Using mHealth for the management of hypertension in UK primary care: an embedded qualitative study of the TASMINH4 randomised controlled trial

Background: Self-monitoring of blood pressure is common but how telemonitoring (TM) with a mobile healthcare (mHealth) solution in the management of hypertension can be implemented by patients and health care professionals (HCPs) is currently unclear.

Aim: Evaluation of the facilitators and barriers to self-monitoring and (TM) interventions for hypertension within the TASMINH4 trial.

Design and Setting: Embedded process evaluation of Telemonitoring And Self-Monitoring in Hypertension (TASMINH4) randomised controlled trial (RCT), West Midlands, UK. Data analysed using Hamilton’s Rapid Analysis Approach.

Methods: 40 participants comprising: 23 patients randomised to one of two arms, i) mHealth (self-monitoring by free text/SMS), ii) self-monitoring without mHealth (self-monitoring using paper-diaries), 15 HCPs and two patient caregivers.

Results: Four key priority areas relating to implementation of self-monitoring concerned i) acceptability of self-monitoring and telemonitoring to patients and HCPs ii) managing data iii) communication and iv) integrating self-monitoring in hypertension management (structured care). Structured home monitoring engaged and empowered patients to self-monitor regardless of the use of mHealth. Telemonitoring potentially facilitated more rapid communication between HCP and patients. Paper-based recording integrated into current work flows but required additional staff input.

Conclusion: The convenience and ease of communication provided by telemonitoring was highly valued by all participants. However, the realities of current UK General Practice meant that a paper-based approach to self-monitoring could be integrated into existing workflows with greater ease. Self-monitoring should be offered to all hypertensive patients, with telemonitoring likely to gain traction as clinical systems evolve to better allow integration with external data sources.