“I wasn’t interested until I actually had that consultation”: Exploring the acceptability of a community pharmacy-based hypertension visualisation intervention
Authors: Brown S , Khan I , Angel P , Hallingberg B , McRae D , McDonnell B , James D H 
Published: November 2023

Abstract

Introduction
Hypertension affects around 30% of the UK population and is the leading modifiable cause of cardiovascular disease1. Despite available evidence-based treatments, nonadherence to antihypertensive medication is prevalent. Health psychology theory suggests that beliefs about a condition and its treatment influence health-related behaviours such as medication adherence through the formation of ‘illness representations’, a lay perception of the health threat. Accurate illness representations and an increased belief in the necessity for medication are associated with greater medication adherence2. Visualisation of the internal process of an illness has been shown to support the accuracy of illness representations3.
ViSTA-BP (Visualisation to Support Treatment Adherence for High Blood Pressure) is a digital intervention used within a healthcare consultation, enabling individuals to visualise and conceptualise hypertension and the resulting changes to the circulatory system using real-time animations. The purpose is to support medication adherence through the improved understanding of hypertension and increased perception of medication necessity.

Aim
To explore the acceptability of a community pharmacy-based hypertension visualisation intervention (ViSTA-BP) with community pharmacists and patients.

Methods
Acceptability of ViSTA-BP was investigated in a community pharmacy setting in South Wales by conducting semi-structured qualitative interviews with pharmacists and patients. Ethical approval was granted by NHS Research Ethics Committee Wales (REC) 5 (20/WA/0280) and Cardiff Metropolitan University Ethics Committee (PGR-3806). Template analysis, a form of qualitative thematic analysis, was used to guide data interpretation. The Theoretical Framework of Acceptability (TFA) provided a lens through which to investigate acceptability, considering affective attitude towards the intervention burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness and self-efficacy.
Patients were purposely selected, incorporating a range of locations, adherence and treatment beliefs, thus minimising bias.

Results
Interviews were conducted with fifteen patients and eight pharmacists who provided feedback.
Both groups demonstrated a positive attitude towards ViSTA-BP. Patients were both interested in and reassured by the intervention. They showed good intervention coherence, articulating an increased understanding of hypertension and suggesting patient groups that could benefit from ViSTA-BP. Pharmacists felt ViSTA-BP illustrated the necessity for medication, demonstrating that hypertension could be managed effectively. Patients and pharmacists were positive about ViSTA-BP’s potential for effectiveness. Patients felt it provided context for their understanding of hypertension and could prompt action. Pharmacists liked the visual elements, with ViSTA-BP providing a useful addition to their consultation ‘toolkit’.
Patients felt that ViSTA-BP fits well within a community pharmacy setting. Intervention accessibility and facilitator knowledge were key; patients found the intervention duration acceptable. Pharmacists felt that ViSTA-BP fits within their current practice. However, the evolving role of the community pharmacy workforce and time pressures from competing workloads created uncertainty regarding the future feasibility of ViSTA-BP within this setting.

Discussion/Conclusion
Both patients and pharmacists were positive about ViSTA-BP, acknowledging the potential effectiveness of the personalised interactive visual to engage the viewer and conceptualise hypertension through visual-based communication. However, pharmacists’ perceptions of future roles supported by the community pharmacy contractual framework in Wales and staff time constraints provide potential barriers to future implementation.

References
1. McDonnell BJ, Rees E, Cockcroft JR, Beaney T, Clayton B, Kieu P Le, et al. May Measurement Month 2019: an analysis of blood pressure screening results from the United Kingdom and Republic of Ireland. Eur Hear Journal, Suppl. 2021;23(supplement B):B147–50.
2. Hagger MS, Orbell S. The common sense model of illness self-regulation: a conceptual review and proposed extended model. Health Psychol Rev [Internet]. 2022;16(3):347–77. Available from: https://doi.org/10.1080/17437199.2021.1878050
3. Jones ASK, Ellis CJ, Nash M, Stanfield B, Broadbent E. Using Animation to Improve Recovery from Acute Coronary Syndrome: A Randomized Trial. Ann Behav Med. 2016 Feb 1;50(1):108–18.