Developing implementation strategies to improve patient education for hypertension in primary care

ABSTRACT Background Effective education improves hypertension self-management but is not routinely delivered, and there is limited guidance to overcome barriers to support delivery in primary care. This study aimed to use co-design and an implementation science framework to develop and prioritize implementation strategies for the delivery of patient education to support blood pressure (BP) management across the hypertension journey in primary care. Methods A two-stage, co-design study using implementation science frameworks. Stage 1 involved mapping interviews with patients to the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change to generate strategies to improve patient education for BP management along the care journey (diagnosis, treatment initiation, long-term management). Stage 2 involved a three-hour multi-disciplinary workshop to refine, rank and prioritize these strategies using patient personas, clinical scenarios, and participatory voting. Finally, the strategies were reviewed by consumer advisors with lived experience of BP management to ensure suitability and acceptability. Results Six context-specific strategy prompts aligned to stages of the hypertension journey were paired with patient personas and clinical scenarios to guide workshop discussions. Twenty-one participants (n=2 general practitioners, n=4 nurses, n=6 pharmacists, n=10 industry professionals) attended the workshop. Ultimately, six refined strategies included: (1) in-pharmacy education for suitable device purchase using a structured protocol; (2) general practitioner consultations about home BP measurement with nurse follow-up; (3) nurse-led drop-in group education sessions; (4) nurse-led group education on interpreting readings with general practitioner follow-up; (5) nurse-led lifestyle planning with allied health referrals; and (6) pharmacist-delivered BP measurement and medication review. Pharmacy-based strategies (1) and (6) ranked highest for feasibility and impact, and cost-effectiveness, respectively. Conclusion We identified evidence-based multidisciplinary strategies to improve the delivery of patient education for hypertension, co-designed with clinicians. Future work should focus on evaluating their implementation in real-world primary care settings. KEY MESSAGES What is already known on this topic Patient education improves hypertension self-management, yet it is rarely delivered consistently in primary care and there is limited guidance on how to overcome practical barriers to implementing education strategies across the care journey. What this study adds This study co-designed and prioritized six multidisciplinary, context-specific strategies to deliver patient education for blood pressure management at diagnosis, treatment initiation, and long-term care, using implementation science frameworks. How this study might affect research, practice or policy These strategies offer a practical roadmap for embedding structured education into routine primary care by leveraging existing workforce and infrastructure, aligning with funded models, and supported by clinician incentives to enhance uptake.