Exploring patient experiences of remote high blood pressure management in Scotland during COVID-19

This blog was written by Dr Sheona McHale, Research Fellow, School of Health and Social Care, Edinburgh Napier University British Heart Foundation Logo

The study discussed in this blog is funded by the British Heart Foundation.

25% is written in the middle of a circle.High Blood pressure can increase your risk of having a heart attack or stroke. If you can lower your blood pressure by 10mmHg, you can lower your risk of stroke by 25%. Find out about whether about whether you are at risk of stroke because of your blood pressure here.

The COVID-19 pandemic forced changes to healthcare delivery, which particularly affected the management of long-term conditions such as high blood pressure in GP surgeries. Telemonitoring is a way to monitor blood pressure without the need to visit your GP. It allows you to take your blood pressure at home and share your readings with your healthcare team via text or the internet. This is convenient and has been shown to improve blood pressure control.

In our study we wanted to understand how people diagnosed with high blood pressure experienced the delivery of a hypertension service during COVID-19. We were particularly interested in exploring people’s views and experiences of using remote home-based blood pressure monitoring technology and what they thought about going to hospital during the pandemic.

We wanted to learn how people diagnosed with high blood pressure accessed healthcare to manage their condition during a time when routine services were severely disrupted due to COVID-19. Also, we wanted to explore the experiences of patients within NHS Lothian primary care centres who used remote blood pressure telemonitoring to self-manage their high blood pressure during COVID-19 and to compare these to the experiences of patients who did not have access to blood pressure telemonitoring during the pandemic.

We designed a study to gain insight from asking people questions during a telephone interview. The telephone interview allowed us to gain personal views and experiences from high blood pressure patients managed in primary care within NHS Lothian, and who gave their consent to take part in the study.

A drawing of a blood pressure monitor.We planned to identify and recruit 40 participants via the NHS Research Scotland (NRS) Primary Care Network (20 participants who had experience of telemonitoring technology and 20 without access to telemonitoring technology). Potential participants were identified from clinical records and provided with study information packs. At this point in time, we have not completed the recruitment stage of the study. Upon completion of study recruitment, we aim to analyse the personal views and experiences of participants to help us understand how those diagnosed with high blood pressure accessed healthcare to manage their chronic condition during the C0VID-19 pandemic.

This study is led by Dr Janet Hanley, Associate Professor, School of Health and Social Care at Edinburgh Napier University. If you would like further information, please contact

Sheona McHale, Research Fellow,

Centre for Cardiovascular Health, Edinburgh Napier University,

Tel: 0131455 3476

Email: s.mchale@napier.ac.uk

Meet Ali, the avatar nurse who wants to help people to manage their atrial fibrillation

By Dr Coral Hanson, Senior Research Fellow, Edinburgh Napier University

Atrial fibrillation is a common abnormal heart rhythm that affects more than 2 million people in the UK. People with atrial fibrillation are more likely to have a stroke and these strokes are more likely to be severely disabling than strokes of other causes. A medication that prevents blood clots from forming (an oral anticoagulant), reduces this risk by two-thirds. However, 75% of people with atrial fibrillation do not take their medication as recommended either because they do not understand or believe in their medications, or forget.

We wanted to develop a digital solution to help people to remember to take their medication. At the start of the project, we talked to people who had atrial fibrillation and asked them what they thought should be included in a mobile app. They told us that they wanted to know more about their medication, get reminders to take it, and be able to record what they had taken. They also wanted easy to understand information about their condition and know when to seek medical help for symptoms.

The team at the Centre for Cardiovascular Health, colleagues at Flinders University in Adelaide in Australia, and a technology company called Monkey Stack developed a mobile health app called My AF Nurse: available at Google Play: My AF Nurse or  Apple: My AF Nurse.

Developing the app

First, we developed a storyboard that contained everything that would be in the app, and a script. We recruited one of our Scottish nurse colleagues to be the ‘voice’ of the app and students from the School of Arts and Creative Industries filmed her reading the script. The avatar’s facial expressions are based on the expressions of our ‘real Ali’.

Monkey Stack used the film and audio recorded by our students to create the finished app.

The My AF Nurse app

Ali, the avatar atrial fibrillation nurse is available 24 hours a day, seven days a week to help people to manage their atrial fibrillation. The app is jam packed full of information. We talked to cardiologists, doctors, other nurses, and patients to make sure we covered all the important stuff. Information is broken down into bite size chunks, so that users can listen in their own time, as many times as they want.  There is a medication tracker to help users to remember to take their medication at the right time, every time.

Testing the My AF Nurse app

Now that we have created the app, we are testing whether we can recruit patients to use it via their GP surgery or cardiology clinic. We are exploring how they use the app and trying to understand the best way to measure whether users take their medication. More information about this study can be found at:  https://doi.org/10.1186/ISRCTN10135302

Find out more about our research linked to Atrial Fibrulation