Intervention planning for a digital intervention for self-management of hypertension: A theory-, evidence- and person-based approach

TY - JOUR

T1 - Intervention planning for a digital intervention for self-management of hypertension

T2 - A theory-, evidence- and person-based approach

AU - Band, Rebecca

AU - Bradbury, Katherine

AU - Morton, Katherine

AU - May, Carl

AU - Michie, Susan

AU - Mair, Frances S.

AU - Murray, Elizabeth

AU - McManus, Richard J.

AU - Little, Paul

AU - Yardley, Lucy

N1 - Funding Information: We would like to thank Gary McLean for leading the quantitative systematic reviewing, Laura Dennison for leading the initial qualitative synthesis, Shelley Mason and Keith Manship for contributing the patient perspective and Tammy Thomas for managing the feasibility trial. Funding This paper reports independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (Grant Reference Number RP-PG-1211-20001). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The feasibility study reported in this manuscript was made possible by a pump priming grant from the NIHR School for Primary Care Research (PI PL, co-applicants RMcM, LY). Funding Information: This paper reports independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (Grant Reference Number RP-PG-1211-20001). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The feasibility study reported in this manuscript was made possible by a pump priming grant from the NIHR School for Primary Care Research (PI PL, co-applicants RMcM, LY). Publisher Copyright: © 2017 The Author(s).

PY - 2017/2/23

Y1 - 2017/2/23

N2 - Background: 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. 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. Methods: Our 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. Results: The 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. Conclusion: 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.

AB - Background: 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. 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. Methods: Our 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. Results: The 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. Conclusion: 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.

KW - Blood pressure

KW - Hypertension

KW - Intervention planning

KW - Methodological study

KW - Self-management

KW - Self-monitoring

KW - Theoretical modelling

UR - http://www.scopus.com/inward/record.url?scp=85013802423&partnerID=8YFLogxK

U2 - 10.1186/s13012-017-0553-4

DO - 10.1186/s13012-017-0553-4

M3 - Article

C2 - 28231840

AN - SCOPUS:85013802423

SN - 1748-5908

VL - 12

JO - Implementation science

JF - Implementation science

IS - 1

M1 - 25

ER -