JMIR Publications

ABSTRACT

Background:

Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level, is poor and worsening. Systematic home blood pressure monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bi-directional text messaging for HBPM and disease self-management support.

Objective:

To produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices.

Methods:

Semi-structured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses and medical assistants (n=6) from primary care settings. The interview was designed to assess a subset of constructs from the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated CFIR constructs

Results:

Healthcare providers reported that MyBP was usable and that it positively influenced patients’ BP self-measurement adherence, health literacy, and empowerment. Provider barriers included the need for training to adopt the innovation. Anticipated barriers to implementation included the lack of integration into the electronic medical record or workflow of the outpatient clinic and lack of an established implementation process (e.g., there were not clear office “champions”). Outer setting barriers included absence of insurance payments for personal BP devices.

Conclusions:

In this qualitative analysis, healthcare providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education.