Using mHealth for the management of hypertension in UK primary care: an embedded qualitative study of the TASMINH4 randomised controlled trial
Open accessAbstract
Background: Self-monitoring of blood pressure is common but how telemonitoring with a mobile healthcare (mHealth) solution in the management of hypertension can be implemented by patients and healthcare professionals (HCPs) is currently unclear. Aim: Evaluation of facilitators and barriers to self- and telemonitoring interventions for hypertension within the Telemonitoring and Self-monitoring in Hypertension (TASMINH4) trial. Design and setting: An embedded process evaluation of the TASMINH4 randomised controlled trial (RCT), in the West Midlands, in UK primary care, conducted between March 2015 and September 2016. Method: A total of 40 participants comprising 23 patients were randomised to one of two arms: mHealth (self-monitoring by free text/short message service [SMS]) and self-monitoring without mHealth (self-monitoring using paper diaries). There were also15 healthcare professionals (HCPs) and two patient caregivers. Results: Four key implementation priority areas concerned: acceptability of self- and telemonitoring to patients and HCPs; managing data; communication; and integrating self-monitoring into hypertension management (structured care). Structured home monitoring engaged and empowered patients to self-monitor regardless of the use of mHealth, whereas telemonitoring potentially facilitated more rapid communication between HCPs and patients. Paper-based recording integrated better into current workflows but required additional staff input. Conclusion: Although telemonitoring by mHealth facilitates easier communication and convenience, the realities of current UK general practice meant that a paper-based approach to self-monitoring could be integrated into existing workflows with greater ease. Self-monitoring should be offered to all patients with hypertension. Telemonitoring appears to give additional benefits to practices over and above self-monitoring but both need to be offered to ensure generalisability.
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The 'improved care' theme was identified in seven of nine included studies.
“The “improved care” theme was identified in seven of nine studies. [19–23, 25, 26]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
The technology acceptability and feasibility theme arose in six studies and comprised three sub-themes: convenience and acceptability, technology feasibility, and barriers of rural areas.
“This theme arose in six studies [19, 22–25, 27] and comprise the following sub-themes: (1) Convenience & Acceptability; (2) Technology feasibility; and (3) Barriers of rural areas.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
Patients and healthcare professionals reported additional benefits from more individualised treatment plans resulting from telemonitoring interventions.
“Patients and HCPs reported additional benefits in having more individualised treatment plans [19, 21–23, 26] resulting from telemonitoring interventions.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
Telemonitoring increased patients' sense of security, with patients feeling more relaxed knowing their health parameters were being monitored.
“Four studies identified an increased sense of security. [20, 22, 25, 26] with patients feeling more relaxed knowing telemonitoring was enabling increased monitoring of their health parameters.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
Communication emerged as a theme in five studies.
““Communication” emerged as a theme in five studies. [21–23, 25, 26]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
While five studies identified clear benefits of telemonitoring, some healthcare professionals highlighted potential drawbacks concerning treatments.
“Whilst five studies [19, 21–23, 26] identified clear benefits of telemonitoring, some HCPs highlighted potential drawbacks concerning treatments.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
GPs reported improved communications from telemonitoring interventions, leading to enhanced doctor-patient relationships.
“GPs reported improved communications resulting from telemonitoring interventions leading to “enhanced doctor-patient relationships”. [22]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
Concerns about the telemonitoring intervention were commonly reported across two sub-themes: privacy and security of personal data, and generational differences.
“Concerns about the telemonitoring intervention were commonly reported [19, 22, 24, 25] across two sub-themes: (1) Privacy and security of personal data; and (2) Generational differences.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
Some participants, both HCPs and patients, thought telemonitoring was fantastic, finding it easy and quick to access, particularly compared to the difficulties of phoning doctors.
“Some participants (both HCPs and patients) thought using telemonitoring was “fantastic”, [22] finding it easy and quick to access, particularly in comparison to the difficulties of phoning doctors. [25]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
Some patients and HCPs expressed concerns over data confidentiality.
“Some patients and HCPs expressed concerns over data confidentiality. [22, 24, 25]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [22]
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- Authors
- Grant, S., Hodgkinson, J., Schwartz, C., Bradburn, P., Franssen, M., Hobbs, F. R., Jowett, S., McManus, R. J., & Greenfield, S.
- Affiliations
- University of Bristol (GB)
- University of Birmingham (GB)
- University of Oxford (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2019-07-01
- Volume
- 69
- Issue
- 686
- Pages
- e612-e620
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC6607844
- OpenAlex
- W2944864139
- Cited by
- 45
- References
- 33
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 10 · 2023: 13 · 2022: 8 · 2021: 5 · 2020: 4 · 2019: 1
- FWCI
- 6.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (acceptedVersion, other-oa)
- Worcester Research and Publications (University of Worcester) (acceptedVersion)
- Explore Bristol Research (acceptedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (NIHR‐RP‐R2‐12‐015, NIHR200201, NF-SI-0611-10273, NIHR-RP-02-12-015, 12/01/52, IS-SPC-0514-10043, RP-PG-1209-10051)
- Department of Health and Social Care
- NIHR Oxford Biomedical Research Centre
- NIHR School for Primary Care Research
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- hypertension, mobile health, remote patient monitoring, self-measured blood pressure, primary care, implementation barriers and facilitators, patient acceptability, healthcare professional-patient communication, structured care
- MeSH terms
- Antihypertensive Agents, Attitude of Health Personnel, Blood Pressure Determination, Female, United Kingdom, Humans, Hypertension, Male, Patient Acceptance of Health Care, Primary Health Care, Self Care, Randomized Controlled Trials as Topic, Telemedicine, Qualitative Research, Text Messaging
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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