Skip to main content

Table 4 Summary of the relationships between hypertension symptoms, beliefs about hypertension and its treatment and potential mediating relationships identified within the literature searches to inform the logic model development

From: Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach

Symptom perception (illness identity) Beliefs about hypertension Beliefs about treatment/medication Potential mediating relationship with self-management
No hypertension symptoms • Less serious consequences, less concern, lower personal and treatment efficacy • Treatment is not necessary
• Medication signifies ill health
• Benefit of taking medication, or the health risk of non-adherence, may not be immediately noticeable in the short term
• Objective BP readings may provide convincing evidence for the necessity of medication adherence
• Medication acceptance is more likely when a clear benefit or rationale for anti-hypertensive medication is presented
Temporary increases in BP (fluctuating symptoms) • High BP is perceived as separate to hypertension and occurring as a result of temporary modifiable factors such as stress or over-exertion • Treatment only necessary when experiencing symptoms (i.e. to alleviate stress or to rest) • BP monitoring would demonstrate that perceived fluctuations in symptoms are not a reliable indicator of when management is appropriate
• Reductions in BP linked to appropriate self-management behaviours
Perception of hypertension-related symptoms (strong illness identity) • High perceived consequences and emotional response to illness • Poor medication adherence if a reduction in perceived symptoms are not observed in line with adherence behaviour • Self-monitoring over extended periods (i.e. 7 days per week each month) may be important in decoupling perceived symptom experience from treatment beliefs
• Feeling better and the perceived benefits of anti-hypertensive medication were identified as reasons to take anti-hypertensive medication