BARRIERS AND PREFERENCES FOR TECHNOLOGY-ASSISTED BLOOD PRESSURE MANAGEMENT AMONG STROKE SURVIVORS WITH HYPERTENSION: A MIXED-METHODS STUDY
Author(s)
Yan HE1, Zhiguang HUANG, PhD2, Xinyao YI, MSc3, Xuanbi Fang, MSc3, Xinchang Liu, MSc4, Wai-kit Ming, MBA, MPH, PhD, MD5.
1PhD student, City University of Hong Kong, Kowlong, China, 2City University of Hong Kong, Hong kong, China, 3City University of Hong Kong, Hong Kong, China, 4City University of Hong Kong, Kowloon, Hong Kong, 5City University of Hong Kong, City University of Hong Kong, China.
1PhD student, City University of Hong Kong, Kowlong, China, 2City University of Hong Kong, Hong kong, China, 3City University of Hong Kong, Hong Kong, China, 4City University of Hong Kong, Kowloon, Hong Kong, 5City University of Hong Kong, City University of Hong Kong, China.
OBJECTIVES: Home blood pressure (BP) management is central to secondary stroke prevention, yet many stroke survivors and their caregivers fail to sustain it. This study aimed to identify barriers to and facilitators of home BP management among stroke patients and caregivers and to translate them into candidate attributes for a planned discrete choice experiment (DCE).
METHODS: In this first, qualitative phase, semi-structured interviews were conducted with stroke patients and their family caregivers, guided by the Theoretical Domains Framework (TDF). Interviews were transcribed and thematically analyzed: deductive coding mapped content to the 11 TDF domains, and inductive coding grouped content into themes and belief statements categorized as barriers or facilitators. Each theme was scored on frequency, perceived impact, and divergence of beliefs to distinguish key from peripheral domains. Recurring high-priority barriers and facilitators were then inductively consolidated into core, modifiable resource concepts, which were finalized, after mapping to their TDF domains and behavior change techniques, as candidate DCE attributes, each defined at two levels (present versus absent).
RESULTS: Forty-four participants (21 patients, 23 caregivers) were interviewed. Twenty-eight themes were identified across all 11 TDF domains. Five domains were key: knowledge; skills; environmental context and resources; memory, attention and decision processes; and beliefs about consequences. Key barriers included knowledge gaps, post-stroke physical and memory limitations, habitual neglect of monitoring, insufficient post-discharge support, medication cost, and monitoring-related anxiety; key facilitators included professional guidance, anticipated regret over recurrence, and caregiver supervision. Seven candidate resource attributes, spanning education, skills training, reminder tools, post-discharge support, personalized recurrence-risk feedback, caregiver-involved support, and cost assistance, were finalized, each with present/absent levels.
CONCLUSIONS: Multifactorial, TDF-based determinants underlie home BP management after stroke. The resulting attributes will anchor a DCE to prioritize resources for improving uptake.
METHODS: In this first, qualitative phase, semi-structured interviews were conducted with stroke patients and their family caregivers, guided by the Theoretical Domains Framework (TDF). Interviews were transcribed and thematically analyzed: deductive coding mapped content to the 11 TDF domains, and inductive coding grouped content into themes and belief statements categorized as barriers or facilitators. Each theme was scored on frequency, perceived impact, and divergence of beliefs to distinguish key from peripheral domains. Recurring high-priority barriers and facilitators were then inductively consolidated into core, modifiable resource concepts, which were finalized, after mapping to their TDF domains and behavior change techniques, as candidate DCE attributes, each defined at two levels (present versus absent).
RESULTS: Forty-four participants (21 patients, 23 caregivers) were interviewed. Twenty-eight themes were identified across all 11 TDF domains. Five domains were key: knowledge; skills; environmental context and resources; memory, attention and decision processes; and beliefs about consequences. Key barriers included knowledge gaps, post-stroke physical and memory limitations, habitual neglect of monitoring, insufficient post-discharge support, medication cost, and monitoring-related anxiety; key facilitators included professional guidance, anticipated regret over recurrence, and caregiver supervision. Seven candidate resource attributes, spanning education, skills training, reminder tools, post-discharge support, personalized recurrence-risk feedback, caregiver-involved support, and cost assistance, were finalized, each with present/absent levels.
CONCLUSIONS: Multifactorial, TDF-based determinants underlie home BP management after stroke. The resulting attributes will anchor a DCE to prioritize resources for improving uptake.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD29
Topic
Health Service Delivery & Process of Care, Health Technology Assessment, Patient-Centered Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Geriatrics