Background: Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. Objective: Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. Methods: We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. Results: The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. Conclusions: This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement.

Background: During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time. Methods: A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics. Results: The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time. Conclusions: The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.

Aims and objectives: The aim was to conduct a synthesis of the literature on value‐creating care for older persons with incontinence provided with toileting assistance and containment strategies, from the perspectives of older persons and healthcare professionals.Background: Incontinence is a health problem for many persons worldwide and the problem will increase as the global population ages. It can have a profound impact on a person's wellbeing, and assistance with toileting and containment strategies is common in home care settings and nursing homes.Design: The design was a literature review with an iterative, reflexive and critical approach.Methods: A critical interpretive synthesis was conducted. Ten papers published between 2011 and 2019 were analysed. The PRISMA ‐ScR Checklist was used in this review.Results: Based on the findings, the conceptual construct ‘The art of connectedness’ was developed, built on co‐created care, personalised care and reflective care between the older person and healthcare professionals. Co‐created care is based on establishing a relationship, building trust and respecting preferences. Personalised care consists of meeting the person's needs, promoting comfort and maintaining self‐determination. Reflective care entails showing empathy, upholding the person's dignity and developing professional competence.Conclusions: Value‐creating care consists conceptually of a connectedness that starts with co‐creating the care together with the older person in a close relationship. Assistance is given and received based on the older person's individual needs and is highly valued by the older person as it helps them maintain self‐determination. Reflective care is of importance for healthcare professionals.Relevance for practice: The findings are hoped to enhance healthcare professionals’ understanding of how to improve the clinical encounter in nursing when providing assistance. They may also stimulate critical reflection among healthcare professionals on how to improve assistance to meet the older person's values.