Table 7 Triangulation outcomes from integrating quantitative and qualitative data

Prescribers’ and supporters’ post-training questionnaires showed positive outcome expectancies and high confidence in intervention acceptability.

Practitioners perceived the digital intervention as a more accurate way of managing blood pressure and as being in line with the direction of Primary Care.

Partial agreement (complementary findings)

No quantitative data were collected on setting up and integrating the digital intervention in normal practice.

Most practitioners considered that the programme was easy to integrate and described flexible approaches to organising the work.

Silence

Adherence to planning three medication escalations was high (82%).

Social cognitive beliefs and perceived acceptability of the intervention were not associated with adherence to planning medication escalations.

Whilst some prescribers perceived planning medication facilitated more comprehensive care, others described issues with planning in advance, including patient anxiety and additional effort when the plan needed revising.

Dissonance

Adherence to initiating medication escalations was moderate (53%).

Pre-planning medication escalations, self-efficacy beliefs and contextual patient factors such as average blood pressure reading and n of previous recommendations were related to adherence to initiating medication escalation.

Some prescribers believed that changing medication in response to recommendations was straightforward, but some reasons were discussed for not changing medication, including readings being close to the threshold, concerns about hypotension, and preferring to wait for more evidence.

Agreement

Adherence to remotely changing medication was fairly low (38%).

Prescribers described preferring real-time contact at the time of a medication escalation in order to ensure patients have understood, and to avoid the hassle of sending a letter.

Agreement

Adherence to sending patient support emails was moderate (56%).

Social cognitive beliefs and perceived acceptability of the intervention were not associated with adherence to sending patient support emails.

Perceptions about supporting patients by email were mixed. Positive feedback from patients about the emails seemed to promote the perceived value of email support for supporters.

Agreement

No quantitative adherence data were collected on using the CARE approach.

Supporters described a very low uptake to appointments by patients, so many had no experience of using CARE in practice. Hypothetical concerns included how to congratulate when patients’ progress was limited, and how to avoid giving advice when the patient expected it.

Silence