Adopting self-measured blood pressure monitoring in underserved primary care settings: a qualitative study using customer discovery and value proposition principles.

Abstract

Background: Despite being recommended in clinical practice guidelines as an effective strategy to control blood pressure, self-measured blood pressure monitoring (SMBP) adoption in the US remains low with clear disparities among underserved patients. Our objective was to develop a prototype SMBP Clinical Integration Package to support the use of standard, cost-effective SMBP devices requiring minimal technology investment for healthcare systems.

Methods: The I-Corps™ methodology, designed to promote the successful adoption of interventions, was used to create a value proposition and to conduct customer discovery interviews with hypertension patients, primary care providers, and healthcare system leaders from a Midwestern healthcare system. Interviews were analyzed using rapid qualitative analysis methods. Emerging themes were used to revise the value proposition, create the minimum viable product, and propose an SMBP intervention to increase its adoption in primary care.

Results: A total of 28 interviews were conducted. Six themes emerged including (1) access to a blood pressure device with the appropriate cuff size (2), Self-efficacy in performing SMBP (3), motivation to perform SMBP (4), an acceptable pathway to share SMBP readings with the care team (5), processes to document and address SMBP readings, and (6) unmet social needs. Key findings from these interviews suggest the need for an intervention that addresses multifaceted emerging barriers at the patient, provider, and health system levels.

Conclusions: The I-Corps™ methodology led to identifying the clinical problem relevant to the SMBP adoption in low resource primary care settings where patients cannot afford enhanced SMBP devices and health systems do not have the resources to invest in high-cost technology solutions. The proposed ASPIRE Clinical Integration Package incorporates the identified minimum valuable product and includes supporting the patient in completing SMBP readings at home, documenting the readings in an acceptable method to the patient, sharing them with the care team to be incorporated into the treatment plan, and addressing the patient's unmet social needs.