Abstract
BackgroundThis paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Person-Based Approach to intervention development emphasises the use of qualitative research to ensure that the intervention is acceptable, persuasive, engaging and easy to implement.MethodsOur intervention planning process comprised two parallel, integrated work streams, which combined theory-, evidence- and person-based elements. The first work stream involved collating evidence from a mixed methods feasibility study, a systematic review and a synthesis of qualitative research. This evidence was analysed to identify likely barriers and facilitators to uptake and implementation as well as design features that should be incorporated in the HOME BP intervention. The second work stream used three complementary approaches to theoretical modelling: developing brief guiding principles for intervention design, causal modelling to map behaviour change techniques in the intervention onto the Behaviour Change Wheel and Normalisation Process Theory frameworks, and developing a logic model.ResultsThe different elements of our integrated approach to intervention planning yielded important, complementary insights into how to design the intervention to maximise acceptability and ease of implementation by both patients and health professionals. From the primary and secondary evidence, we identified key barriers to overcome (such as patient and health professional concerns about side effects of escalating medication) and effective intervention ingredients (such as providing in-person support for making healthy behaviour changes). Our guiding principles highlighted unique design features that could address these issues (such as online reassurance and procedures for managing concerns). Causal modelling ensured that all relevant behavioural determinants had been addressed, and provided a complete description of the intervention. Our logic model linked the hypothesised mechanisms of action of our intervention to existing psychological theory.ConclusionOur integrated approach to intervention development, combining theory-, evidence- and person-based approaches, increased the clarity, comprehensiveness and confidence of our theoretical modelling and enabled us to ground our intervention in an in-depth understanding of the barriers and facilitators most relevant to this specific intervention and user population.
Highlights
This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME blood pressure (BP)), a digital intervention to promote hypertension self-management
Our integrated approach to intervention development, combining theory, evidence- and person-based approaches, increased the clarity, comprehensiveness and confidence of our theoretical modelling and enabled us to ground our intervention in an in-depth understanding of the barriers and facilitators most relevant to this specific intervention and user population
At an early stage of intervention planning, we decided to reduce the emphasis in the intervention on patients undertaking healthy behaviour change, as our evidence suggested that most UK primary patients were not motivated to undertake sufficient behaviour change to influence blood pressure [47] and we were concerned that ineffective health promotion attempts could detract from effective implementation of the central target behaviours in HOME BP, which were self-monitoring blood pressure and appropriately escalating medication
Summary
This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. It has been estimated that a 10 mmHg reduction in BP could lead to a 41% reduction in stroke and a 22% reduction in CHD [4], and recent findings from the SPRINT trial suggest that further reductions in target BP are beneficial to patient health outcomes [5] Both hypertension treatment and control within the UK are currently suboptimal [6], with almost 20% of the variance in BP control accounted for by ‘clinical inertia’—clinician failure to intensify treatment when necessary [7, 8]. Interventions combining intensive support from a variety of sources including medication titration, patient education and pharmacist support appear to be the most effective in reducing BP [13, 14, 16]
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