Design and development of a smartphone app for hypertension management: An intervention mapping approach.

Background: Several research studies have demonstrated the potential of mobile health apps in supporting health management. However, the design and development process of these apps are rarely presented. Objective: We present the design and development of a smartphone-based lifestyle app integrating a wearable device for hypertension management. Methods: We used an intervention mapping approach for the development of theory- and evidence-based intervention in hypertension management. This consisted of six fundamental steps: needs assessment, matrices, theoretical methods and practical strategies, program design, adoption and implementation plan, and evaluation plan. To design the contents of the intervention, we performed a literature review to determine the preferences of people with hypertension (Step 1) and necessary objectives toward the promotion of self-management behaviors (Step 2). Based on these findings, we implemented theoretical and practical strategies in consultation with stakeholders and researchers (Steps 3), which was used to identify the functionality and develop an mHealth app (Step 4). The adoption (Step 5) and evaluation (Step 6) of the mHealth app will be conducted in a future study. Results: Through the needs analysis, we identified that people with hypertension preferred having education, medication or treatment adherence, lifestyle modification, alcohol and smoking cessation and blood pressure monitoring support. We utilized MoSCoW analysis to consider four key elements, i.e., education, medication or treatment adherence, lifestyle modification and blood pressure support based on past experiences, and its potential benefits in hypertension management. Theoretical models such as (i) the information, motivation, and behavior skills model, and (ii) the patient health engagement model was implemented in the intervention development to ensure positive engagement and health behavior. Our app provides health education to people with hypertension related to their condition, while utilizing wearable devices to promote lifestyle modification and blood pressure management. The app also contains a clinician portal with rules and medication lists titrated by the clinician to ensure treatment adherence, with regular push notifications to prompt behavioral change. In addition, the app data can be reviewed by patients and clinicians as needed. Conclusions: This is the first study describing the design and development of an app that integrates a wearable blood pressure device and provides lifestyle support and hypertension management. Our theory-driven intervention for hypertension management is founded on the critical needs of people with hypertension to ensure treatment adherence and supports medication review and titration by clinicians. The intervention will be clinically evaluated in future studies to determine its effectiveness and usability.

A margin of exposure approach to assessment of non-cancerous risk of diethyl phthalate based on human exposure from bottled water consumption.

Phthalates may be present in food due to their widespread presence as environmental contaminants or due to migration from food contact materials. Exposure to phthalates is considered to be potentially harmful to human health as well. Therefore, determining the main source of exposure is an important issue. So, the purpose of this study was (1) to measure the release of diethyl phthalate (DEP) in bottled water consumed in common storage conditions specially low temperature and freezing conditions; (2) to evaluate the intake of DEP from polyethylene terephthalate (PET) bottled water and health risk assessment; and (3) to assess the contribution of the bottled water to the DEP intake against the tolerable daily intake (TDI) values. DEP migration was investigated in six brands of PET-bottled water under different storage conditions room temperature, refrigerator temperature, freezing conditions (40 °C ,0 °C and -18 °C) and outdoor] at various time intervals by magnetic solid extraction (MSPE) using gas chromatography-mass spectroscopy (GC-MS). Eventually, a health risk assessment was conducted and the margin of exposure (MOE) was calculated. The results indicate that contact time with packaging and storage temperatures caused DEP to be released into water from PET bottles. But, when comprising the DEP concentration with initial level, the results demonstrated that the release of phthalates were not substantial in all storage conditions especially at low temperatures (<25 °C) and freezing conditions. The daily intake of DEP from bottled water was much lower than the reference value. However, the lowest MOE was estimated for high water consumers (preschooler > children > lactating women > teenagers > adults > pregnant women), but in all target groups, the MOE was much higher than 1000, thus, low risk is implied. Consequently, PET-bottled water is not a major source of human exposure to DEP and from this perspective is safe for consumption.