Behavior change features and techniques in electronic health-supported walking interventions for hypertension: A scoping review
-
Dwi Esti Handayani
,
Stang Stang
,
Masyita Muis
,
Veni Hadju
,
Ansariadi Ansariadi
,
Kadek Ayu Erika
Abstract
Background & Aim: Hypertension remains a major global health challenge associated with cardiovascular morbidity and mortality. Brisk walking is widely recommended as a non-pharmacological strategy for blood pressure control; however, maintaining long-term adherence remains challenging. The integration of electronic health technologies into walking interventions may enhance motivation and behavioral engagement. This scoping review aimed to map digital behavior features and Behavior Change Techniques within eHealth-supported walking interventions for hypertension management.
Methods & Materials: This scoping review followed the Arksey and O’Malley framework and adhered to PRISMA-ScR guidelines. Literature searches were conducted across PubMed, Scopus, ScienceDirect, ProQuest, and Google Scholar for studies published between 2016 and 2025. Eligible studies included adults with hypertension receiving electronic health-supported walking interventions incorporating digital behavior features and/or Behavior Change Techniques. Data were synthesized narratively.
Results: A total of 21 studies were included. Frequently used eHealth technologies included mobile applications, wearable activity trackers, telemonitoring systems, and web-based platforms. Common digital behavior features included step monitoring, reminders, motivational messaging, personalized feedback, coaching support, and gamification. Frequently identified Behavior Change Techniques based on the Behavior Change Technique Taxonomy version 1 included goal setting, self-monitoring, feedback on behavior, prompts/cues, action planning, and social support. Most studies reported improved walking adherence, increased physical activity, enhanced self-management behaviors, and reduced blood pressure.
Conclusion: Electronic health-supported walking interventions demonstrate potential for improving hypertension self-management through integrated digital behavior change strategies. Future studies should emphasize theory-driven intervention design and standardized Behavior Change Technique reporting.
1. WHO. Hypertension. News Room [Internet]. 2023; Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
2. B Zhou, RM Carrillo-Larco, G Danaei, LM Riley, CJ Paciorek, GA Stevens EG. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. 2021 Sep;398(10304):957–80.
3. Tham LTH, Thuy LT. Sleep quality and associated factors in older outpatients with hypertension in Vietnam: A cross-sectional study. Nursing Practice Today. 2024;11(4):361–8.
4. Aljuraiban GS, Gibson R, Chan DSM, Elliott P, Chan Q, Griep LMO. Lifestyle Score and Risk of Hypertension in the Airwave Health Monitoring Study of British Police Force Employees. Vol. 20, International Journal of Environmental Research and Public Health. 2023. p. 4029.
5. Pescatello LS, MacDonald H V, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Current Hypertension Reports. 2015;17(11):87.
6. Farrell C, Turgeon DR. Normal versus chronic adaptations to aerobic exercise. In: StatPearls [Internet]. StatPearls Publishing; 2023.
7. He LI, Wei WR, Can Z. Effects of 12-week brisk walking training on exercise blood pressure in elderly patients with essential hypertension: a pilot study. Clinical and Experimental Hypertension. 2018;40(7):673–9.
8. Zhao B, Wang H. Effect of abdominal breathing combined with brisk walking on intervention effect of female patients with essential hypertension. Global Journal of Health Science. 2021;13(3):76.
9. Igarashi Y, Akazawa N, Maeda S. The required step count for a reduction in blood pressure: a systematic review and meta-analysis. Journal of Human Hypertension. 2018;32(12):814–24.
10. Malem R, Ristiani R, Puteh MA. Brisk walking exercise has benefits of lowering blood pressure in hypertension sufferers: a systematic review and meta-analysis. Iranian Journal of Public Health. 2024;53(4):774.
11. Yu Y, Chang C, Wu Y, Guo C, Xie L. Dose‐effect relationship between brisk walking and blood pressure in Chinese occupational population with sedentary lifestyles: Exercise and blood pressure. The Journal of Clinical Hypertension. 2021;23(9):1734–43.
12. WHO. Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth. World Health Organization; 2017.
13. Sulfikar A, Rachmawaty R, Sjattar EL. Emerging digital health approaches for the detection of undiagnosed type 2 diabetes mellitus in underserved populations: A scoping review. Nursing Practice Today. 2026;13(2):127–46.
14. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine. 2013;46(1):81–95.
15. Bandura A. Health promotion by social cognitive means. Health Education & Behavior. 2004;31(2):143–64.
16. Direito A, Carraça E, Rawstorn J, Whittaker R, Maddison R. mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Annals of Behavioral Medicine. 2017;51(2):226–39.
17. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology [Internet]. 2005 Feb 1;8(1):19–32. Available from: https://doi.org/10.1080/1364557032000119616
18. Danielle Levac HC, Kelly K O’Brien. Scoping studies: advancing the methodology. Represent Interv. 2010;1–18.
19. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine [Internet]. 2018 Sep 4;169(7):467–73. Available from: https://doi.org/10.7326/M18-0850
20. Hargreaves EA, Mutrie N, Fleming JD. A web-based intervention to encourage walking (StepWise): Pilot randomized controlled trial. JMIR Research Protocols. 2016;5(1):e4288.
21. Okura T, Enomoto D, Miyoshi K, Nagao T, Kukida M, Tanino A, et al. The importance of walking for control of blood pressure: Proof using a telemedicine system. Telemedicine and e-Health. 2016;22(12):1019–23.
22. Dye CJ, Williams JE, Evatt JH. Activating patients for sustained chronic disease self-management: thinking beyond clinical outcomes. Journal of Primary Care & Community Health. 2016;7(2):107–12.
23. Dasgupta K, Rosenberg E, Joseph L, Cooke AB, Trudeau L, Bacon SL, et al. Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension. Diabetes, Obesity and Metabolism. 2017;19(5):695–704.
24. Nolan RP, Feldman R, Dawes M, Kaczorowski J, Lynn H, Barr SI, et al. Randomized controlled trial of e-counseling for hypertension: REACH. Circulation: Cardiovascular Quality and Outcomes. 2018;11(7):e004420.
25. Leung AYM, Chau PH, Leung ISH, Tse M, Wong PLC, Tam WM, et al. Motivating diabetic and hypertensive patients to engage in regular physical activity: a multi-component intervention derived from the concept of photovoice. International Journal of Environmental Research and Public Health. 2019;16(7):1219.
26. Li T, Ding W, Li X, Lin A. Mobile health technology (WeChat) for the hierarchical management of community hypertension: protocol for a cluster randomized controlled trial. Patient Preference and Adherence. 2019;1339–52.
27. Schlenk EA, Fitzgerald GK, Rogers JC, Kwoh CK, Sereika SM. Promoting physical activity in older adults with knee osteoarthritis and hypertension: a randomized controlled trial. Journal of Aging and Physical Activity. 2020;29(2):207–18.
28. Jahan Y, Rahman MM, Faruque ASG, Chisti MJ, Kazawa K, Matsuyama R, et al. Awareness development and usage of mobile health technology among individuals with hypertension in a rural community of Bangladesh: randomized controlled trial. Journal of Medical Internet Research. 2020;22(12):e19137.
29. Weerahandi H, Paul S, Quintiliani LM, Chokshi S, Mann DM. A mobile health coaching intervention for controlling hypertension: Single-arm pilot pre-post study. JMIR Formative Research. 2020;4(5):e13989.
30. Rodriguez MA, Wang B, Hyoung S, Friedberg J, Wylie-Rosett J, Fang Y, et al. Sustained benefit of alternate behavioral interventions to improve hypertension control: a randomized clinical trial. Hypertension. 2021;77(6):1867–76.
31. Nau T, Owen A, Mazza D, Smith BJ. Engaging primary care providers in a mobile health strategy to support lifestyle change and blood pressure management. Digital Health. 2021;7:20552076211066744.
32. Bai Y, Burns R, Gell N, Byun W. A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients. Journal of Sports Sciences. 2022;40(14):1648–57.
33. Lewey J, Murphy S, Zhang D, Putt ME, Elovitz MA, Riis V, et al. Effectiveness of a text-based gamification intervention to improve physical activity among postpartum individuals with hypertensive disorders of pregnancy: a randomized clinical trial. JAMA Cardiology. 2022;7(6):591–9.
34. Abel WM, Efird JT, Crane PB, Ferdinand KC, Foy CG, DeHaven MJ. Use of coaching and technology to improve blood pressure control in Black women with hypertension: Pilot randomized controlled trial study. The Journal of Clinical Hypertension. 2023;25(1):95–105.
35. Willms A, Rhodes RE, Liu S. Effects of mobile-based financial incentive interventions for adults at risk of developing hypertension: feasibility randomized controlled trial. JMIR Formative Research. 2023;7(1):e36562.
36. Leitner J, Chiang P-H, Khan B, Dey S. An mHealth lifestyle intervention service for improving blood pressure using machine learning and IoMTs. In: 2022 IEEE International Conference on Digital Health (ICDH). IEEE; 2022. p. 142–50.
37. Lefferts EC, Saavedra JM, Song BK, Brellenthin AG, Pescatello LS, Lee D. Increasing lifestyle walking by 3000 steps per day reduces blood pressure in sedentary older adults with hypertension: results from an e-health pilot study. Journal of Cardiovascular Development and Disease. 2023;10(8):317.
38. Razai MS, Trinder B, Perry A, Cauldwell M, Reid F, Oakeshott P. Encouraging brisk walking with the free Active10 app in postnatal women who had a hypertensive pregnancy: “Just Walk It” feasibility study. PLOS ONE. 2023;18(2):e0282066.
39. Zhu Y, Long Y, Wei L, Zhang Y, Ma Z, Lee K-P, et al. Developing cue-behavior association for habit formation: A qualitative study to explore the role of avatar in hypertension. Digital Health. 2024;10:20552076241265216.
40. Heidari N, Rajati F, Heidari P, Rajati M. Lifestyle modification intervention among pregnant women with hypertension based on the self-determination theory using M-Health. Frontiers in Public Health. 2025;13:1495281.
41. Dinh-Le C, Chuang R, Chokshi S, Mann D. Wearable health technology and electronic health record integration: scoping review and future directions. JMIR mHealth and uHealth. 2019;7(9):e12861.
42. Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: promises and barriers. PLOS Medicine. 2016;13(2):e1001953.
43. Johnson D, Deterding S, Kuhn K-A, Staneva A, Stoyanov S, Hides L. Gamification for health and wellbeing: A systematic review of the literature. Internet Interventions. 2016;6:89–106.
44. Edney S, Ryan JC, Olds T, Monroe C, Fraysse F, Vandelanotte C, et al. User engagement and attrition in an app-based physical activity intervention: secondary analysis of a randomized controlled trial. Journal of Medical Internet Research. 2019;21(11):e14645.
45. Ryan RM, Deci EL. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology. 2020;61:101860.
46. Clayton ZS, Brunt VE, Hutton DA, Casso AG, Ziemba BP, Melov S, et al. Tumor necrosis factor alpha-mediated inflammation and remodeling of the extracellular matrix underlies aortic stiffening induced by the common chemotherapeutic agent doxorubicin. Hypertension. 2021;77(5):1581–90.
47. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-57.
2. B Zhou, RM Carrillo-Larco, G Danaei, LM Riley, CJ Paciorek, GA Stevens EG. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. 2021 Sep;398(10304):957–80.
3. Tham LTH, Thuy LT. Sleep quality and associated factors in older outpatients with hypertension in Vietnam: A cross-sectional study. Nursing Practice Today. 2024;11(4):361–8.
4. Aljuraiban GS, Gibson R, Chan DSM, Elliott P, Chan Q, Griep LMO. Lifestyle Score and Risk of Hypertension in the Airwave Health Monitoring Study of British Police Force Employees. Vol. 20, International Journal of Environmental Research and Public Health. 2023. p. 4029.
5. Pescatello LS, MacDonald H V, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Current Hypertension Reports. 2015;17(11):87.
6. Farrell C, Turgeon DR. Normal versus chronic adaptations to aerobic exercise. In: StatPearls [Internet]. StatPearls Publishing; 2023.
7. He LI, Wei WR, Can Z. Effects of 12-week brisk walking training on exercise blood pressure in elderly patients with essential hypertension: a pilot study. Clinical and Experimental Hypertension. 2018;40(7):673–9.
8. Zhao B, Wang H. Effect of abdominal breathing combined with brisk walking on intervention effect of female patients with essential hypertension. Global Journal of Health Science. 2021;13(3):76.
9. Igarashi Y, Akazawa N, Maeda S. The required step count for a reduction in blood pressure: a systematic review and meta-analysis. Journal of Human Hypertension. 2018;32(12):814–24.
10. Malem R, Ristiani R, Puteh MA. Brisk walking exercise has benefits of lowering blood pressure in hypertension sufferers: a systematic review and meta-analysis. Iranian Journal of Public Health. 2024;53(4):774.
11. Yu Y, Chang C, Wu Y, Guo C, Xie L. Dose‐effect relationship between brisk walking and blood pressure in Chinese occupational population with sedentary lifestyles: Exercise and blood pressure. The Journal of Clinical Hypertension. 2021;23(9):1734–43.
12. WHO. Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth. World Health Organization; 2017.
13. Sulfikar A, Rachmawaty R, Sjattar EL. Emerging digital health approaches for the detection of undiagnosed type 2 diabetes mellitus in underserved populations: A scoping review. Nursing Practice Today. 2026;13(2):127–46.
14. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine. 2013;46(1):81–95.
15. Bandura A. Health promotion by social cognitive means. Health Education & Behavior. 2004;31(2):143–64.
16. Direito A, Carraça E, Rawstorn J, Whittaker R, Maddison R. mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Annals of Behavioral Medicine. 2017;51(2):226–39.
17. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology [Internet]. 2005 Feb 1;8(1):19–32. Available from: https://doi.org/10.1080/1364557032000119616
18. Danielle Levac HC, Kelly K O’Brien. Scoping studies: advancing the methodology. Represent Interv. 2010;1–18.
19. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine [Internet]. 2018 Sep 4;169(7):467–73. Available from: https://doi.org/10.7326/M18-0850
20. Hargreaves EA, Mutrie N, Fleming JD. A web-based intervention to encourage walking (StepWise): Pilot randomized controlled trial. JMIR Research Protocols. 2016;5(1):e4288.
21. Okura T, Enomoto D, Miyoshi K, Nagao T, Kukida M, Tanino A, et al. The importance of walking for control of blood pressure: Proof using a telemedicine system. Telemedicine and e-Health. 2016;22(12):1019–23.
22. Dye CJ, Williams JE, Evatt JH. Activating patients for sustained chronic disease self-management: thinking beyond clinical outcomes. Journal of Primary Care & Community Health. 2016;7(2):107–12.
23. Dasgupta K, Rosenberg E, Joseph L, Cooke AB, Trudeau L, Bacon SL, et al. Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension. Diabetes, Obesity and Metabolism. 2017;19(5):695–704.
24. Nolan RP, Feldman R, Dawes M, Kaczorowski J, Lynn H, Barr SI, et al. Randomized controlled trial of e-counseling for hypertension: REACH. Circulation: Cardiovascular Quality and Outcomes. 2018;11(7):e004420.
25. Leung AYM, Chau PH, Leung ISH, Tse M, Wong PLC, Tam WM, et al. Motivating diabetic and hypertensive patients to engage in regular physical activity: a multi-component intervention derived from the concept of photovoice. International Journal of Environmental Research and Public Health. 2019;16(7):1219.
26. Li T, Ding W, Li X, Lin A. Mobile health technology (WeChat) for the hierarchical management of community hypertension: protocol for a cluster randomized controlled trial. Patient Preference and Adherence. 2019;1339–52.
27. Schlenk EA, Fitzgerald GK, Rogers JC, Kwoh CK, Sereika SM. Promoting physical activity in older adults with knee osteoarthritis and hypertension: a randomized controlled trial. Journal of Aging and Physical Activity. 2020;29(2):207–18.
28. Jahan Y, Rahman MM, Faruque ASG, Chisti MJ, Kazawa K, Matsuyama R, et al. Awareness development and usage of mobile health technology among individuals with hypertension in a rural community of Bangladesh: randomized controlled trial. Journal of Medical Internet Research. 2020;22(12):e19137.
29. Weerahandi H, Paul S, Quintiliani LM, Chokshi S, Mann DM. A mobile health coaching intervention for controlling hypertension: Single-arm pilot pre-post study. JMIR Formative Research. 2020;4(5):e13989.
30. Rodriguez MA, Wang B, Hyoung S, Friedberg J, Wylie-Rosett J, Fang Y, et al. Sustained benefit of alternate behavioral interventions to improve hypertension control: a randomized clinical trial. Hypertension. 2021;77(6):1867–76.
31. Nau T, Owen A, Mazza D, Smith BJ. Engaging primary care providers in a mobile health strategy to support lifestyle change and blood pressure management. Digital Health. 2021;7:20552076211066744.
32. Bai Y, Burns R, Gell N, Byun W. A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients. Journal of Sports Sciences. 2022;40(14):1648–57.
33. Lewey J, Murphy S, Zhang D, Putt ME, Elovitz MA, Riis V, et al. Effectiveness of a text-based gamification intervention to improve physical activity among postpartum individuals with hypertensive disorders of pregnancy: a randomized clinical trial. JAMA Cardiology. 2022;7(6):591–9.
34. Abel WM, Efird JT, Crane PB, Ferdinand KC, Foy CG, DeHaven MJ. Use of coaching and technology to improve blood pressure control in Black women with hypertension: Pilot randomized controlled trial study. The Journal of Clinical Hypertension. 2023;25(1):95–105.
35. Willms A, Rhodes RE, Liu S. Effects of mobile-based financial incentive interventions for adults at risk of developing hypertension: feasibility randomized controlled trial. JMIR Formative Research. 2023;7(1):e36562.
36. Leitner J, Chiang P-H, Khan B, Dey S. An mHealth lifestyle intervention service for improving blood pressure using machine learning and IoMTs. In: 2022 IEEE International Conference on Digital Health (ICDH). IEEE; 2022. p. 142–50.
37. Lefferts EC, Saavedra JM, Song BK, Brellenthin AG, Pescatello LS, Lee D. Increasing lifestyle walking by 3000 steps per day reduces blood pressure in sedentary older adults with hypertension: results from an e-health pilot study. Journal of Cardiovascular Development and Disease. 2023;10(8):317.
38. Razai MS, Trinder B, Perry A, Cauldwell M, Reid F, Oakeshott P. Encouraging brisk walking with the free Active10 app in postnatal women who had a hypertensive pregnancy: “Just Walk It” feasibility study. PLOS ONE. 2023;18(2):e0282066.
39. Zhu Y, Long Y, Wei L, Zhang Y, Ma Z, Lee K-P, et al. Developing cue-behavior association for habit formation: A qualitative study to explore the role of avatar in hypertension. Digital Health. 2024;10:20552076241265216.
40. Heidari N, Rajati F, Heidari P, Rajati M. Lifestyle modification intervention among pregnant women with hypertension based on the self-determination theory using M-Health. Frontiers in Public Health. 2025;13:1495281.
41. Dinh-Le C, Chuang R, Chokshi S, Mann D. Wearable health technology and electronic health record integration: scoping review and future directions. JMIR mHealth and uHealth. 2019;7(9):e12861.
42. Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: promises and barriers. PLOS Medicine. 2016;13(2):e1001953.
43. Johnson D, Deterding S, Kuhn K-A, Staneva A, Stoyanov S, Hides L. Gamification for health and wellbeing: A systematic review of the literature. Internet Interventions. 2016;6:89–106.
44. Edney S, Ryan JC, Olds T, Monroe C, Fraysse F, Vandelanotte C, et al. User engagement and attrition in an app-based physical activity intervention: secondary analysis of a randomized controlled trial. Journal of Medical Internet Research. 2019;21(11):e14645.
45. Ryan RM, Deci EL. Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology. 2020;61:101860.
46. Clayton ZS, Brunt VE, Hutton DA, Casso AG, Ziemba BP, Melov S, et al. Tumor necrosis factor alpha-mediated inflammation and remodeling of the extracellular matrix underlies aortic stiffening induced by the common chemotherapeutic agent doxorubicin. Hypertension. 2021;77(5):1581–90.
47. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-57.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| hypertension; walking; digital health; health behavior; telemedicine; exercise | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Handayani D, Stang S, Muis M, Hadju V, Ansariadi A, Erika K. Behavior change features and techniques in electronic health-supported walking interventions for hypertension: A scoping review. Nurs. pract. today. 2026;:X-X.
