Optimizing a digital intervention for managing blood pressure in stroke patients using a diverse sample: Integrating the person-based approach and patient and public involvement

TY - JOUR

T1 - Optimizing a digital intervention for managing blood pressure in stroke patients using a diverse sample

T2 - Integrating the person-based approach and patient and public involvement

AU - Rai, Tanvi

AU - Morton, Kate

AU - Roman, Cristian

AU - Doogue, Roisin

AU - Rice, Cathy

AU - Williams, Marney

AU - Schwartz, Claire

AU - Velardo, Carmelo

AU - Tarassenko, Lionel

AU - Yardley, Lucy

AU - McManus, Richard J.

AU - Hinton, Lisa

N1 - Funding Information: This study was part of a programme of work commissioned by the Stroke Association and British Heart Foundation (TSA BHF 2018-01). The planned trial to test the BP:Together intervention was paused in March 2020 due to the risk of COVID-19 for participants and closed down in October 2020 following withdrawal of funding due to on-going coronavirus restrictions. Initial feasibility data from that trial will be published separately in due course. We would like to thank all our study participants and PPI contributors for taking part in this study. We are grateful to the primary care practices that sent out participant invitation letters and helped recruit health-care practitioners for the focus group discussions. Thanks also to the following organizations for their help with participant recruitment and PPI input: the Stroke Association's London-based Support Groups; Abingdon Stroke Group; Central Oxford Mosque, Medina Mosque, Word Fountain Christian Ministries and Christian Life Centre in Oxford; the Oxford Aphasia Group; and Different Strokes Southampton. Lucy Yardley is NIHR Senior Investigator, and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). Richard McManus is NIHR Senior Investigator and is partly supported by NIHR Applied Research Collaboration (ARC)-Oxford and Thames Valley. Funding Information: Lucy Yardley is NIHR Senior Investigator, and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)‐West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). Richard McManus is NIHR Senior Investigator and is partly supported by NIHR Applied Research Collaboration (ARC)‐Oxford and Thames Valley. Publisher Copyright: © 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd

PY - 2021/4/1

Y1 - 2021/4/1

N2 - Background: Having a stroke or transient ischaemic attack increases the risk of a subsequent one, especially with high blood pressure (BP). Home-based BP management can be effective at maintaining optimal BP. Objective: To describe the optimization of a digital intervention for stroke patients and the value of participant diversity, using the person-based approach (PBA) and integral patient and public involvement (PPI). Setting and participants: Stroke patients recruited from primary care and community settings, and health-care professionals in primary care, in England and Ireland. Design: Three linked qualitative studies conducted iteratively to develop an intervention using the PBA, with integral PPI. Intervention: The BP: Together intervention, adapted from existing BP self-monitoring interventions, is delivered via mobile phone or web interface to support self-monitoring of BP at home. It alerts patients and their clinicians when a change in antihypertensive medication is needed. Findings: Feedback from a diverse range of participants identified potential barriers, which were addressed to improve the intervention accessibility, feasibility and persuasiveness. Easy-to-read materials were developed to improve usability for patients with aphasia and lower literacy. The importance of including family members who support patient care was also highlighted. Feedback messages regarding medication change were refined to ensure usefulness for patients and clinicians. Discussion: Input from PPI alongside qualitative research with a diverse study sample allowed the creation of a simple and equitable BP management intervention for stroke patients. Patient involvement: Two PPI co-investigators contributed to design, conduct of study, data interpretation and manuscript preparation; community PPI sessions informed early planning. Study participants were stroke patients and family members.

AB - Background: Having a stroke or transient ischaemic attack increases the risk of a subsequent one, especially with high blood pressure (BP). Home-based BP management can be effective at maintaining optimal BP. Objective: To describe the optimization of a digital intervention for stroke patients and the value of participant diversity, using the person-based approach (PBA) and integral patient and public involvement (PPI). Setting and participants: Stroke patients recruited from primary care and community settings, and health-care professionals in primary care, in England and Ireland. Design: Three linked qualitative studies conducted iteratively to develop an intervention using the PBA, with integral PPI. Intervention: The BP: Together intervention, adapted from existing BP self-monitoring interventions, is delivered via mobile phone or web interface to support self-monitoring of BP at home. It alerts patients and their clinicians when a change in antihypertensive medication is needed. Findings: Feedback from a diverse range of participants identified potential barriers, which were addressed to improve the intervention accessibility, feasibility and persuasiveness. Easy-to-read materials were developed to improve usability for patients with aphasia and lower literacy. The importance of including family members who support patient care was also highlighted. Feedback messages regarding medication change were refined to ensure usefulness for patients and clinicians. Discussion: Input from PPI alongside qualitative research with a diverse study sample allowed the creation of a simple and equitable BP management intervention for stroke patients. Patient involvement: Two PPI co-investigators contributed to design, conduct of study, data interpretation and manuscript preparation; community PPI sessions informed early planning. Study participants were stroke patients and family members.

KW - blood pressure

KW - community-based recruitment

KW - digital health

KW - hypertension

KW - patient and public involvement

KW - person-based approach

KW - qualitative research

KW - seldom-heard groups

KW - self-monitoring

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85097510507&partnerID=8YFLogxK

U2 - 10.1111/hex.13173

DO - 10.1111/hex.13173

M3 - Article

C2 - 33316120

AN - SCOPUS:85097510507

SN - 1369-6513

VL - 24

SP - 327

EP - 340

JO - Health Expectations

JF - Health Expectations

IS - 2

ER -