Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?

Sau Nga Fu, Man Chi Dao, Carlos K H Wong, Bernard M Y Cheung, Sau Nga Fu, Man Chi Dao, Carlos K H Wong, Bernard M Y Cheung

Abstract

Background: Little is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme.

Methods: A cluster randomised controlled trial in five primary care clinics recruited participants with uncontrolled hypertension. Clinics were randomised either to a HBPM group education (Risk Assessment and Management Programme (RAMP-group), or individual counselling of self-management (RAMP-individual). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. Practice and knowledge of HBPM were surveyed by a 10-item HBPM knowledge checklist and patient record review 6 months after interventions. Predictors for regular HBPM and good HBPM knowledge were assessed by multivariate logistic regression models.

Results: 287 participants (RAMP-group: 151; RAMP-individual: 136) were follow-up for 6 months. 272 participants completed the knowledge questionnaires (response rate 94.8%). 67.8% of the participants performed HBPM regularly, and there was no statistical difference between both interventions. Age more than 65 (adjusted odds ratios (aOR) 2.58, 95% CI 1.37 to 4.86, p=0.003), not working (aOR 2.34, 95% CI 1.10 to 4.97, p=0.027)and adequate health literacy (aOR 2.25, 95% CI 1.28 to 3.95, p=0.005) predicted regular HBPM. Participants in RAMP-group demonstrated a significant lower body weight than those in RAMP-individual (-0.3±2.0 kg vs +0.7 ±1.7 kg, p<0.001).The RAMP-group participants were eight times more likely to have full HBPM knowledge score than the RAMP-individual participants (aOR 8.46, 95% CI 4.68 to 15.28, p<0.001).

Conclusion: Patients could retain HBPM knowledge better after RAMP-group than RAMP-individual. Older, retired and patients with adequate health literacy were more likely to continue weekly HBPM 6 months after education.

Trial registration number: NCT02551393.

Keywords: hypertension; primary care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Whelton PK, Carey RM, Aronow WS, et al. . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol 2018;71:e127–248. 10.1016/j.jacc.2017.11.006
    1. McCormack T, Krause T, O'Flynn N. Management of hypertension in adults in primary care: NICE guideline. Br J Gen Pract 2012;62:163–4. 10.3399/bjgp12X630232
    1. Ayala C, Tong X, Neeley E, et al. . Home blood pressure monitoring among adults-American heart association cardiovascular health consumer survey, 2012. J Clin Hypertens 2017;19:584–91. 10.1111/jch.12983
    1. Wang Y, Wang Y, Gu H, et al. . Use of home blood pressure monitoring among hypertensive adults in primary care: Minhang community survey. Blood Press Monit 2014;19:140–4. 10.1097/MBP.0000000000000035
    1. Glynn LG, Murphy AW, Smith SM, et al. . Self-Monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review. Br J Gen Pract 2010;60:e476–88. 10.3399/bjgp10X544113
    1. Tucker KL, Sheppard JP, Stevens R, et al. . Self-Monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med 2017;14:1549–1277. 10.1371/journal.pmed.1002389
    1. Ringrose JS, Polley G, McLean D, et al. . An assessment of the accuracy of home blood pressure monitors when used in device owners. Am J Hypertens 2017;30:683–9. 10.1093/ajh/hpx041
    1. Mondal S, Mondal H, Dutta R, et al. . Competency in home blood pressure monitoring and effect of training program on competency. Journal Of Clinical And Diagnostic Research 2018;12:OC10–14. 10.7860/JCDR/2018/32111.11427
    1. Sendra-Lillo J, Martínez-Martínez F, García-Corpas JP, et al. . Validity of home blood pressure measurements manually registered by patients after an educational session provided by community pharmacists. Blood Press Monit 2015;20:232–6. 10.1097/MBP.0000000000000119
    1. Hwang KO, Thomas EJ, Petersen LA. Use of home blood pressure results for assessing the quality of care for hypertension. JAMA 2018;320:1753–4. 10.1001/jama.2018.12365
    1. Tirabassi J, Fang J, Ayala C. Attitudes of primary care providers and recommendations of home blood pressure monitoring--DocStyles, 2010. J Clin Hypertens 2013;15:224–9. 10.1111/jch.12059
    1. Dugelay G, Kivits J, Desse L, et al. . Implementation of home blood pressure monitoring among French GPs: a long and winding road. PLoS One 2019;14:e0220460. 10.1371/journal.pone.0220460
    1. Fu SN, Dao MC, Wong CKH, et al. . The association of health literacy with high-quality home blood pressure monitoring for hypertensive patients in outpatient settings. Int J Hypertens 2020;2020:7502468. 10.1155/2020/7502468
    1. Kallioinen N, Hill A, Horswill MS, et al. . Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review. J Hypertens 2017;35:421–41. 10.1097/HJH.0000000000001197
    1. SN F, Dao MC, Luk W. A cluster-randomized study on the risk assessment and management program for home blood pressure monitoring in an older population with inadequate health literacy. J Clin Hypertens 2020;22:1565–76. 10.1111/jch.13987
    1. Leblanc M-E, Cloutier L, Veiga EV. Knowledge and practice outcomes after home blood pressure measurement education programs. Blood Press Monit 2011;16:265–9. 10.1097/MBP.0b013e32834b667a
    1. Dawes MG, Kaczorowski J, Swanson G, et al. . The effect of a patient education booklet and BP 'tracker' on knowledge about hypertension. A randomized controlled trial. Fam Pract 2010;27:472–8. 10.1093/fampra/cmq048
    1. Kim KB, Han H-R, Huh B, et al. . The effect of a community-based self-help multimodal behavioral intervention in Korean American seniors with high blood pressure. Am J Hypertens 2014;27:1199–208. 10.1093/ajh/hpu041
    1. Dymek J, Skowron A, Polak W, et al. . Assessment of knowledge and skills of patients with hypertension related to self-measurement of blood pressure (SBPM). Arterial Hypertension 2015;19:39–44. 10.5603/AH.2015.0007
    1. Shimbo D, Artinian NT, Basile JN, et al. . Self-Measured blood pressure monitoring at home: a joint policy statement from the American heart association and American Medical association. Circulation 2020;142:e42–63. 10.1161/CIR.0000000000000803
    1. British Hypertension Society . Taking your blood pressure at home, 2020. Available: [Accessed 23 Sep 2020].
    1. Sharman JE, Howes F, Head GA, et al. . How to measure home blood pressure: recommendations for healthcare professionals and patients. Aust Fam Physician 2016;45:31–4.
    1. Bancej CM, Campbell N, McKay DW, et al. . Home blood pressure monitoring among Canadian adults with hypertension: results from the 2009 survey on living with chronic diseases in Canada. Can J Cardiol 2010;26:e152–7. 10.1016/S0828-282X(10)70382-2
    1. Ostchega Y, Zhang G, Kit BK, et al. . Factors associated with home blood pressure monitoring among US adults: National health and nutrition examination survey, 2011-2014. Am J Hypertens 2017;30:1126–32. 10.1093/ajh/hpx101
    1. Wake AD, Bekele DM, Tuji TS. Knowledge and attitude of self-monitoring of blood pressure among adult hypertensive patients on follow-up at selected public hospitals in Arsi zone, Oromia regional state, Ethiopia: a cross-sectional study. Integr Blood Press Control 2020;13:1–13. 10.2147/IBPC.S242123
    1. Paldan K, Sauer H, Wagner N-F. Promoting inequality? self-monitoring applications and the problem of social justice. AI & society, 2018: 1–11.
    1. Paulsen MS, Andersen M, Munck AP, et al. . Socio-Economic status influences blood pressure control despite equal access to care. Fam Pract 2012;29:503–10. 10.1093/fampra/cmr130
    1. Seidlerová J, Filipovský J, Wohlfahrt P, et al. . Availability and use of home blood pressure measurement in the Czech general population. Cor Vasa 2014;56:e158–63. 10.1016/j.crvasa.2014.02.011

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner