Using the Behaviour Change Wheel framework to develop an integrated intervention for diabetes and hypertension co-management in China: a case report

The increasing prevalence of multimorbidity and an ageing 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 clusters-has been placed in the forefront of China's national health policies. A 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 is a case report on the application of the Behaviour Change Wheel (BCW) framework to rapidly develop 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: personalised lifestyle prescriptions, digital tool assistance, and caregiver engagement. The BCW framework enables seamless integration of multiple intervention components and informs tailored 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 Kunshan, China. In this case study, we highlight the potential of behavioural science frameworks to address the complex challenge of multimorbidity. To fully realise this potential, empirical evidence is urgently needed to link mechanisms of change and implementation outcomes in theory-informed interventions.