Empowering Patients to better blood pressure control: A Qualitative Study of Patients’ Views, Practice and Response to Self-Blood Pressure Monitoring

Problem

Poor blood pressure (BP) control is a leading risk factor for disease globally. Self-Blood Pressure Monitoring (SBPM) is proven to improve drug compliance, increase engagement in chronic disease control and reduce BP readings in subjects with uncontrolled hypertension. Many patients initiated SBPM themselves without health care professionals’ input. Many clinicians found difficult to interpret patients’ SBPM readings without knowing the quality of BP measurement. There is no standard patient education program to achieve high quality SBPM that may potentially affect clinical management. By understanding patients’ barriers to accurate measurement, knowledge, practice and response to variable BP reading, we could determine the focus of patient education in SBPM.

Approach

Subjects from 3 general practices with history of uncontrolled hypertension (clinic BP ≥140/90mmHg) in past 12 months were invited for individual semi-structured interview, using qualitative research method. The author interviewed the subjects after their normal consultation with written consent. They were encouraged to share their knowledge, view, experience and response to SBPM. Purposive sampling yielded a mixture of women and men; working groups and retired or housewife group; uncomplicated and complicated HT; with and without other comorbidity such as diabetes; who have attended and not attended structured HT education group. All interviews were audiotaped with informed consent and transcribed into Cantonese verbatim. Thematic analysis was undertaken by computer software NViVo10®.

Findings

There were seven men and eight women with age ranged from 44 to 82 (mean 64). Five of them (33%) were full-time employed. Most of them (86.7%) attained primary school or below. Four of them (27%) had complicated HT. All except three men regularly perform SBPM. The reasons of SBPM were getting to know their BP were stable and encouragement by health care professionals or significant others. Barriers to perform accurate HBPM includes (1)lacking knowledge to select validated electronic BP device; (2) easy access to different community BP monitoring service, which may or may not be accurate; (3)no health care professionals input about SBPM technique: most of them learnt by observation of BP measurement during clinic visits, or by reading user manuals; (4)lacking knowledge to perform correct SBPM, especially in preparation, technique of putting on BP cuff, frequency of measurement and correct record of BP readings; (5)difficulty in interpreting SBPM readings because the readings could be highly variable. Some of them felt emotionally distressed or even overreacted when BP readings fell outside normal range. They were fear of HT complications such as stroke. They would increase frequency of measurement, postpone normal duties, increase rest time, seek medical advice and eat more “healthy food”.

Consequences

The SBPM education program should include basic knowledge of hypertension, selection of validated BP devices, technique of BP measurement and recording, self- management of various home BP readings.