Co-Designing Pragmatic implementation strategies to improve adoption of self-measured blood pressure monitoring by patients and clinicians in community health centers

Background Self-measured blood pressure (SMBP) monitoring is an evidence-based practice that improves hypertension outcomes. However, multiple patient- and clinic-level barriers limit SMBP adoption, particularly in safety-net settings. We co-designed implementation strategies to increase SMBP adoption in a pragmatic clinical trial at six community health centers within two healthcare systems. Methods Using human-centered design (HCD), we co-designed strategies to increase patient- and clinic-level SMBP adoption. For the patient intervention, we conducted nine focus groups and 18 interviews in English, Spanish, and Chinese with 60 patients to understand challenges with SMBP engagement and preferences related to SMBP training, hypertension education, and engaging peer, family, or friend support in their hypertension care. For the clinic intervention, we convened seven focus groups with 62 clinicians to identify challenges across the SMBP implementation process, such as confirming device validation and cuff size, training patients on how to perform SMBP, and documenting plans and communicating them to patients. We prioritized pragmatic, low-cost strategies centered on (a) training care teams and/or clinical champions and (b) developing EHR-embedded tools to support adoption. Result Patients preferred in-person, language-concordant training on SMBP engagement and mobile health app use, and wanted ongoing access to training resources (e.g., videos). Patients expressed interest in peer engagement through virtual or in-person support groups led by trained research staff using vetted discussion content. Most patients preferred low-touch approaches to engaging family/friend support to avoid burdening them, such as ways to access the same educational materials that patients received. Clinicians identified challenges across many facets of SMBP implementation, such as lack of standardized workflows for SMBP education, confirming BP device validation, and documenting care plans. Low-cost EHR tools included reminders about core SMBP teaching content and how to validate home BP monitors, tools such as smartphrases to standardize documentation in the EHR, and patient-facing language-concordant instructions on SMBP monitoring. Conclusions Despite growing adoption of SMBP monitoring, patients and clinicians reported several implementation challenges, particularly in under-resourced community health centers serving diverse patient populations. Patients can be engaged to co-design SMBP monitoring education for themselves and family/friend support, while clinicians support EHR-based tools to optimize workflows for implementing SMBP monitoring. Trial registration NCT, NCT06871462. Registered 4 March, 2025, https://clinicaltrials.gov/study/NCT06871462 .