Abstract
BACKGROUND: Limited research has investigated the influence of patient engagement on the long-term effects of mobile health (mHealth) interventions, particularly among older adults. OBJECTIVE: This study aimed to examine the long-term impact of a social media-driven mHealth intervention on blood pressure control among older Chinese individuals with hypertension, through repeated measurements of patient engagement and outcomes at 5 preset time points. METHODS: The study included older Chinese individuals with hypertension between 2017 and 2022. Participants received a hypertension self-management program via the WeChat social media app (Tencent Holdings Ltd), which provided clinically based digital coaching. Blood pressure measurements were taken repeatedly using a home blood pressure monitor (HBPM) connected to the app at baseline, 3, 6, 9, and 12 months. Patient engagement was evaluated based on the frequency of completed measurements at corresponding follow-ups. Latent growth curve models (LGCMs) served to assess the impact of patient engagement on blood pressure among older individuals with hypertension across preset points. RESULTS: A total of 1723 patients completed the 12-month follow-up (average age 70.1, SD 6.8 years; 890/1723, 51.7% female; and baseline systolic blood pressure 137.2 mm Hg). LGCMs revealed systolic blood pressure decreased significantly over 1 year, notably at 9 months (131 mm Hg, β9=3.244, P<.001), and continued up to 12 months (131.6mm Hg, β12=2.827, P<.001). In addition, a higher frequency of completed measurements was associated with better systolic blood pressure control at 3, 6, 9, and 12 months (β3=-0.016, P=.002; β6=-0.006, P=.02; β9=-0.002, P=.44; β12=-0.003, P=.02). These results remained significant even after accounting for age, sex, and comorbidity status. CONCLUSIONS: This study, using LGCMs and repeated measures data, revealed a significant positive impact of patient engagement on long-term blood pressure control in mHealth interventions targeting older individuals with hypertension. These findings stress the importance of integration of patient-centered engagement approach into mHealth programs designed for chronic disease management in aging populations.