Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone

Ulrika Andersson, Ulrika Bengtsson, Agneta Ranerup, Patrik Midlöv, Karin Kjellgren, Ulrika Andersson, Ulrika Bengtsson, Agneta Ranerup, Patrik Midlöv, Karin Kjellgren

Abstract

Background: The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them.

Objective: The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient's own mobile phone.

Methods: Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis.

Results: Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient's understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential.

Conclusions: The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working.

Trial registration: ClinicalTrials.gov NCT03554382; https://ichgcp.net/clinical-trials-registry/NCT03554382.

Keywords: digital health; eHealth; hypertension; mobile phones; patient-professional partnership; person-centered care; self-management.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ulrika Andersson, Ulrika Bengtsson, Agneta Ranerup, Patrik Midlöv, Karin Kjellgren. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.06.2021.

Figures

Figure 1
Figure 1
Overview of the interactive web-based communication system: (a) blood pressure device; (b) self-reports, reminders, and optional motivational messages via patient’s own mobile phone; (c) database where self-reports are saved; and (d) secure web portal available to patients and professionals for data visualization.
Figure 2
Figure 2
Graph showing correlation of physical activity with blood pressure, as shown to participants.
Figure 3
Figure 3
Overview of the themes and subthemes.

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