“Could the app be tailor-made?” Patients and healthcare providers give feedback on a prototype intervention to support patients with high blood pressure to take medication.
The idea of the intervention is to help patients take their medication as prescribed and so help manage their blood pressure better.
The intervention is a brief five minute discussion with a professional in primary care (a GP surgery) followed by an app or SMS messaging to provide reminders and ongoing support.
The insights on the prototype intervention were reported in a new study conducted by researchers at the University of Cambridge’s Primary Care Unit and published in BMJ Open.
Participants in the study liked the idea of receiving tailored messages and most thought that it would also be acceptable to use location sensing technology to personalise the messages even more, for example, to provide reminders based on real-time location.
What is the problem?
High blood pressure is associated with increased risks of heart disease and causes nearly 20% of deaths worldwide.
It is estimated that just 41% of patients take their blood pressure medication as prescribed, so an intervention that successfully encourages patients to stick to their medication regime could have a large impact on public health.
What did the researchers do?
The research team collected and analysed qualitative data from 20 patients and 11 healthcare providers (including GPs, practice nurses, healthcare assistants and pharmacists), either in one-to-one interviews or focus groups.
Participants were recruited through four general practices in Eastern England and London. They provided feedback on the prototype intervention, viewing example SMS messages and smartphone app features to help generate discussion.
What could the app and SMS messages look like?
Above image shows example hypothetical smartphone app/SMS content to generate discussion in interviews and focus groups: medication reminder notification, feedback on medication adherence levels (weekly and monthly), SMS message (Miranda Van Emmenis)
What did researchers find?
Participants described several reasons for missing or skipping medication: they self-reported more on forgetting (so-called ‘non-intentional nonadherence’) rather than on unpleasant side effects and a general reluctance to be reliant on medication (called ‘intentional nonadherence’). Thus, most of the discussion about a potential new messaging system focused on how it might help address non-intentional nonadherence, mainly forgetting to take the tablets.
Messages with simple reminders for taking medication and ordering prescriptions were popular. Some participants suggested interactive feedback on behaviour in the form of graphs or statistics, on the percentage of tablets taken as prescribed each week, for example.
‘I think the percentage thing would give people pride, you know, ‘oh, I’ve reached 100% [of taking my medication] this month, I feel really good about that’. Once a month I’d like to know what my score was for the month’ (male, 60s).
Tailoring information to individual patients was important and ideas included giving users control over the SMS/app settings to specify timing and frequency of messages.
‘Some people are on medication once a day, twice a day, three, four. Could the app be tailor-made for the individual? And remind us accordingly?’ (female in focus group).
Having the option for a ‘snooze’ function (similar to an alarm snooze) was well-received by participants, provided users could set their own parameters, for example, personalising the snooze duration and maximum number of snoozes.
‘If you hit the ‘snooze’ for an hour or whatever you choose it to be, […] and it’ll keep reminding me again and I’ll take the tablets [when I’m home]’ (male in focus group).
Information about the consequences of skipping medication doses was only viewed as useful for patients who are newly diagnosed and could be unwelcome for patients who already know what the health complications of their long-term health conditions are:
‘I know what the risk is [from not taking my medication]. I don’t feel that I want it repeated, no’ (male, 60s).
Participants liked the idea of enabling location sensing technology, such as GPS or Wi-Fi, to personalise smartphone messages even more, for example, to provide reminders based on real-time location.
‘It would make it impossible to forget ‘cos I’d just walk through the door and take ‘em. That would be brilliant’ (male at focus group).
But they were concerned about being subject to “Big Brother” surveillance and about the security of their data and emphasised that these concerns would have to be addressed to make the use of sensing technology acceptable.
To increase the acceptability of sensing technology, participants thought future apps should spell out the benefits for users and provide them with flexible opt in/out option.
‘I think it would be a case of opt-in because I think some people would think it an invasion of privacy. I mean, personally I think it’s a good idea but, you see, some people wouldn’t like it’ (female in focus group).
They also suggested that people might trust a location-sensing app from a university or charity more than one from a commercial company.
Routine primary care consultations such as medication reviews or blood pressure checks were seen as an appropriate setting to introduce the intervention to patients and discuss their medication-taking behaviour. But some of the healthcare practitioners pointed out the need for additional training and some were concerned about the ‘very brief’ five minute time frame for delivering the intervention.
Overall, it’s clear that the messaging system should be straightforward and easy to use and that the intervention should be delivered in a non judgmental way, taking into account the patient-provider relationship.
Our participants explained why the messaging system needs to be highly tailored to individual need: most of them have multiple conditions and may be taking many tablets per day.
Many thought that sensing technology could be acceptable as a way of improving the personalised nature of the messages as long as privacy and data protection concerns were addressed upfront.”
– Miranda Van Emmenis, lead author, Primary Care Unit, University of Cambridge
The findings from this exploratory research could be used to inform the development of a combined face-to-face and digital intervention to support patients with taking their blood pressure medication. A large-scale randomised controlled trial called Programme on Adherence to Medication, or PAM, is now being conducted to assess effectiveness and cost effectiveness of a combined intervention within primary care.
This research was funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme [RP-PG-0615-20013].
Read the research
M Van Emmenis, J Jamison, A Kassavou, W Hardeman, F Naughton, C A’Court, S Sutton, H Eborall. Patient and practitioner views on a combined face-to-face and digital intervention to support medication adherence in hypertension: a qualitative study within primary care. BMJ Open. 28 February 2022
Find out more
Information about the research: Miranda Van Emmenis
Media queries: Lucy Lloyd
Image: via Pixabay