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Hallberg, Inger
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Publications (10 of 23) Show all publications
Bengtsson, U., Kjellgren, K., Hallberg, I., Manhem, K. & Taft, C. (2018). Links between blood pressure and life-style factors reported via a mobile phone-based self-management support system. In: : . Paper presented at 28th European Meeting on Hypertension and Cardiovascular Protection, Poster session, Barcelona, June 8-11, 2018. Wolters Kluwer, 36, Article ID e63.
Open this publication in new window or tab >>Links between blood pressure and life-style factors reported via a mobile phone-based self-management support system
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2018 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Objective: To explore relationships between patients’ self-monitoring of blood pressure and their concurrent self-reports of medication intake, wellbeing stress, physical activity and symptoms.

Design and method: This was a prospective study exploring the eight-week effectiveness of a mobile phone based self-management support system for patients with hypertension. 50 patients undergoing treatment for hypertension, from four primary health care centers situated in urban and suburban communities in Sweden, self-reported through the system once daily during eight weeks.

Scientific data: Associations between systolic and diastolic blood pressure and 10 self-report lifestyle-related variables.

Results: The single strongest association was found between medication intake and systolic blood pressure, where failure to take medications was associated with an estimated 7.44 mmHg higher systolic blood pressure. To a lesser degree, medication intake was also associated with diastolic blood pressure. Wellbeing and stress were consistently associated with systolic blood pressure and diastolic blood pressure, whereas physical activity was associated with only systolic blood pressure. None of the symptoms dizziness, headache, restlessness, fatigue or palpitations were significantly associated with blood pressure.

Conclusions: Blood pressure was associated with patients’ blood pressure management behaviors, eg drug intake and experiences of wellbeing and stress. No association was found between blood pressure and side effects. Enabling persons with hypertension to monitor and track their BP in relation to medication intake, symptoms and life-style variables may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-151713 (URN)10.1097/01.hjh.0000539137.18258.1e (DOI)000455593900185 ()
Conference
28th European Meeting on Hypertension and Cardiovascular Protection, Poster session, Barcelona, June 8-11, 2018
Available from: 2018-10-03 Created: 2018-10-03 Last updated: 2019-04-11Bibliographically approved
Taft, C., Hallberg, I., Bengtsson, U., Manhem, K. & Kjellgren, K. (2018). Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care. BMJ Open, 8(8), Article ID 020849.
Open this publication in new window or tab >>Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id 020849Article in journal (Refereed) Published
Abstract [en]

Objectives: To explore relationships between patients’ self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms.

Design: This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension.

Setting: Four primary healthcare centres situated in urban and suburban communities in Sweden.

Participants: 50 patients undergoing treatment for hypertension.

Primary and secondary outcome measures: Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling.

Results: Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70 mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms—dizziness, headache, restlessness, fatigue or palpitations—were significantly associated with BP.

Conclusions: Our findings that BP was associated with patients’ BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations.

Trial registration number NCT01510301; Pre-results.

Place, publisher, year, edition, pages
British Medical Journal Publishing Group, 2018
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-151712 (URN)10.1136/bmjopen-2017-020849 (DOI)000446470200051 ()
Note

Funding agencies: Gothenburg Centre for Person-Centred Care (GPCC) in Sweden; Swedish Governments grant for Strategic Research Areas, Care Sciences (Application to Swedish Research Council) [2009-1088]; University of Gothenburg, Sweden

Available from: 2018-10-03 Created: 2018-10-03 Last updated: 2018-10-30
Bengtsson, U., Kjellgren, K., Hallberg, I., Lundin, M. & Mäkitalo, Å. (2018). Patient contributions during primary care consultations for hypertension after self-reportingvia a mobile phone self-management support system. Scandinavian Journal of Primary Health Care, 36(1), 70-79
Open this publication in new window or tab >>Patient contributions during primary care consultations for hypertension after self-reportingvia a mobile phone self-management support system
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2018 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 1, p. 70-79Article in journal (Refereed) Published
Abstract [en]

Objective: This paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in followup consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. Design: A qualitative, explorative study design was used, examining 20 audio- (n ¼ 10) and video-recorded (n ¼ 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. Setting: Four primary health care centers in Sweden. Subjects: Patients with hypertension (n ¼ 20) and their health care professional (n ¼ 7). Results: The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Conclusion: Patients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management KEY POINTS The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations. Self-reporting combined with increased patient–health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life. These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-145428 (URN)10.1080/02813432.2018.1426144 (DOI)
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-03-09
Bengtsson, U., Kjellgren, K., Hallberg, I., Lindwall, M. & Taft, C. (2016). Improved blood pressure control using an interactive mobile phone support system. The Journal of Clinical Hypertension, 18(2), 101-108
Open this publication in new window or tab >>Improved blood pressure control using an interactive mobile phone support system
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2016 (English)In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 18, no 2, p. 101-108Article in journal (Refereed) Published
Abstract [en]

This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-124014 (URN)10.1111/jch.12682 (DOI)26456490 (PubMedID)
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2018-01-10
Hallberg, I., Ranerup, A. & Kjellgren, K. I. (2016). Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system. Journal of Human Hypertension, 30(2), 141-146
Open this publication in new window or tab >>Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system
2016 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 30, no 2, p. 141-146Article in journal (Refereed) Published
Abstract [en]

Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients’ experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.

Place, publisher, year, edition, pages
Nature Publishing Group, 2016
Keywords
Interface · Discontinuous coefficients problems · Initial boundary value problems · Well-posedness · Conservation · Stability · Interface conditions · High order accuracy · Summation-by-parts operators
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-121488 (URN)10.1038/jhh.2015.37 (DOI)000370448900012 ()25903164 (PubMedID)
Available from: 2015-09-22 Created: 2015-09-22 Last updated: 2017-12-04Bibliographically approved
Ranerup, A. & Hallberg, I. (2015). Actors and intentions in the development process of a mobile phone platform for self-management of hypertension. Informatics for Health and Social Care, 40(4), 299-318
Open this publication in new window or tab >>Actors and intentions in the development process of a mobile phone platform for self-management of hypertension
2015 (English)In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 40, no 4, p. 299-318Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to enhance the knowledge regarding actors and intentions in the development process of a mobile phone platform for self-management of hypertension. Methods: Our research approach was a 14-month longitudinal “real-time ethnography” method of description and analysis. Data were collected through focus groups with patients and providers, patient interviews, and design meetings with researchers and experts. The analysis was informed by the concepts of actors and inscriptions in actor-network theory (ANT). Results: Our study showed that laypersons, scientific actors, as well as technology itself, might influence development processes of support for self-management of hypertension. The intentions were inscribed into the technology design as well as the models of learning and treatment. Conclusions: The study highlighted important aspects of how actors and intentions feature in the development of the mobile phone platform to support self-management of hypertension. The study indicated the multifacetedness of the participating actors, including the prominent role of technology. The concrete results of such processes included questions in the self-report system, learning and treatment models.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
Keywords
Cellular phone, development process, hypertension, participatory design, self-management
National Category
Information Systems Nursing
Identifiers
urn:nbn:se:liu:diva-121490 (URN)10.3109/17538157.2014.924948 (DOI)
Available from: 2015-09-22 Created: 2015-09-22 Last updated: 2018-01-11Bibliographically approved
Bengtsson, U., Kjellgren, K., Hallberg, I., Lindwall, M. & Taft, C. (2014). Blood pressure decrease with a mobile phone-based system to support self-management. In: : . Paper presented at Joint Meeting ESH-ISH Hypertension, 13-16 June 2014, Athens, Greece.
Open this publication in new window or tab >>Blood pressure decrease with a mobile phone-based system to support self-management
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2014 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108435 (URN)
Conference
Joint Meeting ESH-ISH Hypertension, 13-16 June 2014, Athens, Greece
Available from: 2014-06-27 Created: 2014-06-27 Last updated: 2016-09-26
Hallberg, I., Taft, C., Ranerup, A., Bengtsson, U., Hoffman, M., Höfer, S., . . . Kjellgren, K. I. (2014). Phases in development of an interactive mobile phone-based system to support self-management of hypertension. Integrated Blood Pressure Control, 7, 19-28
Open this publication in new window or tab >>Phases in development of an interactive mobile phone-based system to support self-management of hypertension
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2014 (English)In: Integrated Blood Pressure Control, ISSN 1178-7104, E-ISSN 1178-7104, Vol. 7, p. 19-28Article in journal (Refereed) Published
Abstract [en]

Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%–50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.

Place, publisher, year, edition, pages
Dove Medical Press, 2014
Keywords
adherence, blood pressure, cellular phone, communication, devices, person-centered care
National Category
Cardiac and Cardiovascular Systems Medical Engineering
Identifiers
urn:nbn:se:liu:diva-106911 (URN)10.2147/IBPC.S59030 (DOI)2-s2.0-84900409226 (Scopus ID)
Available from: 2014-05-26 Created: 2014-05-26 Last updated: 2017-12-05Bibliographically approved
Bengtsson, U., Ring, L., Hallberg, I. & Kjellgren, K. (2013). Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers. In: : . Paper presented at XV Svenska Kardiovaskulära Vårmötet, 17-19 april 2013, Göteborg.
Open this publication in new window or tab >>Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers
2013 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108445 (URN)
Conference
XV Svenska Kardiovaskulära Vårmötet, 17-19 april 2013, Göteborg
Available from: 2014-06-27 Created: 2014-06-27 Last updated: 2016-09-26
Bengtsson, U., Ring, L., Kjellgren, K. & Hallberg, I. (2013). Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers. In: : . Paper presented at 21st International Conference on Health Promoting Hospitals and Health Services (HPH), 22-24 May 2013, Gothenburg, Sweden.
Open this publication in new window or tab >>Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers
2013 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Introduction: Hypertension is a risk factor for cardiovascular disease for which poor adherence to therapy becomes a substantial threat to health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies designed to facilitate an increased understanding for the complexity of hypertension and treatment by strengthening of patient participation as well as patient empowerment. Purpose / Methods: The aim of this study was to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 15 persons with hypertension and 12 health care providers and analysed according to thematic analysis. Results: Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. Conclusion: The study presents aspects that persons with hypertension and health care providers deem important in hypertension management. Our finding provides input for future outcome measures, such as self-reports and may serve as a foundation for the development of a self-report system for persons with hypertension. They may further facilitate patient empowerment by increasing the understanding of hypertension and its’ treatment, from a person-centred perspective.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108442 (URN)
Conference
21st International Conference on Health Promoting Hospitals and Health Services (HPH), 22-24 May 2013, Gothenburg, Sweden
Available from: 2014-06-27 Created: 2014-06-27 Last updated: 2016-09-26
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