Providers' Perspective on the Feasibility of Digital Self-Management of Blood Pressure in Refugees: Mixed Methods...

Mass displacement is a grand public health challenge. Refugees and immigrants experience a disparate hypertension burden and disparities in self-management. Successful hypertension self-management is key for improving outcomes, but research on its feasibility in refugee and immigrant health care settings is limited.

This study aimed to identify clinic staff-perceived barriers to and facilitators of implementing a digital intervention for hypertension self-management among refugee and immigrant patients and to identify its feasibility and usability.

Primary care physicians and medical assistants who care for refugees and immigrants in San Diego were interviewed using human-centered semistructured methods (n=18). Interviews were analyzed using an inductive approach. Usability testing for the software (Med Pro Care) was conducted with participants (n=15) to test the feasibility of real-time tracking of blood pressure (BP) home readings for hypertension self-management. Clinical staff rated their satisfaction on the System Usability Scale and the NASA Task Load Index, which measured mental workload.

For refugee and immigrant patients self-managing hypertension, clinical staff identified barriers and facilitators in the following areas: (1) social determinants of health increase hypertension burden among refugee and immigrant patients, (2) clinical staff face challenges to effective hypertension care for refugee and immigrant patients, (3) perceived benefits of potential intervention for self-management, and (4) perceived barriers to potential intervention for self-management. Primary care physicians completed 90% of the tasks, and medical assistants completed 83% of the tasks successfully. Most clinic staff found the software system for monitoring BP to be easy to use with an average score for usability of 4.1 of 5.0 (SD 0.4).

Addressing identified barriers to and facilitators of self-management of hypertension is crucial to designing effective interventions in real-world refugee and immigrant health care settings. Telemonitoring interventions using software that transfers BP readings to clinical staff in real time may be feasible from the perspective of clinic staff and can address hypertension disparities in marginalized populations, such as immigrants and refugees. Addressing identified barriers to and facilitators of self-management is crucial to designing effective interventions in real-world refugee and immigrant health care settings. Our findings suggest that clinic staff view digital telemonitoring as both feasible and supportive of patient empowerment, health literacy, and improved communication-factors essential to addressing hypertension disparities in marginalized populations.