Strategies to improve uptake and adherence of non-pharmacologic interventions for orthostatic hypotension in older people: a qualitative study

PURPOSE: Non-pharmacologic therapies are a safe and effective treatment for orthostatic hypotension (OH) in older adults. However, adherence to non-drug therapies is challenging and may require specific behaviour change approaches to promote uptake and adherence. The study aim is to identify specific behavioural change techniques to promote uptake and adherence with non-pharmacologic interventions for older adults with OH. METHODS: Forty semi-structured, qualitative interviews were performed in 25 older adults with OH. Each participant experienced bolus-water drinking, physical counter-manoeuvres and compression garments during two efficacy studies. Emergent themes were identified through framework analysis, based on The Behaviour Change Technique Taxonomy. RESULTS: Several themes to encourage uptake and adherence arose. Motivation to adhere with an intervention may be improved by demonstrating its effectiveness, either through symptom monitoring or biofeedback. Practising or rehearsing how to use an intervention may improve self-efficacy and promote habit formation. Embedding therapies into daily life so that they become second nature was felt to be a useful strategy. Educating older adults about why they are being asked to use a therapy and demonstrating how to use it is important. More specific barriers may be overcome by encouraging a personal problem-solving approach. CONCLUSION: These specific behaviour change techniques, derived by older people with OH and based on evidence-based approaches, provide useful strategies to improve the uptake and adherence of non-drug therapies in the treatment of OH. TRIAL REGISTRATION: ISRCTN15084870.