'In the end, I'm the one who has to do the job': Participant experience of a lifestyle intervention for patients with hypertension.

ABSTRACT

OBJECTIVE: Cardiovascular disease can be prevented through lifestyle changes, but such changes are often hard to attain. Text message interventions with lifestyle advice have shown small but promising effects. Our objective was to explore participant experience of a text message lifestyle intervention for patients with hypertension, and implications for future lifestyle interventions. DESIGN AND SUBJECTS: Fourteen participants were purposefully selected for telephone interviews after completion of a text message lifestyle intervention. A semi-structured interview guide with open-ended questions was used. Interviews were recorded and transcribed verbatim. The material was analyzed through systematic text condensation as described by Malterud, a data-driven analysis style that includes deductive elements. SETTING: Primary care in three regions in southern Sweden. RESULTS: The analysis resulted in three themes. 'Blood pressure and lifestyle, how seriously to take it?' revealed a remaining need for knowledge regarding to what extent lifestyle affects risk for cardiovascular disease. 'The text messages - a useful reminder in need of tailoring' described that the design of the intervention was satisfactory, but suggested improvements through increased individualization. Finally, 'Water off a duck's back or a kick in the pants - when does behavior change?' showed how some participants responded to the push to change while others did not, supplying material for further analysis in a framework of behavioral change theory. CONCLUSION: A key to adoption was advice that was applicable in daily life. Timing in relation to a diagnosis of hypertension or other motivational factors, and tailoring to prior knowledge, habits, and limitations could increase effectiveness.

Text message interventions with lifestyle advice for hypertension and cardiovascular disease have shown small effects, but effectiveness may be improved.Our qualitative analysis of patient experience revealed a remaining need for increased knowledge regarding blood pressure, lifestyle, and cardiovascular disease.Text message advice that was applicable in daily life, or perceived as new, seemed most useful to facilitate lifestyle change.Timing in relation to motivational factors and tailoring to individual habits and limitations could increase effectiveness of similar interventions.