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Abstract

High blood pressure (HBP) is a chronic, multifactorial condition thought to affect 10-25% of the UK population. Two of its complications, heart disease and stroke, are among the highest causes of mortality and morbidity in developed and, increasingly, developing countries. Yet, poorly understood and asymptomatic, HBP has proved easy to ignore and remains under-diagnosed and sub-optimally managed.

Responsibility for managing BP is a debated issue. Underpinning this project is the concept of individual responsibility to actively participate in one's own health care. For people with HBP this involves permanent lifestyle modification, often combined with adherence to medication. The behaviour changes required for optimal self-care depend on the knowledge and motivation to sustain a perceived decline in quality of life in the absence of the clear rewards which a condition with alleviated symptoms would offer. The current overall picture is of poor adherence to BP-lowering behaviours and routines. Nevertheless, these behaviours are crucial to reducing BP and achieving healthy longevity - as such, their promotion is the aim of this project.

The emergence in recent years of the Web as a mass medium has brought with it opportunities for health promotion initiatives. As a one-to-many mode of communication, it offers a cost-effective way to maximise the scope of interventions while uniting an unprecedented number of different media. Despite this favourable channel, delivery of information about BP over the Web is fraught with pitfalls and, as reviewed in this project, its enormous potential has yet to be achieved.

The project began with the conception of a development methodology, and this was followed by a review of the medical and social aspects of HBP. A review tool was developed to evaluate existing HBP resources on the Web, an exercise which informed the approaches adopted and avoided in the project, and which continued for its duration to accommodate emerging resources. The climate for introducing a Web-based information resource for HBP was investigated through a review of Internet and computer use and a profile of the target user group. Meanwhile a framework for a BP information package was produced on the basis of findings from a survey of Camden and Islington health professionals, observation at a hypertension clinic and general practice surgery, and interviews with patients and practice nurses. This framework was submitted as a concept diagram for online validation by a group of general practitioners, after which the development of content began. Content was produced in a variety of media as appropriate to the subject material. A series of prototype cycles shaped a working version of the multimedia information package, named Pressure's Off, which was produced for the Web. This working version was validated by five health professionals, after which recruitment for a formative evaluation was carried in a hypertension clinic. The evaluation involved six participants, from whom structured feedback on selected sections of Pressure's Off was collected via observation and recorded interview. Recordings and field notes were transcribed, coded, and analysed for themes, and findings from this process fell into two categories. The first discussed responses and revision recommendations for each section, and the second explored contributions which offered valuable insight into the concerns of people using the Web to find information about HBP. Findings from the evaluation were considered in the context of the overall project process to generate conclusions and identify opportunities for future work.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RZ Other systems of medicine
Departments:	School of Health & Psychological Sciences > Healthcare Services Research & Management School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses Doctoral Theses

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