Adaptation of a home blood pressure monitoring program for rural mississippi

The National Heart, Lung, and Blood Institute awarded the University of Mississippi Medical Center $333,250 on August 1, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to adapt and pilot-test a home blood pressure monitoring intervention for rural Mississippi.

The recipient will modify a validated chronic disease self-management program that combines longitudinal home blood pressure monitoring with a smartphone-delivered virtual agent providing personalized education. The adaptation will prioritize user-centered design informed by a community engagement collaborative, retain the program's focus on hypertension management and medication adherence, and incorporate novel gamification elements to enhance home blood pressure monitoring adherence and agent usability. The recipient will conduct a pilot evaluation to assess the intervention's effect on systolic blood pressure and home blood pressure monitoring adherence, with preliminary work supporting the program's acceptability and efficacy in reducing systolic blood pressure at six months.

The award funds preparatory activities for a planned Type 1 hybrid effectiveness-implementation trial targeting hypertension control in rural Mississippi, where the state's lowest life expectancy and highest hypertension prevalence, combined with geographic and contextual barriers, exacerbate chronic disease severity and associated medical and social costs.

Period of performance runs from August 1, 2026, through May 31, 2028, with place of performance in Jackson, Mississippi. The assistance type is a Project Grant (R34HL186336).

Abstract

Mississippi (MS) is the poorest U.S. State with the lowest life expectancy and highest prevalence of hypertension (HTN). Rural individuals in MS additionally experience geographic and contextual factors that exacerbate chronic disease severity and their accompanying medical and social costs. The objective of this program is to conduct essential preparatory activities for a type 1 hybrid effectiveness-implementation trial to address and improve HTN in rural MS. We have developed and validated a program that includes theory- informed chronic disease self-management (cdsm) and incorporates: (1) longitudinal home blood pressure monitoring (hbpm), recognized as highly effective for patient engagement to improve self-efficacy and HTN management; and (2) a virtual agent, delivered by smartphone to provide an empathic, personalized cdsm curriculum. Our preliminary data demonstrate that the agent has high acceptability, enhances hbpm adherence, and contributes to 6-month reduction in systolic blood pressure (SBP). We have developed a community engagement collaborative (CEC) to participate in the adaptation and evaluation of our cdsm program for HTN with the following aims: aim 1. Modify the virtual agent intervention for application in rural MS. We will retain the agent's primary objective to promote cdsm for HTN with routine hbpm and the secondary objectives to address health literacy, medication adherence, and non-pharmacologic approaches to HTN control. We will engage in an iterative, user-centered process that prioritizes the expertise and perspective of the target user. We will apply the results to rapid cycle adaptation of the agent to enhance its accessibility and usability and to evaluate novel gamification elements to support hbpm and agent use. Aim 2. Conduct a pilot evaluation to assess the effect of the intervention on SBP and hbpm adherence. We will enroll individuals with poorly controlled HTN (n=80) to receive a BP cuff and standardized instruction accompanied by 1:1 randomization with or without the virtual agent. As our primary outcome we will evaluate the effect of the HTN virtual agent on SBP at 6 months. As secondary outcomes we will evaluate (1) adherence to hbpm at 6 months and (2) the effect of the HTN virtual agent on SBP at 12 months. Aim 3. Evaluate the implementation process of the program with qualitative assessments of participants and primary care providers as guided by the consolidated framework for implementation research 2.0. We will conduct an explanatory sequential mixed methods design to identify potential mechanisms of effect of the program and its barriers, facilitators, and context. Expected results: our multidisciplinary team in concert with our CEC has expertise in hbpm delivery, interventions for HTN, community engagement, and implementation. The proposed activities will adapt and evaluate a validated intervention to improve HTN control in individuals in rural MS. The results will enhance rigor, infrastructure, community engagement, and capacity to successfully conduct the proposed trial.