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

Abstract

BackgroundLittle is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme.MethodsA 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.Results287 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).ConclusionPatients 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 numberNCT02551393.

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“…In addition, Al-rousan et al ( 27 ) reported patients’ willingness to monitor HBP but had concerns about their ability to do so. While patient education by clinicians and nurses can improve HBP technique ( 25 , 28 ), the time needed to instruct patients on HBP measuring protocols may not be feasible or available in busy clinical settings ( 18 ). Remote patient education through videos and online platforms could help improve HBP practices and techniques while working within the existing time constraints ( 29 ).…”

Perspectives and Experiences of Self-monitoring of Blood Pressure Among Patients With Hypertension: A Systematic Review of Qualitative Studies

“… 53 Addressing uncertainties about correct procedures, inaccuracy of the readings, and technical issues in operating home blood pressure monitoring may also reduce patient concerns. 54 …”

Home Blood Pressure in Health and Disease

“…Although home BP may also trigger stress, it can provide reassurance for patients, and is associated with better adherence to BP-lowering medication and increased hypertension control rates (123)(124)(125). However, health literacy is an important factor in the use of home BP (126), and self-reported BP values, as with other data such as blood sugar in individuals with diabetes, may be inaccurate because of manipulation or human error (127).…”