Connecting self-monitoring device and hypertension management: A qualitative inquiry of women with hypertension in rural Bangladesh (Preprint)

BACKGROUND Like many other developing countries, the implementation of urinary salt-monitoring devices in hypertension (HTN) management is lagging behind in Bangladesh. One possible reason is the limited resources and lack of awareness that impede to get access to home-based HTN management strategies. OBJECTIVE This study has implemented a self-monitoring device (KME-03) with an objective to explore the feasibility of such a device in a rural community level setting to manage HTN. Secondly, the study aimed at showcasing if and how associated socio-cultural aspects influence the understanding of salt intake. METHODS A qualitative approach was adopted for data collection using focus group discussion and key informant interviews. Participants (n=24) were recruited from two different categories namely, community health worker (CHW) (n=8), and hypertensive women (n=16) and the result is reported following the Standards for Reporting Qualitative Research (SRQR) guideline. Data were analyzed using the framework method. RESULTS Two potential themes were emerged (a) perceptions on KME-03: CHW and hypertensive patient; and (b) beliefs of salt intake: Socio-cultural cohesion. The main finding indicated the KME-03 device was effective for urinary salt excretion measurement and can potentially be applicable to HTN self-management. Participants were comfortable with the usage and functionalities of KME-03 and had identified some technical errors. The majority of them have disagreed that the device has reduced extra paperwork. Although few of the participants were aware of the detrimental effects of high salt intake, the majority agreed on unawareness which was stimulated by a number of socio-cultural perceptions. The arbitrarily defined cut-points towards salt intake reported that some individuals were susceptible to salt reduction whereas others did not. CONCLUSIONS The CHWs and hypertensive patients found KME-03 device a useful self-management tool in HTN management. The functionalities of the device motivated the participants to integrate HTN management strategies into their everyday life and made them feel like promising perceptions regarding KME-03. However, the findings also denote noteworthy perceptions of salt ingesting practice among HTN patients that are entangled with socio-cultural aspects. This finding has public health significance. Future research should look into this issue more closely to identify components may have an insidious impact on the positive use of self-monitoring device in HTN management. CLINICALTRIAL Bangladesh Medical Research Council (BMRC) registration number 06025072017.