Supporting self-management in hypertension care through an interactive mobile phone self report system: a Person-Centred approach

Transcription

1 Supporting self-management in hypertension care through an interactive mobile phone self report system: a Person-Centred approach ULRIKA BENGTSSON, PHD, RN, PCN SCIENCE SAHLGRENSKA ACADEMY UNIVERSITY OF GOTHENBURG, SWEDEN ulrika.bengtsson@gu.se Background: a health care facing new challenges Demographic and epidemiological transitions in society: Prolonged life Life-style attributed health problems Chronic disease profile Increased demand on health care organization and delivery Economic constraints Re-thinking health care 1

2 Background: a health care in need of support to change Managing health an increased individual responsibility: Self-management of a condition Participation in the own care New demands on patients require support from health care Hypertension The primary riskfactor of cardiovascular disease Large and growing problem Chronic condition Treatment in a combination of drugs and lifestyle adjustment are effective and decrease risk of cardiovascular disease BP control remains poor World Health Organization. Global status report on noncommunicable diseases Geneva, World Health Organization, Falaschetti et al. Hypertension management in England: a serial cross-sectional study from 1994 to Lancet 2014;383: The Lancet. Hypertenison: an urgent need for global control and prevention. Editorial. Lancet 2014;383:

3 Hypertension No more than 50 % adhere to their treatment. Focus until now: Perceptions Expectations Barriers Facilitators Reasons Medication Wishes Sabate, E. and (ED), Adherence to long-term therapies. Evidence for action, World Health Organization, 2003, Geneva, Switzerland. Lack of successful interventions in order to improve adherence Hypertension New alternative focus: SELF-MANAGEMENT Need for self-management support tools facilitating understanding and interpretation of BP, in relation to perceived symptoms and how we live Need for self-management support tools facilitating the communication between patients and their caregivers, in a way that promotes patient participation in equality with the health care professional 3

4 Theoretical framework Person-centredness: the perspective Personalism: Capabilities, Capacity, In action, Responsibility for actions, Life-plans, Narration, Interpretive, Relational, antireductionsim Person-centred care, the doing, in relation to selfmanagement Participation The indiviudal a contradiction? The person To self-manage within the frame of the relationship Christian Smith (2010) Charles Taylor (1995) Representations Interpretations Construction of personal knowledge Martin Buber (1994) I-thou I-it Overall aim The aim was to, with a person centred perspective, design, develop and evaluate an interactive mobile phone-based system to support self-management of hypertension. 4

5 Methodological framework Theoretical guidance: Participatory oriented design (Spinuzzi, 1999) Common Sense Model (Leventhal et al 1985, 2012) Practical guidance: FDA s model for development of Patient Reported Outcomes ISPOR task force reports on good research practice for developing Patient Reported Outcomes Measures Overview of studies Development Evaluation Focus of study: Design Study 1 Study 2 Study 3 Study 4 What is deemed Comprehension, Effect on blood Effect on important for the comprehensiveness pressure. structure and users: patients and relevance of interaction in and health care items. Reliability of the follow-up? items. Usability of consultation. system. Cross-sectional Validation-study Longitudinal Interpretive Participants Patients (n=15), (n=12) Setting Data collection Analyses 1 Health Care Centre 1 internal medicine outpatient clinic Focus groups Thematic Patients (n=21), (n=4) 2 Health Care Cognitive interviews Structured iterative Item tracking matrix Patients (n=50), (n=8) Self-reporting in daily life Patients and in audio (n=10) and video (n=10) recorded consultations Mobile phone selfreport questions, recordings Audio/video blood-pressure and pulse measurements Descriptive statistics Analytical statistics: Paired sample t-test Latent class growth modelling Interaction 5

6 Design and development phase: focusgroups Focus of study: Design Study I Study II Study III Study IV What is deemed Comprehension, Effect on blood Effect on important for the comprehensiveness pressure. structure and users: patients and relevance of interaction in and health care items. Reliability of the follow-up? items. Usability of consultation. system. Cross-sectional Validation-study Longitudinal Interpretive Participants Patients (n=15), (n=12) Setting Data collection Analyses 1 Health Care Centre 1 internal medicine outpatient clinic Focus groups Thematic Patients (n=21), (n=4) 2 Health Care Cognitive interviews Structured iterative Item tracking matrix Patients (n=50), (n=8) Self-reporting in daily life Patients and in audio (n=10) and video (n=10) recorded consultations Mobile phone selfreport questions, recordings Audio/video blood-pressure and pulse measurements Descriptive statistics Analytical statistics: Paired sample t-test Latent class growth modelling Interaction Summary of results focus groups Patients To feel control over the blood pressure In need of a deeper understanding Health care Clear and unambiguous information Prevention Concensus of opinion Self-monitoring of blood-pressure Self-reporting of wellbeing, dizziness, stress, headache, tiredness and physical activity Divergence in vievs The view and perception of symptoms The patients capacity Bengtsson et al. Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives. Blood Pressure. 2014;23:

7 Design and development phase: validation Focus of study: Design Study I Study II Study III Study IV What is deemed Comprehension, Effect on blood Effect on important for the comprehensiveness pressure. structure and users: patients and relevance of interaction in and health care items. Reliability of the follow-up? items. Usability of consultation. system. Cross-sectional Validation-study Longitudinal Interpretive Participants Patients (n=15), (n=12) Setting Data collection Analyses 1 Health Care Centre 1 internal medicine outpatient clinic Focus groups Thematic Patients (n=21), (n=4) 2 Health Care Cognitive interviews Structured iterative Item tracking matrix Patients (n=50), (n=8) Self-reporting in daily life Patients and in audio (n=10) and video (n=10) recorded consultations Mobile phone selfreport questions, recordings Audio/video blood-pressure and pulse measurements Descriptive statistics Analytical statistics: Paired sample t-test Latent class growth modelling Interaction Bengtsson et al. Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2: Content validity and usability. Blood Pressure. 2014;23:

8 An overview of the developed self-managment support system Evaluation phase: blood pressure Focus of study: Design Study I Study II Study III Study IV What is deemed Comprehension, Effect on blood Effect on important for the comprehensiveness pressure. structure and users: patients and relevance of interaction in and health care items. Reliability of the follow-up? items. Usability of consultation. system. Cross-sectional Validation-study Longitudinal Interpretive Participants Patients (n=15), (n=12) Setting Data collection Analyses 1 Health Care Centre 1 internal medicine outpatient clinic Focus groups Thematic Patients (n=21), (n=4) 2 Health Care Cognitive interviews Structured iterative Item tracking matrix Patients (n=50), (n=8) Self-reporting in daily life Patients and in audio (n=10) and video (n=10) recorded consultations Mobile phone selfreport questions, recordings Audio/video blood-pressure and pulse measurements Descriptive statistics Analytical statistics: Paired sample t-test Latent class growth modelling Interaction 8

9 Results Bengtsson et al. Improved blood pressure control using an interactvive mobile phone support system. The Journal of Clinical Hypertension, Doi /jch Systolic blood pressure Bengtsson et al. Improved blood pressure control using an interactvive mobile phone support system. The Journal of Clinical Hypertension, Doi /jch

10 Systolic blood pressure Bengtsson et al. Improved blood pressure control using an interactvive mobile phone support system. The Journal of Clinical Hypertension, Doi /jch Evaluation phase:communication and interaction Focus of study: Design Study I Study II Study III Study IV What is deemed Comprehension, Effect on blood Effect on important for the comprehensiveness pressure. structure and users: patients and relevance of interaction in and health care items. Reliability of the follow-up? items. Usability of consultation. system. Cross-sectional Validation-study Longitudinal Interpretive Participants Patients (n=15), (n=12) Setting Data collection Analyses 1 Health Care Centre 1 internal medicine outpatient clinic Focus groups Thematic Patients (n=21), (n=4) 2 Health Care Cognitive interviews Structured iterative Item tracking matrix Patients (n=50), (n=8) Self-reporting in daily life Patients and in audio (n=10) and video (n=10) recorded consultations Mobile phone selfreport questions, recordings Audio/video blood-pressure and pulse measurements Descriptive statistics Analytical statistics: Paired sample t-test Latent class growth modelling Interaction 10

11 Results Contextualizations Professional knowledge, interpreations shared Questions, perceptions and insights shared Life-world Symmetry Life-style New insights! Equality Future actions and care suggested Blood pressure MUTUAL PARTICIPATION IN FOLLOW-UP CONSULTATIONS Summary of Results Blood pressure decreased A tool to support selfmanagement was developed from a person-centred perspective in a participatory and structured manner Patients became partners 11

12 ORGANISATIONSNAMN (ÄNDRA SIDHUVUD VIA FLIKEN INFOGA-SIDHUVUD/SIDFOT) Co-producing data the documentation Mutual sharing and participation Partnership Illustration: Alexandra Flament Togetherness 12