Behaviour change strategies for reducing blood pressure-related disease burden: findings from a global implementation research programme

Published in Implementation Science, v. 10(1)158 
Authors

Peiris, D., Thompson, S.R., Beratarrechea, A., Cárdenas, M.K., Diez-Canseco, F., Goudge, J., Gyamfi, J., Kamano, J.H., Irazola, V., Johnson, C., Kengne, A.P., Keat, N.K., Miranda, J.J., Mohan, S., Mukasa, B., Ng, E., Nieuwlaat, R., Ogedegbe, O., Ovbiagele, B., Plange-Rhule, J., Praveen, D., Salam, A., Thorogood, M., Thrift, A.G., Vedanthan, R., Waddy, S.P., Webster, J., Webster, R., Yeates, K. and Yusoff, K.
Publication year 2015
DOI https://doi.org/10.1186/s13012-015-0331-0
Affiliations
  • The George Institute for Global Health, The University of Sydney, Sydney, Australia
  • UCL Institute for Global Health, London, UK
  • Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina
  • Universidad Peruana Cayetano Heredia, Lima, Peru
  • Universidad Peruana Cayetano Heredia, Lima, Peru
  • University of the Witwatersrand, Johannesburg, South Africa
  • New York University School of Medicine, New York, USA
  • Moi University, Eldoret, Kenya
  • Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina
  • The George Institute for Global Health, The University of Sydney, Sydney, Australia
  • South African Medical Research Council, Cape Town, South Africa
  • Universiti Teknologi Mara, Selangor, Malaysia
  • Universidad Peruana Cayetano Heredia, Lima, Peru
  • Public Health Foundation of India, New Delhi, India
  • Mildmay Uganda, Lweza, Uganda
  • Population Health Research Institute, Hamilton, Canada
  • McMaster University, Hamilton, Canada
  • New York University School of Medicine, New York, USA
  • Medical University of South Carolina, Charleston, USA
  • Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • The George Institute for Global Health, New Delhi, India
  • The George Institute for Global Health, New Delhi, India
  • University of Warwick, Coventry, UK, University of the Witwatersrand, Johannesburg, South Africa
  • School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
  • Icahn School of Medicine at Mount Sinai, New York, USA
  • National Institutes of Health, Bethesda, USA
  • The George Institute for Global Health, The University of Sydney, Sydney, Australia
  • The George Institute for Global Health, The University of Sydney, Sydney, Australia
  • Queen&rsquos University School of Medicine, Kingston, Canada
  • Universiti Teknologi Mara, Selangor, Malaysia
IAI Program

CRN3
IAI Project CRN3036
Keywords
Implementation science
Hypertension
Behaviour change theory
Collaborative research
Low- and middle-income countries

Abstract

  • Background

The Global Alliance for Chronic Diseases comprises the majority of the world&rsquos public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects.

  • Methods

Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings.

  • Results

There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation.

  • Conclusions

The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.