Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities

This systematic review and meta-analysis characterizes digital health interventions for reducing hypertension and assesses the association of these interventions with blood pressure changes in adults experiencing health disparities.

12 and 22 Search for Web of Science Core Collection #1 TS=("low* income" or "low*-income" or impoverish* or poverty or homeless or disadvantaged or disenfranchis* or "financial* distress*" or "financial* stress*" or "economic factor*" or socioeconomic* or welfare* or subsidized or "economic burden*" or underprivilege* or destitute or bankrupt* or "poverty-stricken") or TS=("social determinant*" or "implicit attitude*" or "implicit bias*" or "health bias*" or "racial bias*" or "conscious attitude*" or "unconscious bias*" or "nonconscious bias*" or "non-conscious bias*" or "conscious bias*") or TS=((minorit* or structural* or cultural* or multi-cultur* or multicultur* or linguistic* or social* or intercultural* or inter-cultural* or cross-cultural or crosscultural or multi-rac* or multi-ethnic* or multiethnic* or multi-lingual or multilingual or trans-cultural or transcultural or ethnocultur* or ethno-cultur* or socio-cultural or sociocultural or bi-rac* or birac*) near/3 (status* or competen* or awareness* or diversit* or discrimin* or bias*)) #2 TS=((high or elevated or raised) near/3 "blood pressure*") or TS=(hypertension or hypertensive) or TS=("blood pressure" near/3 (manage* or control* or prevent* or monitor*)) #3 TS=((mobile or "cell phone" or cellular or smartphone or iphone or android or windows or blackberry or handheld or portable or ipad or tablet or phone or telephone) near/3 (app or apps or application* or health or device* or message* or intervention*)) or TS=(health near/3 (app or apps or application* or device*)) or TS=(mHealth or telemedicine or wearable or "mobile health" or "digital treatment*" or "digital health" or ehealth or e-health or m-health or smartwatch* or "smart watch*" or "tele monitor*" or telemonitor* or "mobile technolog*" or "text message*" or SMS) #4 #1 and #2 and #3 Search for Scopus ( TITLE-ABS-KEY ( "low* income" OR "low*income" OR impoverish* OR poverty OR homeless OR disadvantaged OR disenfranchis* OR "financial* distress*" OR "financial* stress*" OR "economic factor*" OR socioeconomic* OR welfare* OR subsidized OR "economic burden*" OR underprivilege* OR destitute OR bankrupt* OR "poverty-stricken" ) OR TITLE-ABS-KEY ( "social determinant*" OR "implicit attitude*" OR "implicit bias*" OR "health bias*" OR "racial bias*" OR "conscious attitude*" OR "unconscious bias*" OR "nonconscious bias*" OR "non-conscious bias*" OR "conscious bias*" ) OR TITLE-ABS-KEY ( ( minorit* OR structural* OR cultural* OR multicultur* OR multicultur* OR linguistic* OR social* OR intercultural* OR inter-cultural* OR crosscultural OR crosscultural OR multi-rac* OR multi-ethnic* OR multiethnic* OR multilingual OR multilingual OR trans-cultural OR transcultural OR ethnocultur* OR ethno-cultur* OR sociocultural OR sociocultural OR bi-rac* OR birac* ) W/3 ( status* OR competen* OR awareness* OR diversit* OR discrimin* OR bias* ) ) ) AND ( TITLE-ABS-KEY ( ( high OR elevated OR raised ) W/3 "blood pressure*" ) OR TITLE-ABS-KEY ( hypertension OR hypertensive ) OR TITLE-ABS-KEY ( "blood pressure" W/3 ( manage* OR control* OR prevent* OR monitor* ) ) ) AND ( TITLE-ABS-KEY ( ( mobile OR "cell phone" OR cellular OR smartphone OR iphone OR android OR windows OR blackberry OR handheld OR portable OR ipad OR tablet OR phone OR telephone ) W/3 ( app OR apps OR application* OR health OR device* OR message* OR intervention* ) ) OR TITLE-ABS-KEY ( health W/3 ( app OR apps OR application* OR device* ) ) OR TITLE-ABS-KEY ( mhealth OR telemedicine OR wearable OR "mobile health" OR "digital treatment*" OR "digital health" OR ehealth OR e-health OR m-health OR smartwatch* OR "smart watch*" OR "tele monitor*" OR telemonitor* OR "mobile technolog*" OR "text message*" OR sms ) ) Search for Cochrane Library #1 ("low* income" or "low*-income" or impoverish* or poverty or homeless or disadvantaged or disenfranchis* or "financial* distress*" or "financial* stress*" or "economic factor*" or socioeconomic* or welfare* or subsidized or "economic burden*" or underprivilege* or destitute or bankrupt* or "poverty-stricken"):ti,ab or ("social determinant*" or "implicit attitude*" or "implicit bias*" or "health bias*" or "racial bias*" or "conscious attitude*" or "unconscious bias*" or "nonconscious bias*" or "non-conscious bias*" or "conscious bias*"):ti,ab or ((minorit* or structural* or cultural* or multi-cultur* or multicultur* or linguistic* or social* or intercultural* or inter-cultural* or cross-cultural or crosscultural or multi-rac* or multi-ethnic* or multiethnic* or multi-lingual or multilingual or trans-cultural or transcultural or ethnocultur* or ethno-cultur* or socio-cultural or sociocultural or bi-rac* or birac*) near/3 (status* or competen* or awareness* or diversit* or discrimin* or bias*)):ti,ab #2 ((high or elevated or raised) near/3 "blood pressure*"):ti,ab or (hypertension or hypertensive):ti,ab or ("blood pressure" near/3 (manage* or control* or prevent* or monitor*)):ti,ab #3 ((mobile or "cell phone" or cellular or smartphone or iphone or android or windows or blackberry or handheld or portable or ipad or tablet or phone or telephone) near/3 (app or apps or application* or health or device* or message* or intervention*)):ti,ab or (health near/3 (app or apps or application* or device*)):ti,ab or (mHealth or telemedicine or wearable or "mobile health" or "digital treatment*" or "digital health" or ehealth or e-health or mhealth or smartwatch* or "smart watch*" or "tele monitor*" or telemonitor* or "mobile technolog*" or "text message*" or SMS):ti,ab #4 #1 and #2 and #3 eTable 2. Additional study characteristics for the included studies (n=28) meeting our eligibility criteria eFigure 1. Differences in diastolic blood pressure changes from baseline to follow-up time points between digital health intervention and control groups eFigure 5. Sensitivity analysis assessing for the presence of publication bias using the change in diastolic blood pressure (DBP) outcome at the 6-month follow-up duration (top); leave-one-out meta-analysis results for the same outcome as above (bottom) eFigure 6. Sensitivity analysis assessing for the presence of publication bias using the follow-up diastolic blood pressure (DBP) value outcome at the 6-month follow-up duration (top); leaveone-out meta-analysis results for the same outcome as above (bottom)

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* income or low*-income or impoverish* or poverty or homeless or disadvantaged or disenfranchis* or financial* distress* or financial* stress* or economic factor* or socioeconomic* or welfare* or subsidized or economic burden* or underprivilege* or destitute or bankrupt* or poverty-stricken or social determinant* or implicit attitude* or implicit bias* or health bias* or racial bias* or conscious attitude* or unconscious bias* or nonconscious bias* or non-conscious bias* or conscious bias*) AND (high blood pressure* or elevated blood pressure* or raised blood pressure* or hypertension or hypertensive or blood pressure monitor* or blood pressure control* or blood pressure prevent*)) AND ((mHealth or telemedicine or wearable or mobile health or digital treatment* or digital health or ehealth or e-health or m-health or smartwatch* or smart watch* or tele monitor* or telemonitor* or mobile technolog* or text message* or SMS or health app*))

eTable 1 .
Search strategies and additional methodology income or low*-income or impoverish* or poverty or homeless or disadvantaged or disenfranchis* or financial* distress* or financial* stress* or economic factor* or socioeconomic* or welfare* or subsidized or economic burden* or underprivilege* or destitute or bankrupt* or poverty-stricken).mp.20 (social determinant* or implicit attitude* or implicit bias* or health bias* or racial bias* or conscious attitude* or unconscious bias* or nonconscious bias* or non-conscious bias* or conscious bias*).mp.21 (prejudice* or inequal* or inequit* or disparit* or equalit* or equit* or unequal* or discrimination or injustice* or justice* or racist* or racism* or stigma* or sterotyp*).mp.22 ((minitor* or structural* or cultural* or multi-cultur* or multicultur* or linguistic* or social* or intercultural* or inter-cultural* or cross-cultural or crosscultural or multi-rac* or multi-ethnic* or multiethnic* or multi-lingual or multilingual or trans-cultural or transcultural or ethnocultur* or ethno-cultur* or socio-cultural or sociocultural or bi-rac* or birac*) adj3 (status* or competen* or awareness* or diversit* or discrimin* or bias*)).mp.
Baseline demographic and socioeconomic characteristics of participants in the included studies (n=28) Excluded studies from the original search with reasons for exclusion.Abbreviations: DBP, systolic blood pressure; BP, blood pressure.eTable 8. Subgroup analysis showing SBP values at 6 months Abbreviations: SBP, systolic blood pressure; BP, blood pressure.eTable 9. Subgroup analysis showing DBP values at 6 months Abbreviations: DBP, diastolic blood pressure; BP, blood pressure.
© 2024 Katz ME et al.JAMA Network Open.© 2024 Katz ME et al.JAMA Network Open.© 2024 Katz ME et al.JAMA Network Open.© 2024 Katz ME et al.JAMA Network Open.eTable 4. © 2024 Katz ME et al.JAMA Network Open.