Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study

OBJECTIVE: The purpose of this study was to explore perceived ease of use, usability, and the feasibility of using mobile health applications to manage hypertension self-care in rural Black older adults with hypertension. METHODS: A convergent parallel mixed method design was used to study a purposeful sample of 30 Black older adults (29 females, 1 male) from rural East Texas. Quantitative data included demographic characteristics and measured blood pressure, height, and weight, along with questionnaires: the Hill-Bone Compliance to High Blood Pressure Therapy Scale, the Krousel-Wood Medication Adherence Scale-4, and the Technology Acceptance Model Questionnaire (adapted). Qualitative data were obtained from five focus groups and analyzed using thematic analysis. RESULTS: Mean age was 66.3 ± 9.6 years. Less than half of the participants (46.7%) had a systolic and/or diastolic blood pressure >130/80. Greater participant adherence was noted with the Hill-Bone Compliance scale (63.3%) than the Krousel-Wood scale (23.3%). With the Technology Acceptance Model, perceived ease of use was significantly correlated with behavioral intention (r = 0.654, p < 0.000) and perceived usefulness (r = 0.585, p < 0.001), while behavioral intention was negatively associated with age r = −0.047 (p=0.009). Focus group data revealed five themes: 1) useful, 2) counterintuitive, 3) communication, 4) comfort with the status quo, and 5) educate/show me how. CONCLUSION: Smartphone technology and other health-related computer technologies were not preferred by older adults in this study due to limited digital literacy. Simplicity and easy navigation in the design of mHealth apps are needed to improve treatment adherence and blood pressure control in rural older adults with hypertension. CLINICAL RELEVANCE: Mobile health applications have the potential to increase self-management of chronic hypertension if users are digitally literate. Health-care providers need to assess older patients for digital literacy and offer educational support and assistance.