Exploring and evaluating the use of digital health interventions for the management of high blood pressure

Abstract

High blood pressure is a prevalent condition affecting more than 1 in 4 adults in the UK. Many patients need several adjustments to their treatment to successfully lower their blood pressure, but healthcare professionals (HCPs) have shown reluctance to increase dose or add new drugs during annual clinic appointments. Barriers to medication change include concerns about patient side effects, doubts about the accuracy of one-off clinic readings, and low confidence that medication changes will successfully reduce blood pressure.

A digital intervention was developed to help improve blood pressure control in Primary Care, prompting HCPs to initiate planned medication changes when patients’ home readings were above-target. A separate randomised controlled trial found the intervention to be effective. This thesis aimed to develop understanding of how patients and HCPs perceive self-management digital interventions from the literature, and to explore perceptions and implementation of this digital intervention for high blood pressure in Primary Care.

A qualitative meta-ethnography of 30 primary studies was conducted exploring patients’ and HCPs’ experiences of self-management digital interventions across different chronic conditions. This indicated that self-monitoring one’s own health was a powerful mechanism, and feedback on self-monitored data seemed to influence perceptions of responsibility amongst patients and HCPs, with patient-led systems appearing more feasible to implement in practice. A qualitative process evaluation of patients’ experiences of using the digital intervention for high blood pressure suggested that illness and treatment perceptions influenced how beneficial or burdensome the intervention was perceived to be, with implications for evaluating important psychosocial outcomes of using digital interventions such as reassurance, anxiety and guilt. Finally, a mixed methods process evaluation helped understand the extent to which HCPs adhered to target behaviours and possible explanations for this. Suggestions for optimising digital interventions in Primary Care were made, including providing confirmation that patients have received remote support, and ‘in the moment’ reminders of the rationale and evidence for medication change.

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Identifiers

ORCID for Katherine Bradbury: orcid.org/0000-0001-5513-7571

ORCID for Laura Dennison: orcid.org/0000-0003-0122-6610

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

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