Public Health and Primary Care, University of Cambridge, Cambridge, UK
Public Health and Primary Care, University of Cambridge, Cambridge, UK.
BMJ Open. 2022 Feb 28;12(2):e053183. doi: 10.1136/bmjopen-2021-053183.
To explore patients' and healthcare practitioners' (HCPs) views about non-adherence to hypertension medication and potential content of a combined very brief face-to-face discussion (VBI) and digital intervention (DI).
A qualitative study (N=31): interviews with patients with hypertension (n=6) and HCPs (n=11) and four focus groups with patients with hypertension (n=14). Participants were recruited through general practices in Eastern England and London. Topic guides explored reasons for medication non-adherence and attitudes towards a potential intervention to support adherence. Stimuli to facilitate discussion included example SMS messages and smartphone app features, including mobile sensing. Analysis was informed methodologically by the constant comparative approach and theoretically by perceptions and practicalities approach.
Participants' overarching explanations for non-adherence were non-intentional (forgetting) and intentional (concerns about side effects, reluctance to medicate). These underpinned their views on intervention components: messages that targeted forgetting medication or obtaining prescriptions were considered more useful than messages providing information on consequences of non-adherence. Tailoring the DI to the individuals' needs, regarding timing and number of messages, was considered important for user engagement. Patients wanted control over the DI and information about data use associated with any location sensing. While the DI was considered limited in its potential to address intentional non-adherence, HCPs saw the potential for a VBI in addressing this gap, if conducted in a non-judgemental manner. Incorporating a VBI into routine primary care was considered feasible, provided it complemented existing GP practice software and HCPs received sufficient training.
A combined VBI-DI can potentially address intentional and non-intentional reasons for non-adherence to hypertension medication. For optimal engagement, recommendations from this work include a VBI conducted in a non-judgmental manner and focusing on non-intentional factors, followed by a DI that is easy-to-use, highly tailored and with provision of data privacy details about any sensing technology used.
探讨患者和医疗保健从业者（HCPs）对高血压药物治疗依从性的看法，以及一种联合非常简短面对面讨论（VBI）和数字干预（DI）的潜在内容。
一项定性研究（N=31）：对高血压患者（n=6）和 HCPs（n=11）进行访谈，并对 4 组高血压患者（n=14）进行了 4 次焦点小组讨论。参与者通过英格兰东部和伦敦的普通诊所招募。主题指南探讨了药物治疗依从性不佳的原因以及对支持依从性的潜在干预措施的态度。为了促进讨论，使用了包括短信示例和智能手机应用程序功能（包括移动感应）在内的刺激物。分析方法上受不断比较方法的启发，理论上受观念和实践方法的启发。
参与者对非依从性的总体解释是非故意的（忘记）和故意的（对副作用的担忧，不愿意服药）。这些解释了他们对干预措施组成部分的看法：针对忘记服药或获得处方的信息比提供非依从性后果信息的信息更有用。根据个人的需求（包括时间和消息数量）来调整 DI 的个性化，被认为对用户参与很重要。患者希望控制 DI，并了解与任何位置感应相关的数据使用情况。虽然 DI 被认为在解决故意不依从方面的潜力有限，但 HCPs 认为，如果以非评判性的方式进行 VBI，可能会解决这一差距。如果将 VBI 纳入常规初级保健，并且 GP 实践软件得到补充，并且 HCPs 接受了足够的培训，则认为这是可行的。
VBI-DI 联合应用可能会解决高血压药物治疗依从性的故意和非故意原因。为了实现最佳参与，这项工作的建议包括以非评判性的方式进行 VBI，并关注非故意因素，然后是易于使用、高度个性化且提供任何使用的感应技术的数据隐私细节的 DI。
