Implementation of Chronic Disease Management Programme (CHAMP) for self-monitoring of hypertension: Protocol for 3 interlinked implementation studies (Preprint)
Authors: Martinengo Laura , Ha Ngoc Huong Lien , Tay Eugene , Tong Shao Chuen , Sevdalis Nick 
Published: February 2025

BACKGROUND

Hypertension affects 31% of the global adult population. AI-based chatbots may support self-management of hypertension and other chronic disorders. CHAMP (CHronic diseAse Management Program) is a digital health intervention to support chronic disease self-management, that consists of a patient-facing chatbot and an AI-augmented Clinical Decision Support System, linked to electronic medical records.

OBJECTIVE

This project aims to optimize the deployment of CHAMP across primary care centers by developing implementation strategies and pilot-testing their appropriateness and effectiveness.

METHODS

We report 3 interlinked studies: (1) Rapid overview of reviews to evaluate the factors influencing the implementation of mHealth and chatbot interventions in healthcare settings, and the strategies and processes used to implement them. We will follow Cochrane’s methodology for rapid reviews. We will use the Consolidated Framework for Implementation Research (CFIR) and the Unified Theory of Acceptance and Use of Technology (UTAUT) frameworks to analyze the data. (2) Formative, multi-method, qualitative study, to inform the state of CHAMP deployment to date, the organizational structure of primary care centers, and the barriers and facilitators influencing the implementation and scale up of CHAMP in primary care centers. We will interview members of the CHAMP development and initial implementation team, healthcare providers, primary care centers leadership and patients who are using, and not using CHAMP; and conduct 1-day onsite visits to primary care centers. The findings from these studies and the overview of reviews will inform a process map to outline the patient journey and map the barriers and facilitators influencing the implementation of CHAMP. (3) Development of a set of implementation strategies to effectively implement CHAMP using the Expert Recommendations for Implementing Change (ERIC) taxonomy to define the implementation strategies, and the Action, Actor, Context, Target, Time (AACTT) framework to define the strategy implementation processes. We will also assess the readiness for change of the healthcare providers and leadership working in the primary care centers, and, leveraging behavioral science, we will test variations of the chatbot’s messages to increase patient engagement with the chatbot.

RESULTS

To date, the overview of reviews (Study 1) protocol has been registered in PROSPERO, we have completed the screening of title and abstracts and are currently in the full-text screening phase. For Study 2, we obtained ethics approval and conducted the semi-structured interviews with healthcare providers, primary care centers leadership and members of the CHAMP development and initial implementation team. We are awaiting IRB approval to start the interviews with patients.

CONCLUSIONS

The results from these studies will inform the further implementation and scale up of CHAMP across primary care centers in Singapore. The successful implementation of digital health interventions to support self-management of chronic disorders may improve healthcare delivery without further straining healthcare systems.

CLINICALTRIAL

The rapid overview of reviews has been registered in PROSPERO (CRD42024613653) on 2 December 2024.