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Mixed-methods feasibility study of blood pressure self-screening for hypertension detection
  1. Alice Tompson1,
  2. Susannah Fleming1,
  3. Mei-Man Lee1,
  4. Mark Monahan2,
  5. Sue Jowett2,
  6. David McCartney1,
  7. Sheila Greenfield3,
  8. Carl Heneghan1,
  9. Alison Ward1,
  10. Richard Hobbs1,
  11. Richard J McManus1
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Health Economics Unit, University of Birmingham, Birmingham, UK
  3. 3 Institute of Applied Health Service Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Susannah Fleming; susannah.fleming{at}


Objective To assess the feasibility of using a blood pressure (BP) self-measurement kiosk—a solid-cuff sphygmomanometer combined with technology to integrate the BP readings into patient electronic medical records— to improve hypertension detection.

Design A concurrent mixed-methods feasibility study incorporating observational and qualitative interview components.

Setting Two English general practitioner (GP) surgeries.

Participants Adult patients registered at participating surgeries. Staff working at these sites.

Interventions BP self-measurement kiosks were placed in the waiting rooms for a 12-month period between 2015 and 2016 and compared with a 12-month control period prior to installation.

Outcome measures (1) The number of patients using the kiosk and agreeing to transfer of their data into their electronic medical records; (2) the cost of using a kiosk compared with GP/practice nurse BP screening; (3) qualitative themes regarding use of the equipment.

Results Out of 15 624 eligible patients, only 186 (1.2%, 95% CI 1.0% to 1.4%) successfully used the kiosk to directly transfer a BP reading into their medical record. For a considerable portion of the intervention period, no readings were transferred, possibly indicating technical problems with the transfer link. A comparison of costs suggests that at least 52.6% of eligible patients would need to self-screen in order to bring costs below that of screening by GPs and practice nurses. Qualitative interviews confirmed that both patients and staff experienced technical difficulties, and used alternative methods to enter BP results into the medical record.

Conclusions While interviewees were generally positive about checking BP in the waiting room, the electronic transfer system as tested was neither robust, effective nor likely to be a cost-effective approach, thus may not be appropriate for a primary care environment. Since most of the cost of a kiosk system lies in the transfer mechanism, a solid-cuff sphygmomanometer and manual entry of results may be a suitable alternative.

  • hypertension
  • blood pressure
  • diagnostic self-evaluation
  • screening kiosks
  • primary healthcare

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  • AT and SF contributed equally.

  • Contributors AW, CH and RJM designed the study. SF and AT collected the data with support from DM. SF and AT led the analyses and drafted the manuscript. M-ML contributed to the quantitative analysis. MM and SJ undertook the economic analysis. All authors, including SG and RH, commented on and approved the manuscript. RJM will be the guarantor.

  • Funding This article presents independent research funded by a National Institute for Health Research Programme Grant RP-PG-1209–10051. RJM was supported by an NIHR professorship (NIHR-RP-02-12-015) and now by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust. CH is partly supported by the NIHR Biomedical Research Centre, Oxford and by the NIHR School of Primary Care Research. RH acknowledges part support from the NIHR School for Primary Care Research (SPCR), the NIHR Collaboration for Leadership in Applied Research in Health and Care (CLARHC) Oxford and the NIHR Biomedical Research Centre (BRC), Oxford. SG is partly funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands. DM was supported by an NIHR In Practice Fellowship at the time of the work.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests SF, AT, M-ML, SJ, MM, SG, RH, AW, DM and RJM declare no competing interests. CH has received expenses and payments for media work. He has received expenses from WHO and holds grant funding from the NIHR, the NIHR School of Primary Care Research, The Wellcome Trust and WHO. On occasion, he receives expenses for teaching EBM and is an NHS GP in the out of hours service in Oxford.

  • Ethics approval The study (qualitative and quantitative components) was approved by NRES South West (Cornwall and Plymouth) Research Ethics Committee (14/SW/1167).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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