May 7, 2020
Dr. Michael Dorsch
Michael Dorsch, PharmD, MS, Assistant Professor of Clinical Pharmacy, is a co-principal investigator with the recently established Wearables In Reducing Risk and Enhancing Daily Lifestyle Center,

This article originally appeared on IHPI’s website, view the original article.

A new University of Michigan research initiative aims to investigate how mobile health (mHealth) technology, such as smartwatches and smartphones, can be used to study and improve health behaviors among hypertensive populations. 

The potential to improve hypertensive patient care inspired a multidisciplinary team of researchers to seek funding from the American Health Association (AHA) to establish a new mHealth technology research center at U-M, where studies can be performed to help scientists and doctors understand how to use smartphones and wearables to improve lifestyle behaviors. 

The AHA awarded the U-M team $2.5 million in early April to establish the center, housed within the Michigan Integrated Center for Health Analytics and Medical Prediction and operating in partnership with U-M Precision Health. Another $4 million will be available to support the center’s research in collaboration with investigators from Cincinnati Children’s Hospital, The Johns Hopkins University, and Stanford University School of Medicine, as part of the AHA’s new Strategically Focused Research Network on Health Technologies and Innovation. On April 30, the team received an additional $200,000 from the AHA  for a supplemental, short-term project that will use the new center’s mHealth technology to track the physiological and cardiovascular consequences of the COVID-19 pandemic.

Known as the Wearables In Reducing Risk and Enhancing Daily Lifestyle Center — or WIRED-L, for short — the center will build and test mHealth apps that leverage wearables to improve physical activity and nutrition in hypertensive patients, particularly those in underserved communities. 

Center director Brahmajee Nallamothu, MD, MPH, leads WIRED-L. He is joined by co-principal investigators, Lesli Skolarus, MD, Michael Dorsch, PharmD, MS, and Mark Newman, PhD, MS.  

“All three principal investigators contribute to each facet of the center, with each leading an area,” explains Dr. Michael Dorsch, Assistant Professor of Clinical Pharmacy.  “We will be adapting two mHealth interventions for patients with hypertension the Ann Arbor and Flint populations. One of the two interventions is one I created, LowSalt4Life, which helps patients follow a low sodium diet. Once adapted, we will study the effectiveness of the interventions in the two populations. Then we will build a platform for others to develop these types of interventions.”

LowSalt4Life helps patients develop better dietary behaviors. It uses contextual information to make dynamic, tailored suggestions for nutrition when patients are at home, in a restaurant and at grocery stores to encourage lower salt intake.

A similar mHealth app for encouraging physical activity – HeartSteps – has been designed and tested by Newman and fellow WIRED-L researcher, Pedja Klasjna, PhD, an assistant professor of information.

“People often focus on the ABC’s of cardiovascular disease prevention, aspirin therapy, blood pressure control and cholesterol, but many forget the D and E — diet and exercise. This grant will allow our research team to focus on two interventions for diet and exercise, the most forgotten and difficult areas of cardiovascular disease prevention,” says Dr. Dorsch. “By tailoring the interventions, or just-in-time-adaptive-interventions (JITAIs), of our mHealth apps to the specific needs of hypertensive patients, and eventually other clinical groups, we hope to see long-term changes in patients’ health behaviors.”

“One of the pillars of my research program is using technology to help patients manage their cardiovascular disease. This initiative will support this pillar,” explains Dr. Dorsch. “Ultimately, I hope that this center will provide long-term collaboration within U-M, but also with the other AHA Strategically Focused Research Network centers.”

Impact with an equity-first lens

An overarching objective of the AHA’s new research network and the WIRED-L center at U-M is to leverage health technology with an “equity-first lens” to study and address racial and socioeconomic health disparities.

“Hypertension is a leading cause of disability and death in the U.S. that disproportionately affects African Americans and older adults. We are committed to promoting health equity through our work,” says Lesli Skolarus, MD, MS, an associate professor of neurology who has worked closely with community partners in Flint on stroke prevention and preparedness for the past 11 years. She is one of the center’s principal investigators and focused on health equity. 

“The promise of mHealth will be achieved by partnering with underserved communities from the beginning so that the interventions are created with the community rather than delivered in a community,” says Dr. Skolarus. 

Innovative interventions 

After conducting participatory research, the WIRED-L team will develop a mHealth app that leverages health behavior change theory and real-time contextual information to create tailored JITAIs. These interventions deliver notifications to users when they are most likely to be responsive using contextual information obtained from their devices.

Building a reusable platform

The researchers aim to develop the WIRED-L platform to allow distinct clinical areas and patient needs beyond hypertensive care to share an integrated mHealth application with a reusable set of customization options, user interface elements and participant notification mechanisms.

Dr. Nallamothu says, “By developing an app that can be easily modified for other clinical purposes and by training future mHealth innovators, we hope our center’s work can have a long-lasting impact in the field of clinical health technology and make a significant difference in the care of our patients.”