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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