Stroke patients' perceptions of home blood pressure monitoring: a qualitative study.

BACKGROUND Stroke is the leading cause of adult disability in the UK. Hypertension is the leading modifiable risk factor for stroke. There is increasing interest n home blood pressure monitors for self-monitoring, but no published research on the experiences of stroke patients who do self-monitor. AIM To explore stroke patients' experiences of self-monitoring with nurse-led support. DESIGN AND SETTING A qualitative study of 26 (66%) patients from the first 39 participants to complete the intervention arm of a community-based randomised controlled trial (RCT) of home blood pressure monitoring in 381 patients recruited from hospital stroke clinics in south London. METHOD Semi-structured face-to-face interviews were conducted with 26 patients. Interviews were digitally recorded and transcribed, and a thematic analysis of the data was undertaken. RESULTS Participants were highly motivated to avoid a further stroke and developed a strong focus on blood pressure control and attaining a 'good result'. Only a minority reported anxiety about their blood pressure. Participants gained a welcome sense of empowerment and control over managing their health; some felt confident and 'experimented' with their medication doses. Eight patients required physical help to self-monitor and there was uncertainty about where responsibility lay for such help. Patients who lived alone and were functionally impaired had the least positive experience. Active engagement with the home blood pressure monitoring process by GPs was variable. CONCLUSION Patients in this study generally reported increased knowledge and empowerment about blood pressure control and avoiding further strokes. The technique is overall welcome, acceptable, and successful, even in patients with disabilities. Since home blood pressure monitoring can also lead to improved blood pressure control, this simple, pragmatic intervention might be more widely used.