Hypertension Visualisation: illness perception and medicines adherence
Research type
Research Study
Full title
The Visualisation of Hypertension: A Novel Communication Approach to Support Adherence to Medication.
IRAS ID
272005
Contact name
Delyth James
Contact email
Sponsor organisation
Cardiff Metropolitan University
Duration of Study in the UK
1 years, 5 months, 27 days
Research summary
Research Summary
Hypertension (high blood pressure) is an asymptomatic long-term condition; the greatest contributor to preventable death worldwide. For many long-term conditions, the patient’s ability to self-manage their condition is key to good health outcomes; this includes appropriate use of prescribed medication. Research shows that up to 50% of patients with long-term conditions are non-adherent to medication.
The study aim is to evaluate a digital platform which allows users, through animations, to visualise both the condition that is hypertension and how blood pressure impacts the circulatory system. The purpose of the platform is to improve patients’ understanding of hypertension, increase perceived necessity of treatment and ultimately increase medication adherence when used within a pharmacist-patient consultation.
The platform consists of the animated model and spoken narrative. The model shows the heart, the brain and the main connecting artery. It can be personalised to show the patients’ blood pressure.
This research consists of two studies, a pilot study followed by a feasibility study. The same methodology will be adopted for both studies unless the pilot study highlights significant methodological issues.
The pilot study will take place in four to five community pharmacy (CP) sites. Hypertensive patients will attend two consultations, one where they view the hypertension model (consultation 1) and a follow-up (consultation 2). Outcome measures will be recorded at both consultations. Outcome measures: Beliefs about Medicines Questionnaire (specific), Illness Perception Questionnaire, blood pressure, pharmacy medication dispensing and collection data, MARS-5 medication and Extent of Non-adherence (DOSE-Nonadherence) medication adherence questionnaires. Both consultations will be facilitated by a researcher.
The feasibility study will be across four or five community pharmacy sites. Both consultations will be facilitated by a pharmacist. Outcome measures as per pilot study.
Qualitative feedback will be sought from pharmacists and patients during both studies to explore platform acceptability.
Summary of Results
This study focuses on high blood pressure (also known as hypertension), a common chronic condition that often goes unnoticed due to its lack of symptoms. Hypertension can lead to serious cardiovascular issues if left untreated. Although medication can effectively lower blood pressure and reduce cardiovascular risks, many people do not adhere to their treatment plans. This non-adherence is often intentional and can be influenced by individuals' beliefs about their condition and its treatment.
To address this challenge, we developed a visual communication tool called ViSTA-BP (Visualisation to Support Treatment Adherence in High Blood Pressure), which aims to positively influence patients' beliefs and behaviours related to hypertension and its treatment. ViSTA-BP is designed to be used during an in-person consultation between a healthcare professional and a person with hypertension. It consists of a personalisable animated representation of how hypertension affects the cardiovascular system, with the healthcare professional explaining further.
We conducted several studies to explore the feasibility and acceptability of ViSTA-BP. First, a researcher delivered the intervention to patients in community pharmacies. Pharmacists then delivered the intervention in both community pharmacies and general practice. We also gathered patient and pharmacist feedback through interviews. We considered the feasibility of the intervention by looking at the delivery and use of ViSTA-BP in practice, for example, by understanding patient recruitment. We explored acceptability by asking patients and pharmacists to share their feedback. This included asking whether they understood ViSTA-BP and believed it would be effective, their thoughts about the healthcare setting and barriers to using ViSTA-BP in practice. We also measured participating patients' beliefs about hypertension and its treatment, their medication adherence and their blood pressure at several time points. We used this information to explore whether there was potential for ViSTA-BP to be effective at supporting medication adherence and improved blood pressure in the future.
ViSTA-BP was found to be feasible and acceptable when facilitated by a researcher in a community pharmacy. However, recruitment for pharmacist-led consultations was low and appeared to be influenced by the pharmacists' availability to deliver the intervention. Despite this, patients and pharmacists showed a positive attitude towards ViSTA-BP and recognised its potential benefits. Patients' perceptions of hypertension improved, with participating patients believing they had more personal control over their hypertension and treatment for hypertension being considered more necessary. Significant blood pressure reduction indicated the intervention's potential to improve clinical outcomes. There was no improvement in medication adherence; however, most patients reported they were 100% adherent at the beginning of the study.
Further research is needed to understand whether these positive effects would occur if the study was repeated with more patients, over a longer time or in different geographical areas. We also need to understand more about the issues that might affect the delivery of ViSTA-BP by pharmacists in routine practice.
Overall, this study highlights the potential for visual interventions like ViSTA-BP to positively impact the health-related beliefs and behaviours that influence hypertension management.
This study was funded by Kess2 and Cwm Taf Morgannwg University Health Board as part of a PhD studentship. Cardiff Metropolitan University was the study sponsor. We would like to thank the patients and pharmacists who participated in this study.
REC name
Wales REC 5
REC reference
20/WA/0280
Date of REC Opinion
21 Oct 2020
REC opinion
Favourable Opinion