BACKGROUND: San Joaquin County (SJC) has very high rates of death from heart disease and stroke. Mobile health technology may improve blood pressure and cardiovascular health in populations with access and familiarity with health technology, but the expense of these devices and low health literacy levels in south Stockton as well as other medically underserved areas (MUAs) may inhibit use. This pilot study aims to assess whether infusing tech-savvy young people trained as health technology coaches (1) is feasible approach in an MUA, (2) would improve the frequency of self-monitoring of blood pressure, and (3) would improve blood pressure control more than for patients who receive either a health coach or blood pressure cuff alone.
METHODS: Fifteen high school students were trained to work with patients recruited from a primary care clinic and San Joaquin General Hospital. The “Cuff Only” group was provided a QardioArm cuff only and encouraged to use the cuff at their convenience. The “Student Only” group was instructed to meet for 30 minutes once a week for 5 weeks with a health coach to create action plans for reducing blood pressure. The third group “Student+Cuff” received both a QardioArm cuff and a student couch, as described above.
RESULTS: Twenty-seven participants were randomly assigned to the 3 intervention arms (9:9:9). Most participants (56%) either did not know how many days of the week their blood pressure was well controlled (37%). Many (37%) also reported that there were not adequate resources in SJC for blood pressure management. Feasibility was assessed through student coach surveys describing their experiences (12/15=80%). All twelve reported that they valued the opportunity to care for their own patients. Drawbacks reported included difficulty in maintaining patient follow up and coordinating appointment times with patients’ and students’ schedules. Follow up surveys are currently being conducted with patients (17/27=63%). Sixty percent of patients reported that their blood pressure was well-controlled on most days of the week. Additionally, there were significant differences in the average frequency of self-monitoring between the cuff+student group and the cuff alone group (37 versus 17 readings; p<0.01).
CONCLUSIONS: This pilot trial demonstrated feasibility of pairing technology with young student coaches. There were clear differences in the frequency of QardioArm use between the cuff alone and cuff plus student groups, suggesting that there are barriers to using health technology without the assistance of a health coach. Further research is needed.