Table 3 Potential barriers to home BP monitoring
Barrier categories | Barriers | Representative qualitative quotation |
|---|---|---|
Patient Barriers | Health literacy | “I think the number one barrier is when they've not been properly educated. If they don't understand. Once they have the understanding, I believe they will use it. So the next thing will be working on their understanding. So lots of counseling.” ID 21, Male Consultant |
Agency to make and act upon healthcare decisions | “Here is a case that a lady comes, she's told about everything. But the husband doesn't come. The husband doesn't see the need to come and listen to what we say. Meanwhile, he is the provider. Yes, so if you say, okay, let's get a [BP monitor],….[he] tells you that I don't have the money to buy the [BP monitor] or I won't do it. He's taking the major decision here.” ID 9, Male Senior Resident | |
Willingness to perform regular BP monitoring | “Every woman wants to have a safe delivery and to have their babies. So, if they understand the complications of the disease, they will be motivated.” ID 11, Male Senior Resident | |
Ability to use BP monitor | “If they have been taught well…I think our patients are smart enough to do it and it should be accurate.” ID 6, Male Senior Resident | |
Clinical Barriers | Provider comfort with home management | “If something goes wrong, we will be held responsible. Because you allowed her to go home and now she has had a stroke. So I think from healthcare workers, that may be the resistance to allowing more women to monitor their blood pressures at home. If something goes wrong, who is going to be held responsible?” ID 4, Female Consultant |
Provider trust in home BP values | “Most patients who understand what is wrong with them, will not lie…I think that is the bottomline. By and large I think most people will not give false readings.” ID 14, Male Junior Resident | |
Systemic Barriers | Cost of BP monitors | “When it comes to our care, cost is literally a big barrier. You know most patients cannot afford [a BP monitor].” ID 19, Male Senior Resident |
Quality of BP monitors | “You have to check to see the cuff size, whether it tallies. Whether the machine is working well or not. Use it on another person to be really sure that hey this machine is good. It's not just that the values are high, the machine is actually appropriate for the person.” ID 5, Male Junior Resident | |
Provider-patient communication of abnormal BP values | “I think [there should be] systems in place so that when BPs are elevated…that the [patient] can call and complain to somebody that this is the BP I checked and these are the symptoms I am feeling and all of that. And if they need for the person to [come to the hospital], then the person reports.” ID 8, Male Junior Resident |