The Visualisation of Hypertension: a novel communication approach to support adherence to medication

  

Hypertension, an asymptomatic chronic condition, is a major treatable cause of cardiovascular disease. Antihypertensive medication reduces blood pressure (BP) and cardiovascular risk, yet treatment adherence is sub-optimal. Intentional nonadherence, i.e., a decision not to adhere, is often influenced by beliefs about a condition or its treatment. Using visuals is one method to positively influence beliefs and subsequent behaviour.

This research aimed to develop a hypertension visualisation intervention and investigate its feasibility and acceptability when delivered in a community pharmacy setting. Trends in direction of patients’ hypertension perceptions and antihypertensive adherence were explored.

A scoping literature review yielding forty-five studies found that visual interventions conceptualising a medical condition could be effective as a single facilitated session. Five behaviour change techniques frequently identified within effective interventions were incorporated into the hypertension visualisation intervention (ViSTA-BP). ViSTA-BP is a personalised animated representation of hypertension physiology with an accompanying narrative, informed by stakeholders and refined through iterative cycles. 

Feasibility was explored through three empirical studies using a priori criteria. First with thirteen stakeholders, then as a researcher-facilitated intervention with sixty-nine hypertensive patients in community pharmacy and finally as a pharmacist-facilitated intervention. Qualitative semi-structured interviews with fifteen patients and six pharmacists explored acceptability. Trends in direction of patients’ perceptions of hypertension, medication adherence and BP were investigated.

ViSTA-BP was feasible as a researcher-facilitated intervention; however, recruitment for pharmacist-facilitated consultations was low. ViSTA-BP was acceptable to patients and pharmacists. Both demonstrated a positive attitude towards the intervention, understood its purpose, and saw future potential. There were significant improvements in three aspects of illness beliefs, sustained at three-month follow-up. Adherence was unchanged; however, BP significantly decreased, showing potential for ViSTA-BP to improve clinical outcomes.

Contextual issues may have influenced recruitment for pharmacist-facilitated consultations; further research is needed to explore the feasibility of ViSTA-BP delivery by pharmacists within routine practice.