JMIR Publications

ABSTRACT

Background:

Information on how behavior change strategies have been used to design digital interventions (DI) for patients with hypertension to improve blood pressure (BP) control and/or medication adherence (MA) is currently limited and difficult to find.

Objective:

Hypertension, as a major modifiable risk factor for cardiovascular diseases, can be controlled through appropriate medication. Many interventions exist that target MA in order to improve BP, increasingly making use of modern digital technologies. This systematic review was conducted to discover how DIs have been designed, developed and employed 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:

All the studies that had developed DIs for patients with hypertension in order to improve MA or BP control, and published in PubMed from 2008 to 2018 were included. The analysis has been done by mapping all the DI components into the Matrix of Change Objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care system and team levels), targeted patients’ behaviors and components of the DIs from the reviewed studies.

Results:

54 eligible studies were included in this analysis. The determinants were considered in two levels: patient, health care system and team. The most commonly described determinants from patient level were Lack of education, Lack of self-awareness, Lack of self-efficacy and Forgetfulness. Clinical inertia and Inadequate health workforces were the most commonly targeted determinants from healthcare team and system level. Taking medication, patient-provider interactive communication, self-measurement, and lifestyle management were the most cited patient behaviors on both levels. Most of the studies did not involve getting support from peers or families, despite its effectiveness and penetration rate of social media.

Conclusions:

This review highlights the need to design a multi-faceted digital interventions that can be personalized according to patients’ behavior(s) which need to be changed. Overcoming the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension requires considering different levels, including patient and healthcare team, as well as system involvement.