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01.12.2017 | Methodology | Ausgabe 1/2017 Open Access

Implementation Science 1/2017

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

Zeitschrift:
Implementation Science > Ausgabe 1/2017
Autoren:
Rebecca Band, Katherine Bradbury, Katherine Morton, Carl May, Susan Michie, Frances S. Mair, Elizabeth Murray, Richard J. McManus, Paul Little, Lucy Yardley
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13012-017-0553-4) contains supplementary material, which is available to authorized users.

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.
Zusatzmaterial
Additional file 1: Full methods for work stream 1: collating and analysing evidence. (DOCX 33 kb)
13012_2017_553_MOESM1_ESM.docx
Additional file 2: Scoping search of qualitative literature for digital intervention use in long-term health conditions (such as hypertension, asthma, diabetes and associated conditions) and final article inclusion. (DOCX 21 kb)
13012_2017_553_MOESM2_ESM.docx
Additional file 3: Excerpt from the rapid review of qualitative studies of digital interventions for long-term condition self-management. (DOCX 21 kb)
13012_2017_553_MOESM3_ESM.docx
Additional file 4: Synthesis of the qualitative literature to identify potential barriers and facilitators for key target behaviours, acceptability and engagement for digital self-management interventions. (DOCX 25 kb)
13012_2017_553_MOESM4_ESM.docx
Additional file 5: Excerpts from the quantitative review of evidence for intervention components used for hypertension self-management. (DOCX 18 kb)
13012_2017_553_MOESM5_ESM.docx
Additional file 6: Behavioural analysis of HOME BP using the Behaviour Change Wheel (BCW) and Normalisation Process Theory (NPT). (DOCX 26 kb)
13012_2017_553_MOESM6_ESM.docx
Additional file 7 Applying the NPT and BCW theoretical frameworks to the HOME BP intervention content: an analysis of patient intervention components for each NPT and BCW construct. (DOCX 19 kb)
13012_2017_553_MOESM7_ESM.docx
Additional file 8: Excerpts from the key findings arising from qualitative and quantitative literature searches to identify studies examining the potential determinants of key HOME BP patient behaviours. (DOCX 17 kb)
13012_2017_553_MOESM8_ESM.docx
Literatur
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