Abstract P228: Text-Facilitated Home Blood Pressure Monitoring: A Qualitative Analysis of Health Behavior Change

Abstract

Uncontrolled hypertension constitutes a major challenge for healthcare systems. Home blood pressure monitoring (HBPM) is widely recommended and may lower BP when combined with other supports. However, scalable and systematic HBPM interventions are lacking and the behavioral mechanism(s) through which BP is lowered remain poorly understood. Our team designed the MyBP program with video-based education and a fully automated, bi-directional texting to facilitate longitudinal HBPM. Exit interviews conducted after six-weeks of MyBP revealed that most participants made at least one healthy behavior change. The current study examines why participants made healthy behavior changes, and what specific components of the MyBP program facilitated those changes. Adults with hypertension were recruited from either an urban emergency department, a primary care office, or a hypertension referral center. The 40 enrolled participants were widely representative: age range 34-70, 23 women, 24 minority, 14 completed only high school, BP range 110-250/70-130 mm Hg, and prescribed BP medications range 0-5. A thematic analysis of transcribed exit interview audio-recordings identified three themes contributing to patients’ decision to initiate a behavior change: 1) improved hypertension literacy from viewing educational videos; 2) increased day-to-day salience of one’s BP as a result of consistent HBPM; and 3) use of BP readings as feedback on participants’ health behaviors, with high readings often triggering intrinsic motivations to make behavior changes. These themes and associated sub-themes were found to have analogous constructs in the Health Belief Model and Social Cognitive Theory. The presentation of educational materials at baseline, followed by regular BP self-monitoring, increased confidence and motivation to initiate changes in health behaviors. The receipt of bi-weekly reports then acted as feedback fueling participants’ motivation to maintain or add healthy behaviors. Facilitation of HBPM with automated texting, in conjunction with educational videos and regular feedback, appears to stimulate improvements in hypertension self-management via mechanisms consistent with recognized models of behavior change.