Behavior change features and techniques in electronic health-supported walking interventions for hypertension: A scoping review

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.