Understanding Patient-related Factors that Impact Telemonitoring of Hypertension: A Mixed-methods Approach

Abstract

About half of the adults in the United States have hypertension, and uncontrolled hypertension leads to significant illness and death. Telemonitoring of blood pressure (BP), where patients with hypertension take their BP at home and remotely communicate with their healthcare providers through technologies from the comfort of their homes and receive feedback, improves BP control. However, many patients are not using BP telemonitoring due to personal, technological and health system barriers. Specifically, individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services such as BP telemonitoring effectively. Yet, patients’ e-HL in using BP telemonitoring is not known. To fully understand the factors impacting telemonitoring of BP, we did three studies of BP telemonitoring and BP-related technology behaviors using a mixed-methods approach. The studies included, 1. Prediction of smartphone and tablet use in achieving health goals and communicating with healthcare providers via SMS text messaging among people with hypertension using patient-reported data from 3045 patients with hypertension within the Health Information National Trends Survey (HINTS), 2. Facilitators and barriers to telemonitoring of BP using the e-HL framework (comprised of 7 domains) among 21 patients receiving care at Michigan Medicine, 3. Predictors of participation in BP telemonitoring using an online national survey of 507 people with hypertension sampled based on age and education a priori quotas. In the first study, we found that electronic communication with the doctor or doctor’s office through email or internet and having a wellness app were significant predictors of using SMS text message communication with a healthcare professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age and ownership of basic cellphones. However, they increased significantly with being a woman or with being married having a wellness app using devices other than smartphones or tablets to monitor health, making health treatment decisions, and discussing with a with the help of a tablet or smartphone. The second study identified five main themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring. The mixed-methods results showed concordance between the participants’ e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HL framework. The third study showed that about 12 percent of people with hypertension use BP telemonitoring. Participation in BP telemonitoring was positively predicted by awareness of BP telemonitoring, sharing health information electronically with a healthcare provider, and having digital services that suit individual needs (domain 7). Collectively, the results show that considering patient characteristics such as age and education and prior technology use will likely increase BP telemonitoring. As well, awareness of BP telemonitoring programs and recommendation to participate from healthcare providers are likely to increase BP telemonitoring. Participants’ e-HL status was related to their ability to actively engage in BP monitoring and management through digital services. Future research is needed to incorporate these concepts into media and programs to increase the uptake of BP telemonitoring.