"I wasn't interested until I actually had that consultation": Exploring the acceptability of a community pharmacy-based hypertension visualisation intervention.

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. [ABSTRACT FROM AUTHOR]