Developing an integrated intervention to co-manage diabetes and hypertension in China: an application of the Behaviour Change Wheel Framework

The increasing prevalence of multimorbidity and aging society present a major challenge for China’s health system. The co-management of hypertension and type 2 diabetes—one of the most common and clinically significant multimorbidity cluster—have been placed in the forefront of China’s national health policies. Substantial evidence base exists for lifestyle practices and treatment plans for managing this multimorbidity. Yet, implementation challenges persist within the existing structure and resources of primary health care in China. Behavioural science frameworks hold great potential to address these implementation challenges via identifying the behavioural barriers and rendering tailored implementation strategies. However, existing multimorbidity interventions often do not explicitly link behavioural influences with intervention design. This paper presents a case report of applying Behaviour Change Wheel (BCW) framework to guide the rapid development of an intervention for hypertension and diabetes co-management. The resulting evidence-based, people-centred, integrated care (EPIC) intervention restructures the standard of care by delivering three core features: personalized lifestyle prescriptions, digital tool assistance, and caregiver engagement. The BCW enables seamless integration of multiple intervention components and informed context-specific design. Specifically, the EPIC intervention can be readily implemented during the routine follow-up of older adults with hypertension and diabetes at primary health care facilities in a county-level city. Our case highlights the potential of behavioural science frameworks to address the complex challenge of multimorbidity. To fully realize this potential, empirical evidence is urgently needed to link mechanisms of change and implementation outcomes in theory-informed interventions.