How Behavior Change Strategies are Used to Design Digital Interventions to Improve Medication Adherence and Blood Pressure Among Patients With Hypertension: Systematic Review

Abstract

Background Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. Objective Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. Methods We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. Results The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. Conclusions This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement.

Home Care Improves Knowledge, Attitude, Practice and Blood Pressure Control in Hypertensive Patients: Exploring the Expanded Role of Community Pharmacists

“…A meta-analysis of 30 clinical trials uncovered that 5 mmHg reduction in SBP may lower the risk of cardiovascular events by 25-30% [31] In line with our finding, other Indonesian studies also demonstrated beneficial impact on BP improvement after provision of community pharmacist-directed health education through home visit [27,28,32,33]. Home care studies conducted overseas in USA [7,34], Canada [35], Australia [36] and less developed countries [17,29,37] also revealed similar findings on BP improvement.…”

Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study

“…There were opposing opinions regarding the gamification and social network components, also observed in a previous study with adolescents with asthma [ 20 ]. To accommodate these differences, and as personalized strategies to treatment adherence have better results [ 47 , 48 ], gamification and social network features of the app will become optional and patients not willing to use these features will be able to turn them off. This modification is in line with previous work advocating that flexible apps may better meet the needs of a broader range of patients [ 49 , 50 ].…”

Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia

“…However, participants’ responses in interviews also revealed several concerns or limitations, suggesting that an app alone would not be a sufficient tool for self-management. Some external factors and barriers, for example, family, affected participants’ use of the app such as positively or negatively affecting patients’ optimism and self-esteem, or easing the stress of using the app to support the self-management of their disease [ 50 ]. These factors must also be considered when assessing the benefits of using apps to support the self-management of hypertension.…”