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

Abstract

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.

Keywords: Blood pressure; Hypertension; Intervention planning; Methodological study; Self-management; Self-monitoring; Theoretical modelling.

Fig. 1

The six elements of intervention planning for HOME BP. Note: The colour coding corresponds to the workstream in which the activity was undertaken; orange boxes relate to evidence-based activities, blue boxes relate to theory-based activities

Fig. 2

Screenshot from the patient HOME BP intervention version addressing patient concerns regarding the side effects of anti-hypertensive medication

Fig. 3

Screenshot from the supporter intervention pages outlining the CARE approach to behavioural support within HOME BP

Fig. 4

The HOME BP logic model. Note. The ‘Intervention processes in sessions’ section of the logic model condenses the information already presented in the behavioural analysis (available in Additional file 7). Within the logic model, these are organised around the patient and HCP target behaviours; summaries of the key BCTs used to promote each target behaviour are outlined in addition to the relevant NPT mechanism (presented in brackets)