effectiveness of a 6-month SMS texting program for managing diabetes in 100 adults experiencing homelessness, measuring changes in HbA1c and adherence to self-care activities over 9 months.

The research will also gather insights from both patients and healthcare providers to assess the acceptability and experiences of the SMS program, aiming to improve diabetes management in this underserved population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short messaging service (SMS) texting for uncontrolled diabetes among persons experiencing homelessness: Study protocol for a randomized trial. Asgary, R., Beideck, E., Naderi, R., et al.[2023]

This study will evaluate the effectiveness of a 6-month SMS texting program in reducing blood pressure and improving medication adherence among 120 adults experiencing homelessness with uncontrolled hypertension, using a randomized controlled trial design.

In addition to measuring health outcomes, the study will assess the acceptability and experiences of both patients and healthcare providers regarding the SMS intervention, providing valuable insights into its feasibility in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SMS text intervention for uncontrolled hypertension among hypertensive homeless adults in shelter clinics of New York City: protocol for a pragmatic randomised trial study. Asgary, R., Bauder, L., Naderi, R., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10619124/

SMS text intervention for uncontrolled hypertension among ... We have documented a rate of 40.1% of uncontrolled BP among hypertensive PEH in New York City's (NYC) homeless shelters, which is in sharp ...

2. withpower.com withpower.com/trial/phase-hypertension-1-2022-c988c

Text Message Reminders for High Blood Pressure Research shows that text messaging has been effective in improving health care engagement and medication adherence in homeless populations, and has helped ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT03034993

Self-Management Using Text Messaging in a Homeless ... The purpose of this study is to determine if an automated text message intervention is beneficial for homeless patients in reducing their hospital visits, ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4709154/

Rates and Predictors of Uncontrolled Hypertension Among ... This study aims to assess the rates and predictors of uncontrolled blood pressure among hypertensive homeless adults and a nonhomeless, low-socioeconomic adult ...

5. researchgate.net researchgate.net/publication/290213907_Rates_and_Predictors_of_Uncontrolled_Hypertension_Among_Hypertensive_Homeless_Adults_Using_New_York_City_Shelter-Based_Clinics

Rates and Predictors of Uncontrolled Hypertension Among ... Purpose: We undertook a study to determine the rates, predictors, and barriers to blood pressure control among homeless and nonhomeless ...

6. clinicaltrial.be clinicaltrial.be/en/details/18569?per_page=20&recruiting=1&enrolling_by_invitation=1&active_not_recruiting=1&not_yet_recruiting=0&completed=0&only_recruiting=0&only_eligible=0

Uncontrolled Hypertension Among the Homeless The intervention will include 6 months of mHealth HTN management support via short message service (SMS) texts including reminders for ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8600433/

GPS Mobile Health Intervention Among People ... mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; ...

8. trialx.com trialx.com/clinical-trials/listings/263847/uncontrolled-hypertension-among-the-homeless/

Uncontrolled Hypertension Among the Homeless This study is designed to assess the effect of implementing a mobile health (mHealth) strategy using text messaging for hypertension (HTN) ...

9. researchprotocols.org researchprotocols.org/2021/1/e25424/

Protocol for the mGlide Randomized Controlled Trial This study will provide evidence for whether a readily available mHealth care model is better than state-of-clinical care for bridging the guideline-to- ...