Theory-based mobile phone text messaging intervention for blood pressure control (TEXT4BP) among hypertensive patients in Nepal: study protocol for a feasibility randomised controlled trial

Bhandari, Buna; Narasimhan, Padmanesan; Vaidya, Abhinav; Jayasuriya, Rohan

doi:10.1136/bmjopen-2020-040799

Cited by 5 publications

(7 citation statements)

References 37 publications

(42 reference statements)

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“…We conducted a formative qualitative study guided by an evidence-based tool, the COM-B Model of Behaviour Change Wheel [ 20 ], to understand facilitators and barriers to the treatment and control of high blood pressure among hypertensive patients in Nepal and to inform our TEXT4BP intervention study [ 24 ]. This study used theory-based formative research to develop interventions for hypertension management in Nepal [ 24 ]. The study explored the knowledge and misconceptions of the disease and treatment, access to reliable information and health services and many social and cultural factors as the main barriers.…”

Section: Discussionmentioning

confidence: 99%

“…However, the feasibility and effectiveness of intervention using mobile technology in Nepal’s context is yet to be studied. This formative study findings were used to inform the design and contents of our planned mhealth intervention for the patients with hypertension in Nepal [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative methods can provide deep insights into the problem being studied [ 23 ]. The findings of this formative study were used in informing the intervention (TEXT4BP), a pilot randomized control trial being tested among hypertensive patients in Nepal [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

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Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

et al. 2021

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Background Nepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal. Methods We conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach. Results Major uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment. Conclusions This formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

et al. 2021

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“…Therefore, it may be worthwhile to explore the effectiveness and feasibility of telephone follow-ups, web-based and computer-tailored solutions, home-use devices for blood pressure monitoring, smartphone applications, and telemedicine in the Nepalese context. A recently published protocol announced a study that will aim to recruit 200 hypertensive patients in Nepal and evaluate feasibility of a mobile phone text messaging intervention ( 70 ).…”

Section: Discussionmentioning

confidence: 99%

Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review

Dhungana

Pedišić

Pandey

et al. 2021

Front. Cardiovasc. Med.

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Background: Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. However, no systematic investigation of factors influencing hypertension treatment and control in Nepal is available. This study aimed to systematically review the published literature and synthesise the findings on barriers, enablers, and strategies for hypertension treatment and control in Nepal.Methods: Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat, and Nepali journals and government websites were searched for qualitative, quantitative, and mixed-methods studies on factors or strategies related to hypertension treatment and control in Nepal. Information from qualitative studies was analysed using template analysis, while results from quantitative studies were narratively synthesised. Summary findings were framed under “health system”, “provider”, and “patient” domains. The protocol was registered in PROSPERO (registration number: CRD42020145823).Results: We identified 15 studies; ten related to barriers and enablers and five to strategies. The identified barriers associated with the health system were: lack of affordable services and lack of resources. The barriers at the provider's level were: communication gaps, inadequate counselling, long waiting hours for appointments, lack of national guidelines for hypertension treatment, and provider's unsupportive behaviours. Non-adherence to medication, irregular follow-up visits, lack of awareness on blood pressure target, poor help-seeking behaviours, reluctance to change behaviours, perceived side-effects of anti-hypertensive medication, self-medication, lack of family support, financial hardship, lack of awareness on blood pressure complications, and comorbidity were barriers identified at patient level. The following enablers were identified: free essential health care services, family support, positive illness perception, and drug reminders. Strategies implemented at the health system, provider and patient levels were: establishing digital health records at health centres, health worker's capacity development, and health education.Conclusion: There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, health providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.

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“…The findings of this formative research informed the next phase of the TEXT4BP study, tested using a randomised controlled trial design. 52 Information on the contents of SMS texts, their frequency and timing of the messages may be of value in similar resource-limited settings. In Nepal, there are very few studies on mHealth.…”

Section: Implications For Mhealth Design and Future Researchmentioning

confidence: 99%

Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers

et al. 2021

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BackgroundUnderstanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy.ObjectivesThis formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management.DesignA qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model.SettingThe study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal.ParticipantsA total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30–70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy.ResultsThe respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient’s essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient’s details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2–3 times/week) preferably in the morning or evening.ConclusionsWe found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.

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Theory-based mobile phone text messaging intervention for blood pressure control (TEXT4BP) among hypertensive patients in Nepal: study protocol for a feasibility randomised controlled trial

Cited by 5 publications

References 37 publications

Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review

Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers

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