A behavior change wheel-based interactive pictorial health education program for hypertensive patients with low blood pressure health literacy: study protocol for a randomized controlled trial

Wei Gan, Qinghua Zhang, Dan Yang, Jinyu Yin, Yujie Wang, Li Song, Ting Chen, Huan Qi, Wei Gan, Qinghua Zhang, Dan Yang, Jinyu Yin, Yujie Wang, Li Song, Ting Chen, Huan Qi

Abstract

Background: The prevalence of hypertension is increasing worldwide. Hypertension self-management usually involves the application and consideration of oral, written, or quantitative information. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL), which may lead to poorer clinical outcomes. This study aims to determine the feasibility and effectiveness of an interactive pictorial health education program based on behavior change wheel (BCW) theory and its effect on HBP-HL, self-efficacy, self-management ability, and health-related quality of life (HRQOL) in hypertensive patients with low HBP-HL.

Methods: This study is a randomized controlled trial (RCT). One of the municipal districts in Huzhou, China, will be randomly selected, and two communities with similar conditions within this district will be screened and selected. A total of 120 hypertensive patients aged 18 years and older will be recruited from these two community settings. One of the communities will be randomly allocated to an interactive pictorial health education program conducted by a comprehensive health literacy strategy that includes (i) training participants in effective health communication skills that address issues encountered in seeking medical care and (ii) the use of self-developed interactive pictorial hypertension education to improve patient understanding and behaviors versus a control group (routine community lecture health education only). The primary outcome measure is HBP-HL. Secondary outcomes are self-efficacy, self-management ability, HRQOL, social support, and improvement in blood pressure. Outcomes will be collected at 6, 9, and 12 months from trial entry.

Discussion: The strengths of this study are the establishment of a new health management program for hypertensive patients that closely combines BCW theory and health literacy. This trial has the potential to improve HBP-HL in hypertensive Chinese patients with low health literacy to improve the self-management of hypertension and help control blood pressure.

Trial registration: Clinical Trials.gov Protocol Registration and Results System ID NCT04327102 . Prospectively registered on February 29, 2020.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The behavior change wheel consists of three layers. The center layer is composed of the Capability, Opportunity, and Motivation model. The second layer is composed of nine intervention functions which are the general methods by which interventions might change behavior. Examples are “education” and “persuasion.” The topmost layer of the wheel itemizes the policy categories that can be used to support the implement of these functions
Fig. 2
Fig. 2
Overview of the study procedure

References

    1. Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386(10010):2287–2323. doi: 10.1016/S0140-6736(15)00128-2.
    1. Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet (London, England). 2018;392(10159):1923–94.
    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528. doi: 10.1161/CIR.0000000000000659.
    1. Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, et al. Status of hypertension in China: results from the China hypertension survey, 2012-2015. Circulation. 2018;137(22):2344–2356. doi: 10.1161/CIRCULATIONAHA.117.032380.
    1. Yao Q, Liu C, Zhang Y, Xu L. Health-related quality of life of people with self-reported hypertension: a national cross-sectional survey in China. Int J Environ Res Public Health. 2019;16(10):1721.
    1. Naimi AJ, Naderiravesh N, Bayat ZS, Shakeri N, Matbouei M. Correlation between health literacy and health-related quality of life in patients with hypertension, in Tehran, Iran, 2015-2016. Electron Physician. 2017;9(11):5712–5720. doi: 10.19082/5712.
    1. Wang C, Lang J, Xuan L, Li X, Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health. 2017;16(1):58. doi: 10.1186/s12939-017-0551-9.
    1. Park NH, Song MS, Shin SY, Jeong JH, Lee HY. The effects of medication adherence and health literacy on health-related quality of life in older people with hypertension. Int J Older People Nursing. 2018;13(3):e12196. doi: 10.1111/opn.12196.
    1. Sperber NR, Bosworth HB, Coffman CJ, Lindquist JH, Oddone EZ, Weinberger M, et al. Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy. Health Educ Res. 2013;28(3):502–511. doi: 10.1093/her/cyt043.
    1. McNaughton CD, Jacobson TA, Kripalani S. Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease. Patient Educ Couns. 2014;96(2):165–170. doi: 10.1016/j.pec.2014.05.007.
    1. Pandit AU, Tang JW, Bailey SC, Davis TC, Bocchini MV, Persell SD, et al. Education, literacy, and health: mediating effects on hypertension knowledge and control. Patient Educ Couns. 2009;75(3):381–385. doi: 10.1016/j.pec.2009.04.006.
    1. Speros C. Health literacy: concept analysis. J Adv Nurs. 2005;50(6):633–640. doi: 10.1111/j.1365-2648.2005.03448.x.
    1. Nutbeam D. The evolving concept of health literacy [J] Soc Sci Med. 2008;67(12):2072–2078. doi: 10.1016/j.socscimed.2008.09.050.
    1. Liu YY, Li YH, Li L, et al. Study on chronic diseases literacy and its influenceing factors in China from 2012 to 2017[J] Chinese J Health Educ. 2019;35(11):967–972.
    1. Liu H, Xu SY, Wang L, et al. The health literacy and influencing factor of hypertension patients (15-69years old) in Zhejiang province. Chinese J Prev Contr Chron Dis. 2016;24(05):343–347.
    1. Lin SC, Chen IJ, Yu WR, Lee SD, Tsai TI. Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: a quasi-experimental study. Geriatr Nurs. 2019;40(5):494–501. doi: 10.1016/j.gerinurse.2019.03.013.
    1. Fawns-Ritchie C, Starr JM, Deary IJ. Role of cognitive ability in the association between functional health literacy and mortality in the Lothian birth cohort 1936: a prospective cohort study. BMJ Open. 2018;8(9):e022502. doi: 10.1136/bmjopen-2018-022502.
    1. Hossain WA, Ehtesham MW, Salzman GA, Jenson R, Calkins CF. Healthcare access and disparities in chronic medical conditions in urban populations. South Med J. 2013;106(4):246–254. doi: 10.1097/SMJ.0b013e31828aef37.
    1. Shibuya A, Inoue R, Ohkubo T, Takeda Y, Teshima T, Imai Y, et al. The relation between health literacy, hypertension knowledge, and blood pressure among middle-aged Japanese adults. Blood Press Monit. 2011;16(5):224–230. doi: 10.1097/MBP.0b013e32834af7ba.
    1. Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19(12):1228–1239. doi: 10.1111/j.1525-1497.2004.40153.x.
    1. Pleasant A. Advancing health literacy measurement: a pathway to better health and health system performance. J Health Commun. 2014;19(12):1481–1496. doi: 10.1080/10810730.2014.954083.
    1. Hill SJ, Sofra TA. How could health information be improved? Recommended actions from the Victorian consultation on health literacy. Aust Health Rev. 2018;42:134–139. doi: 10.1071/AH16106.
    1. Pignone M, DeWalt DA, Sheridan S, Berkman N, Lohr KN. Interventions to improve health outcomes for patients with low literacy. A systematic review. J Gen Intern Med. 2005;20(2):185–192. doi: 10.1111/j.1525-1497.2005.40208.x.
    1. Chinenye S, Young EE. Diabetes conversation map in Nigeria: a new socioeducational tool in diabetes care. Indian J Endocrinol Metab Diabetes S Afr. 2013;17(6):1009–1011. doi: 10.4103/2230-8210.122613.
    1. Duncan CL, Walker HA, Brabson L, Williford DN, Hynes L, Hogan MB. Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: a qualitative study. J Asthma. 2018;55:915–923. doi: 10.1080/02770903.2017.1371743.
    1. Hall JF, Crocker TF, Clarke DJ, Forster A. Supporting carers of stroke survivors to reduce carer burden: development of the preparing is caring intervention using intervention mapping. BMC Public Health. 2019;19(1):1408. doi: 10.1186/s12889-019-7615-2.
    1. Banbury A, Nancarrow S, Dart J, Gray L, Dodson S, Osborne R, et al. Adding value to remote monitoring: co-design of a health literacy intervention for older people with chronic disease delivered by telehealth - the telehealth literacy project. Patient Educ Couns. 2020;103(3):597–606. doi: 10.1016/j.pec.2019.10.005.
    1. Halladay JR, Donahue KE, Cené CW, Li Q, Cummings DM, Hinderliter AL, et al. The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: the heart healthy Lenoir trial. Patient Educ Couns. 2017;100(3):542–549. doi: 10.1016/j.pec.2016.10.015.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. doi: 10.1186/1748-5908-6-42.
    1. Zhang Q, Huang F, Liu Z, Zhang N, Mahapatra T, Tang W, et al. Cross-cultural validation of the high blood pressure health literacy scale in a Chinese community. PLoS One. 2016;11(4):e0152182. doi: 10.1371/journal.pone.0152182.
    1. Zhao Q, Liu X. Reliability and validity of the hypertension patients self-management behavior rating scale. Chinese Nurs Manage. 2012;12(11):26–31.
    1. Li L, Wang HM, Shen Y. Chinese SF-36 health survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health. 2003;57(4):259–263. doi: 10.1136/jech.57.4.259.
    1. Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care. 2006;44(11):964–971. doi: 10.1097/01.mlr.0000233678.80203.c1.
    1. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multi-dimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41. doi: 10.1207/s15327752jpa5201_2.
    1. Bei-Fan Z. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults–study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2015;11(1):S685–S693.
    1. WHO Expert Consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–163. doi: 10.1016/S0140-6736(03)15268-3.
    1. Bodner TE. What improves with increased missing data imputations? Struct Equ Model Multidiscip J. 2008;15(4):651–675. doi: 10.1080/10705510802339072.

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