Optimizing a digital intervention for managing blood pressure in stroke patients using a diverse sample: Integrating the person-based approach and patient and public involvement

Tanvi Rai*, Kate Morton, Cristian Roman, Roisin Doogue, Cathy Rice, Marney Williams, Claire Schwartz, Carmelo Velardo, Lionel Tarassenko, Lucy Yardley, Richard J. McManus, Lisa Hinton

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Background: Having a stroke or transient ischaemic attack increases the risk of a subsequent one, especially with high blood pressure (BP). Home-based BP management can be effective at maintaining optimal BP. Objective: To describe the optimization of a digital intervention for stroke patients and the value of participant diversity, using the person-based approach (PBA) and integral patient and public involvement (PPI). Setting and participants: Stroke patients recruited from primary care and community settings, and health-care professionals in primary care, in England and Ireland. Design: Three linked qualitative studies conducted iteratively to develop an intervention using the PBA, with integral PPI. Intervention: The BP: Together intervention, adapted from existing BP self-monitoring interventions, is delivered via mobile phone or web interface to support self-monitoring of BP at home. It alerts patients and their clinicians when a change in antihypertensive medication is needed. Findings: Feedback from a diverse range of participants identified potential barriers, which were addressed to improve the intervention accessibility, feasibility and persuasiveness. Easy-to-read materials were developed to improve usability for patients with aphasia and lower literacy. The importance of including family members who support patient care was also highlighted. Feedback messages regarding medication change were refined to ensure usefulness for patients and clinicians. Discussion: Input from PPI alongside qualitative research with a diverse study sample allowed the creation of a simple and equitable BP management intervention for stroke patients. Patient involvement: Two PPI co-investigators contributed to design, conduct of study, data interpretation and manuscript preparation; community PPI sessions informed early planning. Study participants were stroke patients and family members.

Original languageEnglish
Number of pages14
JournalHealth Expectations
Publication statusPublished - 14 Dec 2020

Bibliographical note

Funding Information:
Lucy Yardley is NIHR Senior Investigator, and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)‐West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). Richard McManus is NIHR Senior Investigator and is partly supported by NIHR Applied Research Collaboration (ARC)‐Oxford and Thames Valley.

Publisher Copyright:
© 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd

Copyright 2020 Elsevier B.V., All rights reserved.

Funding information: This study was part of a programme of work commissioned by the Stroke Association and British Heart Foundation (TSA BHF 2018‐01). The planned trial to test the BP:Together intervention was paused in March 2020 due to the risk of COVID‐19 for participants and closed down in October 2020 following withdrawal of funding due to on‐going coronavirus restrictions. Initial feasibility data from that trial will be published separately in due course.

Structured keywords

  • Physical and Mental Health


  • blood pressure
  • community-based recruitment
  • digital health
  • hypertension
  • patient and public involvement
  • person-based approach
  • qualitative research
  • seldom-heard groups
  • self-monitoring
  • stroke

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