Let’s talk! Qualitatively exploring communication about blood pressure self-monitoring between patients and health professionals

Problem

Home monitoring is an effective intervention to help control BP. Despite the popularity of self-monitoring of blood pressure (SMBP) with patients, and its endorsement in hypertension guidelines worldwide, previous research indicates that most people self-initiate SMBP with little consultation with a HCP. In the current literature the impact of SMBP within the doctor-patient consultation is underexplored. This qualitative study aimed to understand the process of communication relating to SMBP between patients and health care professionals (HCPs).

Approach

Purposefully selected patients were recruited from the West Midlands region to represent variation on age, sex, deprivation status (based on GP practice postcode), and self-monitoring experience from both Primary and Secondary Care. Primary care patients and HCPs were former participants of the TASMINH2 randomised controlled trial (RCT). Thirteen focus groups (9 patient, 4 HCPs) (between 3-9 participants) plus 4 HCP interviews, n=66 (41 patients, 25 HCPs) were conducted. Interviews and focus groups (FGs) took place in general practices and at a teaching hospital hypertension clinic. Topic guides covering SMBP current practice, the role of the HCP (patient FGs) or relationship with patient (HCP FGs), and preferences for a standard and shortened self-monitoring protocol based on current national guidance, were used to stimulate discussion about SMBP with patients and health professionals. All FGs and interviews were recorded, transcribed verbatim and analysed by constant comparative method.

Findings

Three distinct themes emerged: ‘Lost in translation?’ describes the dialogue, or lack of, between doctors and patients on SMBP; ‘Misaligned views of home monitoring’ describes the confusion experienced by patients and HCPs alike around recommendations for home BP monitoring and ‘Protecting home space’ describes the different environments of the patient and HCP and factors in those environments that impact on a patient’s decision to self-monitor BP.

Consequences

SMBP ideally would be discussed jointly between patient and HCP within a consultation. However, evidence from our FGs suggests this often does not happen, particularly in primary care, and even when SMBP was originally initiated through a RCT consented to by both patients and HCPs. The data collected here highlight several factors which orient around improving communication between HCP and patient before, during and after the period of SMBP. Behavioural insights into this process reveal the need to align patient and HCP views on self-monitoring so that it can be effectively used in the routine management of hypertension.