{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:09:36Z","timestamp":1789078176506,"version":"build-2803163510"},"reference-count":34,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Young and middle-aged patients with hypertension often show poor self-management due to limited cognitive bandwidth. Mobile health apps using behavioral economics may be helpful for these patients.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate the preliminary effectiveness and usability of a nudge-based mobile app (LeYi) for improving self-management in young and middle-aged patients with hypertension.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This mixed-methods pilot study used a single-group pre-post design. Thirty participants completed a 24-week intervention. Outcomes were assessed using validated scales and interviews.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Self-management scores showed significant pre-to-post improvements (median change from 68.0 to 108.5;\n z<\/jats:italic>\n =4.788;\n P<\/jats:italic>\n <.001), as did eHealth literacy (median change from 15.5 to 34.0;\n z<\/jats:italic>\n =4.544;\n P<\/jats:italic>\n <.001). Usability was favorable (median user version of the Mobile App Rating Scale score 4.5, IQR 4.0-5.0). Thematic analysis identified 6 themes that complemented the quantitative findings and highlighted technology adaptation challenges.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The LeYi app may be feasible and acceptable for enhancing self-management in young and middle-aged patients with hypertension. However, a larger randomized controlled trial is needed to determine its efficacy. Embedding behavioral economics into mobile health is a promising approach to support patient engagement.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/95444","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:30:08Z","timestamp":1785321008000},"page":"e95444-e95444","source":"Crossref","is-referenced-by-count":0,"title":["A Nudge Theory\u2013Based Mobile Health Intervention for Self-Management in Young and Middle-Aged Patients With Hypertension: Mixed Methods Pilot Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1278-7445","authenticated-orcid":false,"given":"Yuanyuan","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7466-3082","authenticated-orcid":false,"given":"Wei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2112-7224","authenticated-orcid":false,"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1402-5782","authenticated-orcid":false,"given":"Xue","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0357-8312","authenticated-orcid":false,"given":"Linling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4108-7417","authenticated-orcid":false,"given":"Jinlong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"issue":"4","key":"R1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1038\/s41581-019-0244-2","article-title":"The global epidemiology of hypertension","volume":"16","author":"Mills","journal-title":"Nat Rev Nephrol"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.13426","article-title":"Expert consensus on the management of hypertension in the young and middle-aged Chinese population","volume":"1","author":"Liu","journal-title":"Int J Clin Pract"},{"issue":"11","key":"R3","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1093\/ajh\/hpu053","article-title":"Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey","volume":"27","author":"Wang","journal-title":"Am J Hypertens"},{"issue":"7","key":"R4","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1136\/jech.2007.071027","article-title":"The concept of prevention: a good idea gone astray?","volume":"62","author":"Starfield","journal-title":"J Epidemiol Community Health"},{"issue":"5","key":"R5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18052247","article-title":"Enablers of patient knowledge empowerment for self-management of chronic disease: an integrative review","volume":"18","author":"Vainauskien\u0117","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09274-4","article-title":"An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension","volume":"20","author":"Xie","journal-title":"BMC Public Health"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/S1474-5151(03)00091-4","article-title":"Adherence to long-term therapies: evidence for action","volume":"2","author":"De Geest","journal-title":"Eur J Cardiovasc Nurs"},{"issue":"22","key":"R8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000015849","article-title":"Socioeconomic status moderates the association between patient satisfaction with community health service and self-management behaviors in patients with type 2 diabetes: a cross-sectional survey in China","volume":"98","author":"Yin","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"R9","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.amepre.2021.11.003","article-title":"Mobile health applications and medication adherence of patients with hypertension: a systematic review and meta-analysis","volume":"62","author":"Mikulski","journal-title":"Am J Prev Med"},{"issue":"7","key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/10723","article-title":"Mobile apps to support the self-management of hypertension: systematic review of effectiveness, usability, and user satisfaction","volume":"6","author":"Alessa","journal-title":"JMIR Mhealth Uhealth"},{"issue":"7328274","key":"R11","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7328274","article-title":"Chinese mobile health apps for hypertension management: a systematic evaluation of usefulness","volume":"2018","author":"Liang","journal-title":"J Healthc Eng"},{"key":"R12","volume":"95","author":"Guix Oliver","journal-title":"Rev Esp Salud Publica"},{"key":"R13","unstructured":"Thaler RH Sunstein CR . Nudge: Improving Decisions about Health, Wealth, and Happiness. Yale University Press; 2008. ISBN: 9780300146813"},{"issue":"12","key":"R14","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/j.healthpol.2019.09.008","article-title":"The effectiveness of nudges in improving the self-management of patients with chronic diseases: a systematic literature review","volume":"123","author":"M\u00f6llenkamp","journal-title":"Health Policy"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/15265161.2011.634481","article-title":"Seeking better health care outcomes: the ethics of using the \u201cnudge\u201d","volume":"12","author":"Blumenthal-Barby","journal-title":"Am J Bioeth"},{"issue":"Suppl 4","key":"R16","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-022-02036-9","article-title":"A psycho-educational intervention programme for parents with SGA foetuses supported by an adaptive mHealth system: design, proof of concept and usability assessment","volume":"22","author":"Balderas-D\u00edaz","journal-title":"BMC Med Inform Decis Mak"},{"key":"R17","unstructured":"Creswell JW Clark VLP . Designing and Conducting Mixed Methods Research. SAGE Publications; 2017. ISBN: 9781483346984"},{"issue":"6 Pt 2","key":"R18","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"Fetters","journal-title":"Health Serv Res"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1097\/MLR.0000000000001664","article-title":"Guidelines for designing and evaluating feasibility pilot studies","volume":"60","author":"Teresi","journal-title":"Med Care"},{"key":"R20","unstructured":"Eldredge LKB Markham CM Ruiter RA Fern\u00e1ndez ME Kok G Parcel GS . Planning Health Promotion Programs: An Intervention Mapping Approach. John Wiley & Sons; 2016. ISBN: 9781119035497"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","first-page":"24","DOI":"10.3969\/j.issn.1007-5410.2019.01.002","article-title":"2018 Chinese guidelines for the management of hypertension [Article in Chinese]","volume":"24","author":"Writing Group of the 2018 Chinese Guidelines for the Management of Hypertension","journal-title":"Chin J Cardiovasc Med"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1177\/0962280215588241","article-title":"Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable","volume":"25","author":"Whitehead","journal-title":"Stat Methods Med Res"},{"issue":"9","key":"R23","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.12102\/j.issn.1009-6493.2021.09.026","article-title":"Development of self\u2043management behavior scale in young and middle\u2043aged patients with hypertension and its reliability and validity test [Article in Chinese]","volume":"35","author":"Gong","journal-title":"Chinese Nursing Research"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: The eHealth Literacy Scale","volume":"8","author":"Norman","journal-title":"J Med Internet Res"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","first-page":"106","DOI":"10.16168\/j.cnki.issn.1002-9982.2013.02.019","article-title":"Adaptation and evaluation of Chinese version of eHEALS and its usage among senior high school students [Article in Chinese]","volume":"29","author":"Guo","journal-title":"Chinese Journal of Health Education"},{"issue":"9","key":"R26","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1080\/0142159X.2018.1497149","article-title":"Twelve tips for conducting qualitative research interviews","volume":"41","author":"McGrath","journal-title":"Med Teach"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1097\/JCN.0000000000000608","article-title":"Self-management among elderly patients with hypertension and its association with individual and social environmental factors in China","volume":"35","author":"Zhang","journal-title":"J Cardiovasc Nurs"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-01011-0","article-title":"Nudge strategies to improve healthcare providers\u2019 implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews","volume":"15","author":"Yoong","journal-title":"Implement Sci"},{"issue":"3","key":"R29","doi-asserted-by":"publisher","DOI":"10.2196\/17776","article-title":"The effectiveness of self-management of hypertension in adults using mobile health: systematic review and meta-analysis","volume":"8","author":"Li","journal-title":"JMIR Mhealth Uhealth"},{"issue":"5","key":"R30","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1111\/jnu.12882","article-title":"The effect of nurse-led digital health interventions on blood pressure control for people with hypertension: a systematic review and meta-analysis","volume":"55","author":"Hwang","journal-title":"J Nurs Scholarsh"},{"issue":"6","key":"R31","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/j.diabet.2020.04.002","article-title":"A systematic review of nudge theories and strategies used to influence adult health behaviour and outcome in diabetes management","volume":"46","author":"Kwan","journal-title":"Diabetes Metab"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0170581","article-title":"What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions","volume":"12","author":"Iribarren","journal-title":"PLoS ONE"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","first-page":"25790799","DOI":"10.1007\/s11906-015-0535-3","article-title":"The role of telemedicine in hypertension management: focus on blood pressure telemonitoring","volume":"17","author":"Omboni","journal-title":"Curr Hypertens Rep"},{"issue":"3","key":"R34","doi-asserted-by":"publisher","DOI":"10.2196\/17046","article-title":"Mobile apps for health behavior change in physical activity, diet, drug and alcohol use, and mental health: systematic review","volume":"8","author":"Milne-Ives","journal-title":"JMIR Mhealth Uhealth"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:13:16Z","timestamp":1789074796000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e95444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":34,"URL":"https:\/\/doi.org\/10.2196\/95444","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"v10i4e95444"}}