Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

Understanding how primary care practitioners perceive an online intervention for the management of hypertension

Authors: Katherine Bradbury, Katherine Morton, Rebecca Band, Carl May, Richard McManus, Paul Little, Lucy Yardley

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

Login to get access

Abstract

Background

In order to achieve successful implementation an intervention needs to be acceptable and feasible to its users and must overcome barriers to behaviour change. The Person-Based Approach can help intervention developers to improve their interventions to ensure more successful implementation. This study provides an example of using the Person-Based Approach to refine a digital intervention for hypertension (HOME BP).

Methods

Our Person-Based Approach involved conducting qualitative focus groups with practice staff to explore their perceptions of HOME BP and to identify any potential barriers to implementation of the HOME BP procedures. We took an iterative approach moving between data collection, analysis and modifications to the HOME BP intervention, followed by further data collection. The data was analysed using thematic analysis.

Results

Many aspects of HOME BP appeared to be acceptable, persuasive and feasible to implement. Practitioners perceived benefits in using HOME BP, including that it could empower patients to self-manage their health, potentially overcome clinical inertia around prescribing medication and save both the patient and practitioner time. However, practitioners also had some concerns. Some practitioners were concerned about the accuracy of patients’ home blood pressure readings, or the potential for home monitoring to cause patients anxiety and therefore increase consultations. Some GPs lacked confidence in choosing multiple medication changes, or had concerns about unanticipated drug interactions. A few nurses were concerned that the model of patient support they were asked to provide was not consistent with their perceived role. Modifications were made to the intervention based on this feedback, which appeared to help overcome practitioners’ concerns and improve the acceptability and feasibility of the intervention.

Conclusions

This paper provides a detailed example of using the Person-Based Approach to refine HOME BP, demonstrating how we improved the acceptability and feasibility of HOME BP based on feedback from practice staff. This demonstration may be useful to others developing digital interventions.
Literature
1.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.CrossRefPubMed
2.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, AlMazroa MA, Amann M, Anderson HR, Andrews KG, Aryee M. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2224–60.CrossRef
3.
Falaschetti E, Mindell J, Knott C, Poulter N. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet. 2014;383(9932):1912–9.CrossRefPubMed
4.
Okonofua EC, Simpson KN, Jesri A, Rehman SU, Durkalski VL, Egan BM. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension. 2006;47(3):345–51.CrossRefPubMed
5.
Ogedegbe G. Barriers to optimal hypertension control. J Clin Hypertens. 2008;10(8):644–6.CrossRef
6.
McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, Kaambwa B, Banting M, Bryan S, Little P, Williams B. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet. 2010;376(9736):163–72.CrossRefPubMed
7.
McManus RJ, Mant J, Haque M, Bray EP, Bryan S, Greenfield SM, Jones MI, Jowett S, Little P, Penaloza C, Schwartz C. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. Jama. 2014;312(8):799–808.CrossRefPubMed
8.
Band R, Morton K, Stuart B, Raftery J, Bradbury K, Yao GL, Zhu S, Little P, Yardley L, McManus RJ. The home and online management and evaluation of blood pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial. BMJ Open. 2016;6:e012684.CrossRefPubMedPubMedCentral
9.
10.
Yardley L, Morrison L, Bradbury K, Muller I. The person-based approach to intervention development: Application to digital health-related behavior change interventions. Journal of medical Internet research. 2015;17(1):e30.
11.
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.
12.
Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: An evidence-based approach. Am J Prev Med. 2002;22(4):267–84.CrossRefPubMed
13.
Yardley L, Ware LJ, Smith ER, Williams S, Bradbury KJ, Arden-Close EJ, Mullee MA, Moore MV, Peacock JL, Lean ME, Margetts BM. Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care. Int J Behav Nutr Phys Act. 2014;11(67):1–1.
14.
Yardley L, Spring BJ, Riper H, Morrison LG, Crane DH, Curtis K, Merchant GC, Naughton F, Blanford A. Understanding and promoting effective engagement with digital behavior change interventions. American Journal of Preventive Medicine. 2016;1-28.
15.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Bmj. 2008;337:a1655.
16.
Kok G, Schaalma H. Using theory in psychological interventions. In: Michie S, Abraham C, editors. Health psychology in practice. Oxford: Blackwell; 2004. p. 203–9.
17.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68.CrossRefPubMed
18.
Little P, Stuart B, Hobbs R, Kelly J, Smith ER, Bradbury KJ, Hughes S, Smith P, Moore MV, Lean MEJ, Margetts B, Bryne CD, Griffin S, Davoudinfar M, Hooper J, Yao G, Zhu S, Raftery J, Yardley L. A randomised controlled trial of a web-based intervention (POWeR+) with brief nurse support to manage obesity in primary care. Lancet Diabetes Endocrinol. 2016;4(10):1–34.
19.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
20.
Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine Publishing Company; 1967.
21.
Bostock Y, Hanley J, McGown D, Pinnock H, Padfield P, McKinstry B. The acceptability to patients and professionals of remote blood pressure monitoring using mobile phones. Primary Health Care Research & Development. 2009;10(04):299–308.CrossRef
22.
Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open. 2013;3(5):e002671.CrossRefPubMedPubMedCentral
23.
Jones MI, Greenfield SM, Bray EP, Baral-Grant S, Hobbs FR, Holder R, Little P, Mant J, Virdee SK, Williams B, McManus RJ. Patients’ experiences of self-monitoring blood pressure and self-titration of medication: the TASMINH2 trial qualitative study. Br J Gen Pract. 2012;62(595):e135–42.CrossRefPubMed
24.
May CR, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A, Murray E. Development of a theory of implementation and integration: Normalization Process Theory. Implement Sci. 2009;4(29):29.CrossRefPubMedPubMedCentral
25.
May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.CrossRef
26.
Anthierens S, Tansens A, Petrovic M, Christiaens T. Qualitative insights into general practitioners views on polypharmacy. BMC Fam Pract. 2010;11(1):65.CrossRefPubMedPubMedCentral
27.
Smith SM, O'Kelly S, O'Dowd T. GPs' and pharmacists' experiences of managing multimorbidity: a ‘Pandora's box’. Br J Gen Pract. 2010;60(576):e285–94.CrossRefPubMedCentral
28.
Sinnott C, Mc Hugh S, Browne J, Bradley C. GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open. 2013;3(9):e003610.CrossRefPubMedPubMedCentral
29.
Ritchie LD, Campbell NC, Murchie P. New NICE guidelines for hypertension. BMJ. 2011;343:d5644.
30.
Jones MI, Greenfield SM, Bray EP, Hobbs FR, Holder R, Little P, Mant J, Williams B, McManus RJ. Patient self-monitoring of blood pressure and self-titration of medication in primary care: the TASMINH2 trial qualitative study of health professionals’ experiences. Br J Gen Pract. 2013;63(611):e378–85.CrossRefPubMedPubMedCentral
31.
Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R. Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci. 2016;11(1):1.
32.
Ryan RM, Mims V, Koestner R. Relation of reward contingency and interpersonal context to intrinsic motivation: A review and test using cognitive evaluation theory. J Pers Soc Psychol. 1983;45(4):736–50.
33.
Renouf S, Bradbury K, Yardley L, Little P. The role of nurse support within an internet-delivered weight management intervention: A qualitative study. Psychology, Health & Medicine. 2015;20(8):963–71.CrossRef
34.
Johnson MJ, May CR. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open. 2015;5(9):e008592.CrossRefPubMedPubMedCentral
35.
Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R. Achieving change in primary care—effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews. BMJ Open. 2015;5(12):e009993.CrossRefPubMedPubMedCentral
36.
Kennedy A, Bower P, Reeves D, Blakeman T, Bowen R, Chew-Graham C, Eden M, Fullwood C, Gaffney H, Gardner C, Lee V. Implementation of self-management support for long term conditions in routine primary care settings: cluster randomised controlled trial. BMJ. 2013;346:f2882.CrossRefPubMedPubMedCentral
37.
Kennedy A, Rogers A, Bowen R, Lee V, Blakeman T, Gardner C, Morris R, Protheroe J, Chew-Graham C. Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: a qualitative study. Int J Nurs Stud. 2014;51(8):1103–13.CrossRefPubMed
38.
Huebschmann AG, Mizrahi T, Soenksen A, Beaty BL, Denberg TD. Reducing clinical inertia in hypertension treatment: a pragmatic randomized controlled trial. J Clin Hypertens. 2012;14(5):322–9.CrossRef
39.
Henderlong J, Lepper MR. The effects of praise on children's intrinsic motivation: a review and synthesis. Psychol Bull. 2002;128(5):774.CrossRefPubMed
40.
Coatsworth JD, Conroy DE. The effects of autonomy-supportive coaching, need satisfaction, and self-perceptions on initiative and identity in youth swimmers. Dev Psychol. 2009;45(2):320.CrossRefPubMedPubMedCentral
41.
Williams GC, Grow VM, Freedman ZR, Ryan RM, Deci EL. Motivational predictors of weight loss and weight-loss maintenance. J Pers Soc Psychol. 1996;70(1):115.CrossRefPubMed
42.
Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. European Health Psychologist. 2008;10(1):2–5.
43.
Pincus T, Holt N, Vogel S, Underwood M, Savage R, Walsh DA, Taylor SJ. Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. PAIN. 2013;154(11):2407–16.CrossRefPubMed
44.
Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil. 2015;37(12):1060–5.CrossRefPubMed
Metadata
Title
Understanding how primary care practitioners perceive an online intervention for the management of hypertension
Authors
Katherine Bradbury
Katherine Morton
Rebecca Band
Carl May
Richard McManus
Paul Little
Lucy Yardley
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-016-0397-x

Other articles of this Issue 1/2017

BMC Medical Informatics and Decision Making 1/2017 Go to the issue

Research article

Social media engagement analysis of U.S. Federal health agencies on Facebook

Correspondence

Utilizing patient data from the veterans administration electronic health record to support web-based clinical decision support: informatics challenges and issues from three clinical domains

Research article

What information is used in treatment decision aids? A systematic review of the types of evidence populating health decision aids

Research article

The use of multi-criteria decision making models in evaluating anesthesia method options in circumcision surgery

Research article

Experimental application of Business Process Management technology to manage clinical pathways: a pediatric kidney transplantation follow up case

Study protocol

Impact of mobile phone-based technology to improve health, population and nutrition services in Rural Bangladesh: a study protocol