Engaging patients in managing hypertension: patient experience with self-monitoring of blood pressure

ISRCTN ISRCTN16450193
DOI https://doi.org/10.1186/ISRCTN16450193
Secondary identifying numbers FHS.HG.13/SBS-2017-0612
Submission date
11/02/2020
Registration date
03/04/2020
Last edited
27/05/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Self-monitoring of blood pressure has the potential to engage patients, increase the accuracy of measurement, and improve management, and it has been endorsed by key professional organizations. However, little is known about how it is perceived and experienced by patients, and how information and counseling interventions can enhance its effects over time. This study is conducted in Lebanon where hypertension and overweight are prevalent and success in reducing hypertension has been limited. This project includes a situation analysis on the context of hypertension management, and a pilot study that assesses the feasibility and acceptability of an intervention built around self-monitoring of blood pressure and health education, and measures its effect on the management of hypertension in a sample of patients.

Who can participate?
Hypertensive patients recruited from physicians’ waiting rooms in two primary health care centers and a tertiary health care center in Beirut. Patients are eligible if they were Lebanese adults (18+) with a prior diagnosis of hypertension.

What does the study involve?
Participants are randomly allocated by the research team to either home self-monitoring of blood pressure with educational sessions, or the standard of care group. Face-to-face interviews are conducted with all participants at the start and 6 weeks later.

What are the possible benefits and risks of participating?
Participation in this study does not involve any physical risk or emotional risk to the patient beyond the risks of daily life. Participating in this study is beneficial to patients in the pilot intervention group, as it would lead to increased awareness of high blood pressure, its causes, management including the use of the self-monitoring blood pressure machines, and recommended lifestyle changes. Patients in the standard of care group would also benefit from added information and awareness, thanks to conversations in the course of the survey and receipt of educational materials. Because of the possibility that the provision of self-monitoring devices to patients may lead to anxiety regarding high blood pressure readings, the researchers provided information on how to deal with anxiety in this context and when to seek care.

Where is the study run from?
1. American University of Beirut Medical Center (Lebanon)
2. Howard Karagheusian Commemorative Corporation (Lebanon)
3. Amel Association (Lebanon)

When is the study starting and how long is it expected to run for?
April 2016 to April 2019

Who is funding the study?
Harvard Medical School Center for Global Health Delivery (Dubai)

Who is the main contact?
Dr Hala Ghattas
hg15@aub.edu.lb

Contact information

Dr Chaza Akik
Scientific

Bliss Street
Beirut
1107
Lebanon

Phone +961 (0)3410366
Email ca36@aub.edu.lb
Dr Hala Ghattas
Scientific

Principal Investigator
Center for Research on Population and Health, Faculty of Health Sciences
American University of Beirut
Van Dyck Building
Room 338
Beirut
-
Lebanon

Phone +961 (0)1 350000 ext: 4679
Email hg15@aub.edu.lb

Study information

Study designRandomized controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Home
Study typeQuality of life
Participant information sheet Not available in web format, please use contact details to request a participant information sheet
Scientific titleEngaging patients in managing hypertension: patient experience with self-monitoring of blood pressure
Study objectivesSelf-monitoring of blood pressure has the potential to engage patients, increase the accuracy of measurement, and improve management, and it has been endorsed by key professional organizations. The researchers sought to investigate how it is perceived and experienced by patients, and how information and counseling interventions can enhance its effects over time, specifically in Arab countries, where hypertension and overweight are prevalent and success in reducing hypertension has been limited.

This project includes:
1. A situation analysis on the context of hypertension management
2. A pilot study that assesses the feasibility and acceptability of an intervention built around self-monitoring of blood pressure and health education, and measures its effect on the management of hypertension in a sample of patients
Ethics approval(s)Approved 06/06/2018, 04/10/2018, American University of Beirut Institutional Review Board (PO Box 11-0236 (F15), Riad El Solh 1107 2020, Beirut, Lebanon; Tel: +961 (0)1 350000 ext: 5445; Email: irb@aub.edu.lb), ref: FHS.HG.13
Health condition(s) or problem(s) studiedHypertension
InterventionHypertensive patients were recruited from physicians’ waiting rooms in two primary and one tertiary health care centers in Beirut.

Patients who agreed to participate in the study were randomly allocated by the research team to either home self-monitoring of blood pressure with educational sessions; or standard of care group, based on a computer-generated series of numbers.

Face-to-face interviews were conducted with all participants at baseline and 6 weeks later at endline.
Intervention typeBehavioural
Primary outcome measure1. Feasibility of the intervention, assessed in the self-monitoring of blood pressure group using three indicators at endline (6 weeks):
1.1. Recruitment rates and retention rates (i.e. the percentage of patients from the self-monitoring group who completed the 6-week study)
1.2. The extent to which participants adhere to the BP measurements protocol
1.3. Responses of patients to the questions of how likely they are to continue using the device on a regular basis and to discuss the educational information with their acquaintances
2. Acceptability of the intervention, measured in the endline questionnaire of the self-monitoring group by responses to open-ended questions about patients’ experiences and opinions regarding self-monitoring of BP and educational materials
3. Blood pressure measured at baseline and endline
Secondary outcome measures1. Understanding of the information provided during educational sessions measured using a questionnaire at baseline and endline
2. Patient engagement:
2.1. Reported changes in lifestyle habits over the course of the 6-week study, including physical activity levels, salt intake, dietary intake, stress management, and smoking habits, assessed during the endline interview
2.2. Medication adherence assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) at baseline and endline
Overall study start date01/04/2016
Completion date02/04/2019

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants80 participants
Total final enrolment80
Key inclusion criteria1. Lebanese adults (aged 18+)
2. Prior diagnosis of hypertension
Key exclusion criteria1. Spouse is a participant in the study
2. Physical or mental health conditions that would interfere with adequate monitoring of BP
Date of first enrolment01/07/2018
Date of final enrolment30/09/2018

Locations

Countries of recruitment

  • Lebanon

Study participating centres

American University of Beirut Medical Center
Bliss Street
Beirut
1107
Lebanon
Howard Karagheusian Commemorative Corporation
Burj Hammoud
Beirut
000
Lebanon
Amel Association
Haret Hreik
Beirut
000
Lebanon

Sponsor information

American University of Beirut
University/education

Bliss Street
Beirut
1107
Lebanon

Phone +961 (0)1350000
Email hg15@aub.edu.lb
Website http://www.aub.edu.lb
ROR logo "ROR" https://ror.org/04pznsd21

Funders

Funder type

University/education

Harvard Medical School Center for Global Health Delivery - Dubai

No information available

Results and Publications

Intention to publish date31/03/2020
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination plan1. Self-monitoring of blood pressure to improve hypertension management in a middle-income country: A proof of concept study – manuscript to be submitted by end of March to BMC Public Health
2. Patient engagement in a middle-income country: Patients’ experiences with self-monitoring of blood pressure – planned publication in a high-impact peer-reviewed journal

The study protocol and statistical analysis plan will not be available.
IPD sharing planThe datasets generated during and/or analysed during the current study are/will be available upon request from Dr Hala Ghattas (hg15@aub.edu.lb). Data can be made available after an embargo period of 2 years. All data are de-identified, and a de-identified subset of data can be shared upon submission of a research proposal to the study team.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Basic results 27/05/2021 27/05/2021 No No

Additional files

ISRCTN16450193_BasicResults_27May2021.pdf
uploaded 27/05/2021

Editorial Notes

27/05/2021: The following changes were made to the trial record:
1. The basic results have been uploaded as an additional file.
2. The total final enrolment was added.
19/02/2020: Trial's existence confirmed by American University of Beirut Institutional Review Board.