Review Article

The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings

Table 3

Summary of a selected randomized controlled trial.

AuthorNLevel of education/Health literacy/Social factorsInterventionControlOutcomesAny association between educational level and home BP monitoring?Do the interventions result in better BP control?Quality of evidence

Bachmann et al. [48], Switzerland, 200248NASubjects received information about the storage capabilities of HBPMSubjects did not receive information about the storage capabilities of HBPMManipulation of HBPM values for the first time. Accuracy and interpretation of HBPM may be increased by using devices with a memoryYNA⊕⊕⊕ moderate
Binstock and Franklin [49], USA, 1988120NAHBPM or a combination of techniquesEducation alone, contract, or pill packs aloneSBP and DBPNAY⊕ low
Brenna et al. [50]. USA, 201048594% ≥graduated high schoolTelephonic nurse DM: educational materials, lifestyle, and diet counselling
HBPM versus HBPM alone
Light support educational programIncrease proportion with BP < 120/80 mmHg, mean systolic BP, mean diastolic BP, and frequency of HBPM after the interventionYY⊕⊕ low to moderate
DeJesus et al. [51], USA, 200954NA(1) Nurse educator conducted class + HBPM
(2) Nurse educator class
Usual careOnly 20% achieved the target BP of 130/80 mmHg and there was no statistical difference in mean systolic and diastolic BP among the three groupsNAN⊕ low
Figar et al. [52], Argentina, 200660Year of educationCompliance-based model includes HBPMPatient empowerment model of educationChange in systolic BP by 24 h ABPMNAN⊕⊕ low to moderate
Fung et al. [53], Hong Kong, 2003240NAIndividual education by research assistance of HBPM device operation
Self-practice under supervision
Checkpoints are correct
Usual careNo significant difference in BP
changes between the two groups
YN⊕⊕⊕⊕ moderate to high
Green et al. [54], USA, 2008778<12 years
Some after high school
4-year college
After 4-year college
HBPM and secure patient web services training + pharmacist care management delivered through web communicationsUsual careBP levelNAY⊕⊕⊕⊕⊕ high
Haynes et al. [55], Canada, 197638SteelworkersTaught how to measure their own BP, chart their pill-taking, taught how to tailor pill-taking to their daily habits and rituals, FU by nonprofessionalsUsual careImprovement in drugs compliance and BPNAY⊕⊕ low to moderate
Kauric-Klein and Artinian [56], USA, 200734Year of educationHBPMUsual careImprovement in SBP but not DBPNAY⊕⊕⊕⊕ moderate to high
Kim et al. [57], USA, 2014369HT knowledge self-efficacy: HT belief scale; HT health literacy scale ≤ middle school graduate; high school graduate; ≥some college2-hour weekly educational sessions × 6 on HBP management skill building, including health literacy training, followed by telephone counselling and HBPM for 12 monthsIntervention delayIntervention group showed improvement in mean SBP & DBP
Improvement in health literacy in 12 and 18 months adherence to HT medication, self-efficacy, and HBP knowledge and less depression
NAY⊕⊕⊕ moderate
Maciejewski et al. [58], USA, 2014591Completed <12 years of education3 telephone-based interventions: nurse administered health behavior promotion
Provider-administered medication adjustments based on HT treatment guideline
Combination of both
Usual carePatients randomized to the combined arm had greater improvement in the proportion of BP control during and after the 18-month trialYYUnclear
Magid et al. [59], USA, 2011338High school educationPatient education including remote HBPM, reporting to an interactive voice response IVR phone system
Pharmacists follow-up
Usual careNo difference in proportion of achieving BP goal at 6 months
Reduction of mean SBP and DBP
NAN⊕⊕⊕ moderate
Morgado et al. [60], Portugal, 2011197Illiterate, elementary schooling, high schooling, university educationQuarter FU by a hospital pharmacist
Provided patient education goal BP to achieve, medication education and recommendations to the physician regarding changes in drug therapy
No pharmacist careBetter medication adherence, significant lower SBP and DBP were observed in the intervention groupNAY⊕⊕⊕⊕⊕ high
Nessman et al. [61], USA, 198052Noncompliance patientHBPM education patients select BP drugs emphasizing self-help informed programListened to audiotape on hypertension knowledge and management nurse adjusted the drug regimensLower DBP
better pill counts
better attendance
NAYUnclear
Ogedegbe et al. [62], USA, 20141059≤High school
Some college
Some graduate school
4 modules of interactive computerized patient education HBPM
Monthly lifestyle counselling
clinicians CME based training, HT case round, clinical audits of patient office BP readings
Patients and physicians received printed patient education material and hypertension treatmentMarginal significantly greater BP control in patients with moderate to good health literacyNAY⊕⊕⊕ moderate
Victor et al. [63], USA, 20111022Black-owned barbershops
</=high school college postgraduate
10 weeks of baseline BP screening offer
BP checks with haircuts promote physician check-up
Sex-specific peer-based health messaging
Received standard BP pamphletsImprovement in hypertension control rateNAY⊕⊕⊕ moderate
Yi et al. [64], USA, 2015900Hispanic urban population
Uninsured
Received a home blood pressure monitor and training on useUsual careNo significant difference in BP changesNAN⊕⊕ low to moderate
Yoo et al. [65], Korea, 2009123NAUbiquitous chronic disease care system using the cellular phone
Internet for overweight patients
Usual careSignificant reduction of BP in the intervention groupNAY⊕⊕⊕ moderate
Zillich et al. [66], USA, 2005125Pharmacists provided patient-specific educationControl group care + patient and physician educational program about hypertension treatment and monitoringProvided with an HBPM device, instructed to measure BP > once daily for 1 monthMore reduction of BP in the intervention groupNAY⊕⊕ low to moderate

BP = blood pressure; DBP = diastolic blood pressure; FU = follow up; HBPM = home blood pressure monitoring; N = No; NA = not available/applicable; SBP = systolic blood pressure; Y = Yes.