Abstract
BACKGROUND: Self-measured blood pressure monitoring is necessary for successful management of hypertension. However, disparities in blood pressure control persist, with low-income patients and racial and ethnic minorities more likely to have uncontrolled hypertension. These patients are also at increased risk for digital exclusion. Several validated blood pressure monitors for self-measured monitoring are available, but little is known about patient preferences between different device traits. Studies have shown that poor usability or technology design can lead to barriers to adoption. OBJECTIVE: We investigated patient-reported barriers, preferences, and facilitators to self-measured blood pressure monitoring from a diverse population at an urban safety-net hospital. METHODS: This qualitative study included English- and Spanish-speaking patients with hypertension. Participants completed a survey about sociodemographic traits, self-measured blood pressure monitoring practices and training, and experience with technology. Semi-structured interviews were conducted to elicit preferences about blood pressure devices, the accompanying mobile apps, and their experience sharing blood pressure measurements with their providers. Interviews included participant demonstration of home blood pressure measurement to evaluate baseline self-measured blood pressure monitoring technique. Two home blood pressure monitoring devices were presented: a Bluetooth-enabled device and a cellular-enabled device that syncs data directly. Surveys and interviews were conducted in participants' preferred language. Rapid qualitative data analysis was applied to analyze qualitative data. RESULTS: Fifteen participants (8 English-speaking and 7 Spanish-speaking) were enrolled. Participants all identified as racial and ethnic minorities. Educational attainment varied, ranging from less than high school to college graduates. Eight exhibited some form of digital inaccessibility: lacking internet access, not activating their patient portal, or having difficulty connecting a device to Wi-Fi. Most required assistance with Bluetooth pairing and navigating app features. Overall, participants valued tracking their blood pressure, were motivated to engage in self-measured blood pressure monitoring practices, and desired training. Nearly all participants demonstrated inconsistencies in blood pressure education, displayed incorrect measurement techniques, and had not received formal training on self-measured blood pressure monitoring. Spanish-speaking participants reported that using apps was challenging because they were presented in English and wanted translated apps and resources. The cost of features was a key factor in device preference. CONCLUSIONS: Patient-reported barriers to successful self-measured blood pressure monitoring adoption include cost, insufficient training, digital inaccessibility, and language discordance. Addressing these challenges may enhance the adoption of self-measured blood pressure monitoring in safety net populations. Providers should evaluate patients' preferences and develop tailored interventions when recommending self-measured blood pressure monitoring. Cellular self-measured blood pressure monitoring devices that automatically transmit blood pressure readings may reduce digital complexity and promote sharing results with providers, though future studies are needed to evaluate usability and implementation.