Feasibility of Implementing a Clinical Integration Package to Support Self-Measured Blood Pressure Monitoring in Primary Care: A Qualitative Study

BACKGROUND: Despite strong evidence, self-measured blood pressure (SMBP) remains underutilized in under-resourced primary care settings. We evaluated barriers and facilitators to implementing a multicomponent SMBP delivery package in a diverse community clinic. METHODS: We examined barriers and facilitators to implementing the ASPIRE (Adapting Self-Measured Blood Pressure Monitoring among Underserved Communities) package, designed to support SMBP adoption in primary care. After an ASPIRE pilot conducted at a Chicago South Side clinic serving a racially diverse population with high social needs, we conducted semistructured interviews with patients and care team members. ASPIRE components consisted of the provision of a free SMBP device, training, a paper tracking log, reminders, resources to address social needs, and documentation workflows. Eligible patients had a hypertension diagnosis, were prescribed 1 or more blood pressure medications, and had elevated blood pressure (blood pressure ≥) between January and May 2024. All 25 patients randomized to the intervention arm were invited to participate. Care team members engaged with the pilot were also invited to participate (n=40). Interviews explored domains impacting implementation, guided by the Consolidated Framework for Implementation Research and analyzed using directed content analysis. RESULTS: Interviews were conducted with 20 patients and 11 care team members (2 attending physicians, 7 residents, and 2 medical assistants). Among patients, 18 (90%) were over the age of 50, 17 (85%) identified as Black, and the median systolic blood pressure at baseline was 142.0 mm Hg (interquartile range, 137.0-153.0). Key facilitators of ASPIRE implementation included in-person SMBP training, which enhanced patient self-efficacy and positive beliefs about SMBP, and reminders and ongoing support, which were viewed as strengths in intervention design. Barriers emerged related to social needs screening processes and self-monitoring log usability, highlighting challenges in execution, planning, and resource alignment. CONCLUSIONS: ASPIRE shows promise for supporting SMBP adoption in under-resourced primary care settings and actionable insights for refining implementation strategies. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06175793.