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

Exploring and evaluating the use of digital health interventions for the management of high blood pressure
Exploring and evaluating the use of digital health interventions for the management of high blood pressure
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.
University of Southampton
Morton, Katherine Sarah
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Morton, Katherine Sarah
4339a030-fff1-4d2e-86d3-1bc10b92de4c
Bradbury, Katherine
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Dennison, Laura
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Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e

Morton, Katherine Sarah (2019) Exploring and evaluating the use of digital health interventions for the management of high blood pressure. University of Southampton, Doctoral Thesis, 301pp.

Record type: Thesis (Doctoral)

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.

Text
Kate Morton thesis final 21.08.19 - Version of Record
Available under License University of Southampton Thesis Licence.
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More information

Published date: March 2019

Identifiers

Local EPrints ID: 435772
URI: http://eprints.soton.ac.uk/id/eprint/435772
PURE UUID: f151bfae-e248-44f6-bef4-c2a62a8a7358
ORCID for Katherine Bradbury: ORCID iD orcid.org/0000-0001-5513-7571
ORCID for Laura Dennison: ORCID iD orcid.org/0000-0003-0122-6610
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 20 Nov 2019 17:30
Last modified: 13 Dec 2021 05:32

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Contributors

Author: Katherine Sarah Morton
Thesis advisor: Katherine Bradbury ORCID iD
Thesis advisor: Laura Dennison ORCID iD
Thesis advisor: Lucy Yardley ORCID iD

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