EVALUATING THE EFFECTIVENESS OF MOBILE HEALTH APPLICATIONS ON ADHERENCE TO MEDICATION AND LIFESTYLE MODIFICATIONS IN PATIENTS WITH HYPERTENSION

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Hypertension is the leading chronic condition responsible for cardiovascular and cerebrovascular events globally, affecting 32.6% of adults in the United States, with estimated annual medical costs exceeding $50 billion (Muntner et al., 2020; CDC, 2021). Worldwide, cardiovascular disease affects 422.7 million individuals and accounts for 16.7 million deaths each year, with 80% of these deaths occurring in low- and middle-income countries (World Health Organization [WHO], 2021). In rural China, a recent study found that hypertension control rates and under-treatment rates were only 8.6% and 19.8%, respectively (Zhao et al., 2021). Decades of research have demonstrated that even modest reductions in blood pressure (BP) can significantly reduce premature mortality and morbidity associated with hypertension (James et al., 2014). Despite the availability of well-tolerated, effective, and affordable medications, around half of treated patients still do not achieve adequate BP control (Burnier & Egan, 2019). This gap in treatment is largely due to poor patient engagement, low medication adherence, and therapeutic inertia (Neiman et al., 2017).

Evidently, Effective management of hypertension relies heavily on patients' adherence to prescribed medications and recommended lifestyle changes such as diet, exercise, and smoking cessation (Burnier & Egan, 2019). However, one of the greatest challenges in treating hypertension is ensuring that patients remain compliant with their medication regimens and lifestyle adjustments over time. Thus various intervention strategies have been implemented to improve BP control and meet therapeutic targets. Systematic reviews of over three decades of research suggest that lifestyle modifications are highly recommended for populations at high risk of cardiovascular disease (Eckel et al., 2013; Whelton et al., 2017). Additionally, team-based care involving nurses and pharmacists has been proven effective in supporting hypertension control and improving patient self-management (Carter et al., 2015; Margolis et al., 2013). However, the majority of evidence supporting the benefits of lifestyle modifications in reducing cardiovascular disease risk comes from studies conducted in high-income countries, with few trials being conducted in low- and middle-income countries, despite strong evidence of their effectiveness (Gaziano et al., 2020).

With the increasing use of mobile phones, mobile health (mHealth) offers a promising solution to addressing healthcare challenges in low- and middle-income countries, such as limited medical resources, an overburdened healthcare workforce, and the rising prevalence of chronic diseases (Labrique et al., 2018). Mobile health (mHealth) applications have emerged as a potential solution to improve patient adherence by providing real-time monitoring, reminders, and educational content (Piao et al., 2020). These applications offer features such as medication reminders, symptom tracking, and telemedicine consultations, which can improve patient engagement and foster better health outcomes. Studies have demonstrated that mHealth applications can play a significant role in chronic disease management, offering convenience and accessibility to patients, while reducing the strain on healthcare providers (Liang et al., 2021). As more patients turn to mobile applications to manage their health, the role of these technologies in improving adherence and outcomes has become a key focus of medical research.

In Nigeria, where the burden of non-communicable diseases like hypertension is rapidly increasing, there is a growing need to explore how mobile health technologies can be leveraged to enhance disease management. According to the Nigerian Hypertension Society, approximately 30% of adults in Nigeria are hypertensive, and many patients struggle with medication adherence due to various factors, including forgetfulness, lack of knowledge, and limited access to healthcare services (Ajayi et al., 2020). The introduction of mHealth applications could potentially bridge these gaps by offering patients a more structured and personalized approach to managing their condition. This study is particularly relevant for Nigeria, where healthcare infrastructure is often inadequate, and innovative solutions are necessary to address the growing burden of hypertension and other chronic diseases.

1.2 Statement of problem 

As healthcare systems continue to evolve in response to technological advances, understanding the role of mHealth applications in chronic disease management has become crucial. Ajayi, Olamide & Uzoma (2020) highlighted that poor adherence to antihypertensive medications and lifestyle modifications such as exercise, diet, and smoking cessation increases the risk of complications, including cardiovascular disease and stroke. The lack of effective strategies to improve adherence has resulted in suboptimal health outcomes and an increased burden on healthcare facilities in rural and urban regions in Nigeria. According to Anna, Josh & Jerome (202) it is very challenging to extend the health care to difficult-to-reach populations, therefore strategies that depend on offering education, providing reminders for medication taking and refilling, or facilitating social interactions have been shown to increase physical activity, promote weight loss, encourage behavior change and improve patient-provider communication . In a systematic review by Julie, Alfred & Rose (2019), use of mobile apps and SMS messaging was found to improve physical health and reduce stress, anxiety, and depression, and the review showed using mobile apps and SMS text messaging as promising mHealth interventions even though there is need for more rigorous research in developing countries.

While mHealth applications have been proven to be useful tools in enhancing disease management in other settings, their effectiveness in improving adherence to medication and lifestyle modifications among hypertensive patients in Nigeria has not been adequately studied. Without this information, it is difficult for healthcare providers and policymakers to make informed decisions on the adoption and implementation of these technologies in Nigerian healthcare settings.

Existing research highlights that mobile health applications have the potential to improve adherence to treatment regimens for chronic diseases (Piao et al., 2020). However, the extent to which these applications can be effective in a Nigerian context, where healthcare access is often limited, remains unclear. Studies conducted in high-income countries have demonstrated the effectiveness of mHealth applications in improving medication adherence and patient engagement (Liang et al., 2021). Still, there is limited empirical evidence to support these findings in Nigeria, particularly in public hospitals where resources are constrained. The gap in the literature regarding the impact of mobile health technologies on hypertensive patients in Nigeria creates a significant research opportunity. This study aims to address this gap by evaluating the effectiveness of mobile health applications in improving adherence to medication and lifestyle modifications in patients with hypertension at Maitama General Hospital.

1.3 Objectives of the Study

The objective of this study is focused on the effectiveness of mobile health applications in improving adherence to medication and lifestyle modifications in patients with hypertension at Maitama General Hospital. Specifically, the study seeks to:

Examine the level of usage of mobile health applications among hypertensive patients in Maitama General Hospital.

evaluate the impact of mobile health applications on medication adherence among hypertensive patients in Maitama General Hospital.

assess the effectiveness of mobile health applications in promoting adherence to lifestyle modifications among  hypertensive patients.

examine the barriers to the use of mobile health applications among hypertensive patients in Maitama General Hospital.

provide recommendations for improving the effectiveness of mobile health applications in managing hypertension.

Research Questions

What is level  of usage of mobile health applications among hypertensive patients in Maitama General Hospital?

What is the impact of mobile health applications on medication adherence among hypertensive patients in Maitama General Hospital?

How effective are mobile health applications in promoting adherence to lifestyle modifications such as diet and exercise among hypertensive patients?

What challenges and barriers do hypertensive patients in Maitama General Hospital face in using mobile health applications?

What recommendations can be made to improve the effectiveness of mobile health applications in managing hypertension?

Research Hypotheses

Ho1: There is no significant  impact of mobile health applications on medication adherence among hypertensive patients in Maitama General Hospital?

Ho2: There is no significant effect of mobile health applications on promoting adherence to lifestyle modifications  among hypertensive patients in Maitama General Hospital

Significance of the Study

Practically, this study holds significant importance for healthcare providers and policymakers in Nigeria. By assessing the effectiveness of mobile health applications in improving medication adherence and lifestyle modifications among hypertensive patients, the research will provide insights into how these technologies can be integrated into existing healthcare frameworks. The findings could inform the development of policies and strategies to improve chronic disease management, reduce complications, and enhance the overall quality of healthcare services in public hospitals like Maitama General Hospital.

Theoretically, the study contributes to the growing body of literature on mobile health interventions for chronic disease management. It offers empirical evidence on the effectiveness of mHealth applications in a low-resource setting, addressing a gap in the literature on the role of technology in improving health outcomes in Nigeria. The study's findings will be valuable for future research on digital health interventions and their potential to transform healthcare delivery in similar settings.

Scope of the Study

The study focuses on patients with hypertension at Maitama General Hospital, Abuja, and evaluates the effectiveness of mobile health applications in improving adherence to medication and lifestyle modifications. The content of the study covers mobile health interventions, patient adherence, and the management of hypertension, while the geographical scope is limited to Maitama General Hospital.

Limitations of the Study

Like every academic endeavor, one limitation of the study is the reliance on self-reported data from patients, which may introduce bias and affect the accuracy of the findings. Additionally, the study is limited to a single hospital, Maitama General Hospital, and may not reflect the broader experiences of hypertensive patients in other healthcare facilities. Lastly, the availability of mobile phones and internet access among patients may affect the generalizability of the findings, as not all patients may have access to or be familiar with mobile health applications. Regardless, the study provides valuable insights into the potential impact of mobile health applications on medication adherence and lifestyle modifications among patients with hypertension. By focusing on a specific population, it highlights key factors that can influence the success of mHealth interventions, offering a foundation for further research and broader implementation in similar healthcare settings.

1.9 Definition of Terms

Mobile Health Applications (mHealth): Software applications designed for mobile devices that provide health-related services, including medication reminders, health tracking, and telemedicine consultations.

Adherence: The extent to which patients follow prescribed medication regimens and lifestyle modifications, such as diet and exercise, to manage their health conditions.

Hypertension: A chronic medical condition characterized by consistently high blood pressure, which increases the risk of heart disease, stroke, and other complications.

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