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运用定性研究和以人为本的方法共同制定一项包容性的产后血压自我管理干预措施。

Using qualitative research and the person-based approach to coproduce an inclusive intervention for postpartum blood pressure self-management.

作者信息

Ochieng Cynthia Akelo, Burke Carol, Green Marcus, Igwe Sandra, Tucker Katherine Louise, Hinton Lisa, Goddard Lucy, Roman Cristian, McManus Richard J, Yardley Lucy

机构信息

School of Psychological Science, University of Bristol, Bristol, UK

School of Psychological Science, University of Bristol, Bristol, UK.

出版信息

BMJ Open. 2025 Jun 24;15(6):e098162. doi: 10.1136/bmjopen-2024-098162.

Abstract

OBJECTIVE

To coproduce an inclusive intervention for blood pressure (BP) self-management post partum.

DESIGN

Using the person-based approach, an intervention was coproduced in three phases. Phase 1 entailed intervention coproduction with a diverse patient and public involvement panel and stakeholders (clinical, academic, government and third sector-based). Phase 2 involved intervention optimisation through think-aloud interviews with former patients and clinicians. Phase 3 was user-testing followed by semistructured interviews with current patients and their clinicians.

SETTING

Patients and clinicians from primary and secondary care drawn from Southern and Northern England.

PARTICIPANTS

Seven former patients and 11 clinicians participated in think-aloud interviews to provide their views of intervention prototypes (phase 2). Additionally, 23 patients and 9 of their clinicians participated in semistructured interviews after using the intervention for 2 weeks (phase 3).

INTERVENTION

An interactive patient app-My BP Care-and accompanying leaflet to support BP self-monitoring. These were linked to a clinician dashboard with alerts and an emailing system to facilitate appropriate titration of patient medication.

RESULTS

The intervention was codeveloped following these guiding principles to ensure it was accessible and inclusive: easily comprehensible, motivating, simple and quick to use. Interview findings indicated that patient adherence to the intervention was promoted by the initial patient training conducted by the midwives, the enhanced clinical oversight they felt they received as a result of the intervention, the free BP monitor they received, reassurance they received of the medication safety for them and their baby, the intervention's simplicity and the motivating reminders they received.

CONCLUSIONS

Through coproduction with a diverse group of patients and stakeholders, and optimisation through testing among further diverse patients and clinicians, we developed a multicomponent intervention that is accessible and engaging for diverse patients, compatible with prevailing clinical practice and adaptable to different clinical contexts.

摘要

目的

共同制定一项针对产后血压自我管理的包容性干预措施。

设计

采用以人为本的方法,分三个阶段共同制定干预措施。第一阶段是与多元化的患者及公众参与小组以及利益相关者(临床、学术、政府和第三部门)共同制定干预措施。第二阶段通过对既往患者和临床医生进行出声思考访谈来优化干预措施。第三阶段是进行用户测试,随后对现患患者及其临床医生进行半结构式访谈。

地点

来自英格兰南部和北部的初级和二级医疗机构的患者及临床医生。

参与者

7名既往患者和11名临床医生参与了出声思考访谈,以提供他们对干预原型的看法(第二阶段)。此外,23名患者及其9名临床医生在使用干预措施2周后参与了半结构式访谈(第三阶段)。

干预措施

一款交互式患者应用程序——“我的血压护理”——以及配套手册,以支持血压自我监测。这些与一个带有警报的临床医生仪表板和一个电子邮件系统相连接,以便于对患者用药进行适当调整。

结果

按照这些指导原则共同开发了该干预措施,以确保其易于获取且具有包容性:易于理解、有激励作用、简单且使用快捷。访谈结果表明,助产士进行的初始患者培训、他们因干预措施而感受到的临床监督增强、收到的免费血压监测仪、对他们自己及婴儿用药安全性的放心、干预措施的简单性以及收到的激励性提醒,促进了患者对干预措施的依从性。

结论

通过与多元化的患者群体和利益相关者共同制定,并通过在更多元化的患者和临床医生中进行测试来优化,我们开发了一种多成分干预措施,该措施对不同患者易于获取且具有吸引力,与现行临床实践兼容,并能适应不同的临床环境。

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