How and why do Australians obtain blood pressure devices for use at home? A mixed-methods study revealing health literacy responsive ways to support this self-management behaviour

Background Adequate health literacy is integral to support self-management behaviours, including home blood pressure (BP) monitoring, which is recommended for hypertension management. Using a validated device that has been tested for accuracy is essential to obtain reliable BP readings, but only 25% of devices available for purchase at pharmacies meet this standard. Little is known about how consumers obtain BP devices, factors influencing their choices, and the impact of health literacy on device selection.Objective To determine how consumers obtain BP devices and explore the impact of health literacy on device ownership.Methods Mixed-methods study with an online survey and phone interviews among adults who measure BP at home in Australia (June-Dec 2023). Survey questions determined health literacy status, BP device make/model, validation status (evidence the device had been tested for accuracy) and factors influencing selection. Interviews further explored these topics among a subset of purposively sampled participants.Results Participants (n = 241) were middle aged (58 ± 16 years, 52% women) and 74% had adequate health literacy. Only 51% (n = 123) of participants used validated BP devices. Most participants purchased their device (91%, n = 189), with 69% (n = 130) from pharmacies. Regardless of health literacy level, accuracy, quality and recommendations from a medical professional were the most important considerations when selecting a BP device. More participants with inadequate health literacy considered medical professional recommendations as most important (48.8% vs. 29.1%, p = 0.035). However, no education was provided to support obtaining a validated BP device by healthcare providers. In the absence of education, interviewees (n = 27) used brand recognition, online reviews and avoided cheaper devices to select an ‘accurate’ device. Health literacy status did not impact ownership of a validated BP device or how devices were obtained.Conclusion Only 51% of Australian adults that measure BP at home use a device that has been tested for accuracy. Despite accuracy and medical professional recommendations being key considerations when choosing a device, little support was provided to aid participants to obtain a validated device. Our findings highlight the need for health services and providers to be more responsive to support consumers to obtain validated devices for home BP monitoring.