English and Spanish-Speaking Patient Preferences on Home Blood Pressure Monitors: A Qualitative Study in an Urban Safety Net Setting (Preprint)

Abstract

Self-measured blood pressure monitoring (SMBP) is necessary for successful management of hypertension (HTN). However, disparities in blood pressure (BP) control persist, with low-income patients and racial/ethnic minorities more likely to have uncontrolled HTN. These patients are also at increased risk for digital exclusion. Several validated BP monitors for SMBP are available, but little is known on patient preferences between different device traits. Studies have shown that poor usability or design of technology can lead to barriers in adoption.

We investigated patient-reported barriers, preferences, and facilitators to SMBP from a diverse population at an urban safety-net hospital.

This qualitative study included English and Spanish-speaking patients with HTN. Participants completed a survey about sociodemographic traits, SMBP practices and training, and experience with technology. Semi-structured interviews were conducted to elicit preferences about BP devices, the accompanying mobile apps, and their experience sharing BP measurements with their providers. Interviews included participant demonstration of home BP measurement to evaluate baseline SMBP technique. Two home BP 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.

Fifteen participants (8 English-speaking; 7 Spanish-speaking) were enrolled. Eight identified as Latine, four as Black or African American, one as American Indian or Native American, one as Asian or Pacific Islander, and one as multi-ethnic. Educational attainment varied: five less than high school, five high school or GED, and five college. 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 BP, are motivated to engage in SMBP practices, and desired training. Nearly all participants demonstrated inconsistencies in BP education, displayed incorrect BP measurement technique, and had not received formal training on SMBP. Spanish-speaking participants reported that using apps was challenging because they were presented in English and wanted translated apps and resources. Cost of features was a key factor in device preference.

Patient-reported barriers to successful SMBP adoption include cost, insufficient training, digital inaccessibility, and language discordance. Addressing these challenges may enhance SMBP adoption in safety-net populations. Providers should evaluate patients’ preferences and develop tailored interventions when recommending SMBP. Cellular SMBP devices that automatically transmit BP readings may reduce digital complexity and promote sharing results with providers, though future studies are needed to evaluate usability and implementation.