Perceptions, Practices and mHealth Readiness for Blood Pressure Self-Monitoring Among Ghanaian Hypertensive Patients

Hypertension is a critical global health issue, with self-monitoring of blood pressure emerging as an essential tool for its management. In Ghana, clinic visits are mostly scheduled at 2-3 monthly intervals, making it difficult to assess patient blood pressure control in between visits. The use of mobile health applications for the self-monitoring of blood pressure among hypertensive patients is not well-documented. Empowering patients through self-monitoring of blood pressure along with feedback from an interactive mobile health application could potentially improve blood pressure control. To ensure that such applications are effective, patient knowledge, perceptions and practices with regard to hypertension must be taken into consideration in the development of the interactive mobile health application. This study investigated patient knowledge of hypertension and the prevalence and practice of self-monitoring, as well as perceptions of hypertension and self-monitoring of blood pressure among Ghanaian patients diagnosed with hypertension at two teaching hospitals.

A cross-sectional pilot study using a mixed-methods approach was conducted among patients aged 30 years and above who have been newly diagnosed without comorbidities with hypertension (blood pressure levels exceeding 140/90 mmHg). The pilot study explored perceptions and practices of the patients with regard to self-monitoring for blood pressure control prior to the introduction of a mobile health technology intervention. Newly diagnosed patients without comorbidities were specifically recruited so that the focus of the study would be solely on hypertension management, ensuring that participants' perceptions, knowledge and self-monitoring practices were not influenced or confounded by the concurrent management of other medical conditions. Recruiting patients at the point of diagnosis also ensured that baseline assessments were conducted prior to any formal patient education or structured self-monitoring coaching by healthcare providers, thereby providing an uncontaminated preintervention baseline for the planned mobile health intervention. Pregnant women and individuals with pre-existing hypertension and coexisting medical conditions were excluded. Quantitative data were analysed using STATA Version 16, while qualitative data from in-depth interviews were transcribed and analysed using NVivo Version 12. Themes from the qualitative analysis were used to contextualize the quantitative results.

The study included 32 hypertensive patients, with more males [53.1% (17/32)] than females. Overall, 71.9% (23/32) of patients knew normal and abnormal blood pressure values, with only 59.4% (19/32) demonstrating good general knowledge of hypertension. Notably, only 37.5% (12/32) of patients indicated that they routinely measured their blood pressure at home. Of the 12 respondents who did so, only nine ever recorded their blood pressure readings. Altogether, 62.5% (20/32) of respondents indicated that they felt comfortable measuring their blood pressure in the presence of others. With regard to confidence in using the blood pressure device independently, 59.4% (19/32) admitted to lacking confidence. Overall, 87.5% (28/32) indicated that they were comfortable using general smartphone applications with 56.2% (18/32) of respondents admitting to using phones for tracking their health status.

This study highlights the need for enhanced information, education and communication if Ghanaian patients are to adopt self-monitoring of their blood pressure in between clinic visits to take charge of their own health and improve hypertension control. Understanding these perceptions and knowing what the existing practices are is critical for healthcare providers to support patients effectively in managing their blood pressure and for the introduction of policies that support and promote the use of mobile health technologies in managing hypertension.