Abstract
BackgroundDespite tremendous investment worldwide, hypertension treatment and control rates remain low. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts.Methods/designPHMA strives to reduce hypertension harms by eight “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors.DiscussionPHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making.Trial registration ISRCTN10999269. July 17, 2020; https://doi.org/10.1186/ISRCTN10999269.
Highlights
Despite tremendous investment worldwide, hypertension treatment and control rates remain low
Blood pressure notification (I4) PHMA sends a weekly notification about trends in Systolic blood pressure (SBP), Diastolic blood pressure (DBP), pulse blood pressure (BP) and BP control rate in turn for every participating patient
Contemporary approaches to hypertension management are mainly population-based though some studies have tried some extent of differentiated interventions, e.g., send a reminder to patients who have failed to attend an appointment [32]
Summary
PHMA introduces innovative approaches to tailor interventions to the complex and dynamic BP and related complications and contexts of individual patients. PHMA adopts pragmatic strategies in securing feasibility and containing cost of interventions It uses multiple modalities (e.g., text and sound) and venues (e.g., telephone, WeChat, Webpages, paper leaflets) in forming and disseminating intervention materials to suit various patients, especially old and illiterate ones. Each of the theories used in PHMA has its own strengths: health belief model is useful in addressing behaviors driven by rational thinking; nudging strategies apply to behaviors triggered by automatic cognitive processes [25, 28]; motivational interviewing is keen at generating and maintaining adequate momentum to leverage sustained behavior changes; system synergy informs incorporation of all intervention ingredients in a way that prevents equifinality and maximizes cost-effectiveness [27, 35, 37]
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