Jafar Tazeen H, Tan Ngiap Chuan, Shirore Rupesh M, Ramakrishnan Chandrika, Yoon Sungwon, Chen Christina, Aravindhan Amudha
Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Patient Prefer Adherence. 2024 Aug 1;18:1603-1618. doi: 10.2147/PPA.S469855. eCollection 2024.
Hypertension is a major public health challenge, globally. Recently, we reported findings from cluster randomized trial in 8 primary care clinics in Singapore and showed that a multicomponent "SingHypertension" intervention comprising 1) motivational conversation by trained nurses, 2) telephone-based follow-ups, 3) standardized algorithm with single-pill combination (SPC) antihypertensive medications, and 4) subsidy on SPC antihypertensive drugs was effective on improving BP control. This paper presents the acceptability of SingHypertension multicomponent intervention among the key stakeholders.
We conducted post-implementation interviews of 38 stakeholders, including 18 patients and 20 healthcare providers (HCPs) in 4 primary care clinics randomized to the multicomponent "SingHypertension" intervention in Singapore. We used Theoretical Framework for Acceptability (TFA) framework with a focus on affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy to assess stakeholders' acceptability of the intervention.
SingHypertension multicomponent intervention had high perceived effectiveness and a good fit with the value system and ethics of patients and HCPs. Physicians appreciated the guidance from standardized training in hypertension management. Although workload was increased, the nurses felt rewarded for their positive interactions with the patients during motivational conversation sessions and the telephone follow-ups. Most patients reported high self-efficacy levels, improved lifestyles, and adherence to antihypertensive medications. The limited choice of SPC medication, lack of subsidy beyond the trial duration, and shortage of nurses were significant challenges to wide-scale implementation. All HCPs and patients supported scaling up the intervention across primary care clinics.
SingHypertension multicomponent intervention is acceptable to the key stakeholders in Singapore. Taken together with the effectiveness of the intervention, our findings make a compelling case for scaling-up SingHypertension in primary care clinics in Singapore and possibly other countries with similar healthcare infrastructure.
高血压是全球主要的公共卫生挑战。最近，我们报告了在新加坡8家基层医疗诊所进行的整群随机试验的结果，结果显示，一种多组分的“SingHypertension”干预措施有效改善了血压控制，该干预措施包括：1）由经过培训的护士进行的激励性谈话；2）电话随访；3）使用单一片剂复方（SPC）抗高血压药物的标准化算法；4）SPC抗高血压药物补贴。本文介绍了关键利益相关者对SingHypertension多组分干预措施的接受程度。
我们对38名利益相关者进行了实施后访谈，其中包括新加坡4家随机接受多组分“SingHypertension”干预措施的基层医疗诊所的18名患者和20名医疗服务提供者（HCP）。我们使用可接受性理论框架（TFA），重点关注情感态度、负担、伦理道德、干预一致性、机会成本、感知有效性和自我效能感，以评估利益相关者对该干预措施的接受程度。
SingHypertension多组分干预措施具有较高的感知有效性，并且与患者和HCP的价值体系及伦理道德高度契合。医生对高血压管理标准化培训的指导表示赞赏。尽管工作量有所增加，但护士们在激励性谈话环节和电话随访中与患者的积极互动中获得了满足感。大多数患者报告自我效能感较高，生活方式得到改善，并且坚持服用抗高血压药物。SPC药物选择有限、试验期之外缺乏补贴以及护士短缺是大规模实施的重大挑战。所有HCP和患者都支持在基层医疗诊所扩大该干预措施的实施范围。
SingHypertension多组分干预措施在新加坡的关键利益相关者中是可接受的。结合该干预措施的有效性，我们的研究结果有力地支持了在新加坡的基层医疗诊所扩大SingHypertension的实施范围，并可能推广到其他具有类似医疗基础设施的国家。
