J Med Internet Res. 2026 Feb 11;28:e83075. doi: 10.2196/83075.
ABSTRACT
BACKGROUND: Mobile health (mHealth) technologies can improve hypertension self-management, yet real-world adoption remains limited and unequally distributed.
OBJECTIVE: This study aimed to characterize the profiles, usage patterns, and engagement of active users of a hypertension self-management app (Hypertension.APP) in Germany, with a focus on user engagement and potential digital divides.
METHODS: We conducted a cross-sectional online survey among adult users of Hypertension.APP in Germany between January and September 2023. An 88-item questionnaire assessed app usage patterns, perceived utility, integration into clinical care, sociodemographic and clinical data, and digital health literacy (eHealth Literacy Scale; scores 16-40). Digital health literacy was categorized as low (16-23.99), moderate (24-31.99), or high (32-40). Descriptive statistics and univariable ordinal logistic regression were used to explore associations between sociodemographic and clinical variables and app usage frequency.
RESULTS: Of 254 respondents, the mean age was 53.6 years, and 54.3% (138/254) were male. A total of 44.5% (113/254) had a university or technical college degree, and 44.5% (113/254) reported a monthly net income higher than €2500 (US $2950). Most participants (224/254, 88.2%) reported access to at least two digital devices. Overall, 88.2% (224/254) had moderate or high digital health literacy (eHealth Literacy Scale ≥24). App engagement was high: 80.7% (205/254) reported using the app at least weekly, and 52.4% (133/254) reported using the app to prepare for medical visits. However, only 20.1% (51/254) reported that the app was formally integrated into their medical care, and 11.8% (30/254) indicated that medication had been adjusted based on app data. In univariable ordinal logistic regression analyses, higher education, longer duration of hypertension, and living in a small town (5000-20,000 inhabitants) were associated with more frequent app use, whereas systolic blood pressure of 140 mm Hg or higher was associated with less frequent use. Digital health literacy was not clearly associated with app usage frequency among current users.
CONCLUSIONS: Users of this hypertension self-management app were predominantly well-educated, digitally literate individuals with established hypertension, reinforcing concerns about a persistent digital divide. While app usability and engagement were high, formal clinical integration remained limited. Simply making an app available is insufficient; strategies to promote equitable access, strengthen clinical integration, and support patients with lower digital health literacy are needed for mHealth to contribute effectively to hypertension management.
PMID:41671553 | DOI:10.2196/83075