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Peng G, Yan F, Sun R, Zhang Y, Zhao R, Zhang G, Qiao P, Ma Y, Han L. Self-management behavior strategy based on behavioral economics in patients with hypertension: a scoping review. Transl Behav Med 2024; 14:405-416. [PMID: 38776869 DOI: 10.1093/tbm/ibae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Hypertensive patients often do not make the most favorable choices and behaviors for managing disease. Behavioral economics strategies offer new ideas for guiding patients toward health behavior. The scoping review aimed to summarize behavioral economics strategies designed to improve hypertension self-management behaviors. A literature search was conducted in September 2022 using the following electronic databases: Embase, Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, CNKI, Wan Fang Database for Chinese Periodicals, and CBM-SinoMed. We screened the literature for experimental studies written in Chinese or English reporting on BE strategies designed to improve self-management behavior in hypertension. We searched 17 820 records and included 18 articles in the final scoping review. We performed qualitative synthesis by the categories of choice architecture. The most common BE strategies were those targeting decision information and decision assistance, such as changing the presentation of information, making information visible, and providing reminders for actions. Most strategies targeted BP, diet, medication adherence, and physical activity behavior. Ten out of 18 studies reported statistically significant improvement in self-management behavior. Further research on BE strategies should focus on addressing the challenges, including changing the decision structure, encompassing a more comprehensive range of target behaviors, and examining the long-term effects of BE strategies.
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Affiliation(s)
- Guotian Peng
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fanghong Yan
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Internal Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Ruiyi Sun
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yanan Zhang
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Rongrong Zhao
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Guoli Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Pengyu Qiao
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Internal Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Lin Han
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Internal Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
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Soltani D, Azizi B, Behnoush AH, Meysamie A, Aein A, Nayebirad S, Vasheghani-Farahani A, Akbari Sari A. Is lifestyle modification with individual face-to-face education and counseling more effective than usual care for controlling hypertension? A systematic review and meta-analysis of randomized controlled trials. HEALTH EDUCATION RESEARCH 2023; 38:490-512. [PMID: 37450326 DOI: 10.1093/her/cyad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 06/05/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
Hypertension (HTN) management continues to be a concern due to challenges with behavioral risk factors. Patient education to modify unhealthy behaviors appears to be effective in managing HTN. Therefore, this meta-analysis aimed to determine whether individualized face-to-face education and counseling have a beneficial effect on systolic and diastolic blood pressure (SBP and DBP) in hypertensive patients. Studies were extracted from PubMed, Scopus, Cochrane Library, and Web of Science databases. Nine studies, comprising 2627 participants, were included. Random effects models were used to pool estimates of mean differences (MDs) with 95% confidence intervals (CIs) in SBP and DBP between the intervention and usual care groups. SBP and DBP were significantly reduced at the 6-month (MD = -4.38 mmHg, 95% CI: -6.95 to -1.81; MD = -2.09 mmHg, 95% CI: -3.69 to -0.50, respectively) and 12-month time points (MD = -2.48 mmHg, 95% CI: -3.96 to -1.01; MD = -1.71 mmHg, 95% CI: -2.88 to -0.55, respectively) with intervention. At the 24-month time point, there was a significant change in SBP (MD = -2.13 mmHg, 95% CI: -3.94 to -0.32) with intervention compared with the usual care group. This study showed that individualized face-to-face education and counseling add significant benefits to usual care for lowering blood pressure in hypertensive patients. Graphical Abstract.
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Affiliation(s)
- Danesh Soltani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran
| | - Bayan Azizi
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran
| | - Amir Hossein Behnoush
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad, Hwy, Tehran 1411713138, Iran
| | - Alipasha Meysamie
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran
- Department of Preventive and Community Medicine, Tehran University of Medical Sciences, Pour Sina St, Tehran 1461884513, Iran
| | - Afsaneh Aein
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran
| | - Sepehr Nayebirad
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Avenue, Tehran 1411713138, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Pour Sina St, Tehran 1461884513, Iran
- National Institute of Health Research, Tehran University of Medical Sciences, Bozorgmehr St., Tehran 1461884513, Iran
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Innab A, Kerari A, Alqahtani N, Albloushi M, Alshammari A. Patient activation, adherence to hypertension treatment plans and blood pressure control in Saudi Arabia: a cross-sectional study. BMJ Open 2023; 13:e067862. [PMID: 36697049 PMCID: PMC9884875 DOI: 10.1136/bmjopen-2022-067862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To explore the relationship between patient activation, adherence to hypertension treatment plans, blood pressure control and other important demographic factors. DESIGN A cross-sectional study. SETTING Primary healthcare centres in Riyadh province, Saudi Arabia. PARTICIPANTS A total of 114 adults with hypertension, including 68 men and 46 women. OUTCOME MEASUREMENTS Blood pressure control is achieved if (a) patients under 80 years of age with treated hypertension have blood pressure under 140/90 mm Hg or (b) patients aged 80 years or over with treated hypertension have blood pressure under 150/90 mm Hg. Secondary outcomes included patient activation, adherence to hypertension treatment plans and demographic factors (age, gender, education, income and comorbidity). Data were analysed using Pearson's correlation and multiple regression models. RESULTS 57% (n=66) of participants did not achieve the ideal blood pressure target. Perfect adherence to hypertension treatment plans was significantly associated with lower systolic (r=-0.38, p<0.01) and diastolic blood pressure (r=-0.50, p<0.01). Age was significantly correlated with patient activation (r=-0.20, p<0.05) and diastolic blood pressure (r=-0.33, p<0.01). There was no statistically significant association between Patient Activation Measure, systolic blood pressure and diastolic blood pressure. In the hierarchical regression analysis, adherence to hypertension treatment plans was found to be a significant predictor and explained 15% of the variance in systolic blood pressure (β=-0.36, p<0.001) and 26% of the variance in diastolic blood pressure (β=-0.51, p<0.001). CONCLUSION The individual and family self-management theory can serve as an effective theory for understanding the key factors in achieving ideal blood pressure target. The majority of patients with hypertension reported lower levels of activation and poor blood pressure control. Inadequate adherence to treatment plans was related to poor blood pressure control. This work is pivotal in devising self-management interventions to assist patients in the management of hypertension disease, especially in Saudi Arabia.
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Affiliation(s)
- Adnan Innab
- Nursing Administration and Education Department, King Saud University, Riyadh, Saudi Arabia
| | - Ali Kerari
- Medical Surgical Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Naji Alqahtani
- Nursing Administration and Education Department, King Saud University, Riyadh, Saudi Arabia
| | - Monirah Albloushi
- Medical Surgical Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Alkadi Alshammari
- Community, Psychiatric and Mental Health Nursing, King Saud University, Riyadh, Saudi Arabia
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Merriel A, Wilson A, Decker E, Hussein J, Larkin M, Barnard K, O'Dair M, Costello A, Malata A, Coomarasamy A. Systematic review and narrative synthesis of the impact of Appreciative Inquiry in healthcare. BMJ Open Qual 2022; 11:e001911. [PMID: 35710130 PMCID: PMC9204436 DOI: 10.1136/bmjoq-2022-001911] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/31/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Appreciative Inquiry is a motivational, organisational change intervention, which can be used to improve the quality and safety of healthcare. It encourages organisations to focus on the positive and investigate the best of 'what is' before thinking of 'what might be', deciding 'what should be' and experiencing 'what can be'. Its effects in healthcare are poorly understood. This review seeks to evaluate whether Appreciative Inquiry can improve healthcare. METHODS Major electronic databases and grey literature were searched. Two authors identified reports of Appreciative Inquiry in clinical settings by screening study titles, abstracts and full texts. Data extraction, in duplicate, grouped outcomes into an adapted Kirkpatrick model: participant reaction, attitudes, knowledge/skills, behaviour change, organisational change and patient outcomes. RESULTS We included 33 studies. One randomised controlled trial, 9 controlled observational studies, 4 qualitative studies and 19 non-controlled observational reports. Study quality was generally poor, with most having significant risk of bias. Studies report that Appreciative Inquiry impacts outcomes at all Kirkpatrick levels. Participant reaction was positive in the 16 studies reporting it. Attitudes changed in the seventeen studies that reported them. Knowledge/skills changed in the 14 studies that reported it, although in one it was not universal. Behaviour change occurred in 12 of the 13 studies reporting it. Organisational change occurred in all 23 studies that reported it. Patient outcomes were reported in eight studies, six of which reported positive changes and two of which showed no change. CONCLUSION There is minimal empirical evidence to support the effectiveness of Appreciative Inquiry in improving healthcare. However, the qualitative and observational evidence suggests that Appreciative Inquiry may have a positive impact on clinical care, leading to improved patient and organisational outcomes. It is, therefore, worthy of consideration when trying to deliver improvements in care. However, high-quality studies are needed to prove its effects. PROSPERO REGISTRATION NUMBER CRD42015014485.
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Affiliation(s)
- Abi Merriel
- Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amie Wilson
- Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Emily Decker
- Royal Manchester Children's Hospital, Manchester, UK
| | - Julia Hussein
- Independent Maternal Health Consultant, Aberdeen, UK
| | - Michael Larkin
- Department of Psychology, Aston University, Birmingham, Birmingham, UK
| | | | - Millie O'Dair
- Bristol Medical School, University of Bristol, Bristol, Bristol, UK
| | | | - Address Malata
- Malawi University of Science and Technology, Limbe, Southern Region, Malawi
| | - Arri Coomarasamy
- Institute for Metabolism and Systems Research University of Birmingham, Birmingham, UK
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Psychometric Analysis of Hypertension Self-Management Behaviors Questionnaire; an Application of Intervention Mapping Approach in Questionnaire Development. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.4.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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