Perception about home-based monitoring of blood pressure and blood sugar among urban and rural individuals

Background: Hypertension and diabetes are the two chronic noncommunicable diseases requiring lifelong care and management. The present study was conducted to understand the perceptions of diabetic and hypertensive individuals regarding the home-based monitoring of blood pressure and blood sugar. Materials and Methods: This cross-sectional study was conducted from August through November 2013 at Saveetha Medical College, Chennai city, located in South India. A convenient sample of 100 individuals was enrolled in this study. Individuals having hypertension or diabetes and visiting to the Internal Medicine, outpatient department (OPD) of Saveetha Medical College were approached for the inclusion in the study. Information about sociodemographic characteristics, disease information source, knowledge, attitude, and practices, and economic aspects related to home-based monitoring of blood pressure and blood sugar. Results: The average age of the participants was 59 years (standard deviation (SD) = 11). Half of the subjects were males (52%) from urban locations (89%). More than half of them have followed some form of dietary measures (58%) to control the blood sugar level in normal limits. Majority of them have heard about home-based blood sugar monitoring device (99%) and 71% of them have heard about home-based blood pressure monitoring devices (electronic or manual). Forty-seven percent of the participants were monitoring their blood pressure, and 90% of them were monitoring their blood sugar at home. Conclusion: There is a need of further research on large scale to evaluate the knowledge, attitude, and practices related to the management of hypertension and diabetes among the individuals monitoring their blood pressure and blood sugar at home.

Keywords: Blood pressure, blood sugar, home-based monitoring, perceptions, rural population, urban population

High blood sugar and hypertension are two of the leading risk factors causing macrovascular and microvascular complications including myocardial infarction and stroke.^[1]

Globally, 382 million people have diabetes and it is expected to reach 592 million by year 2035, approximately 1.44 times of the present figure.^[2] Low- and middle-income countries (LMICs) are the major contributors to the mortality associated with diabetes, comprising of more than 80% of the global deaths.^[3] According to the projections of the World Health Organization (WHO) by the year 2030, diabetes will be the seventh leading cause of death around the world.^[4],[5] Previous studies have manifested substantial overlap of diabetes and hypertension emulating considerable overlap in the etiology and disease pattern.^[1],[6],[7] Report of the WHO has shown that over 1 billion of the world population is living with hypertension.^[8] Worldwide, hypertension accounts for 9.4 million deaths every year.^[9]

Prevalence of hypertension in India is approximately in the range of 10-40%.^{[10],[11],[12],[13]} Sixty-five million individuals living in India are estimated to be diabetic, which is expected to reach 109 million by the year 2035.^[2]

Previous studies have advocated home blood pressure monitoring (HBPM) and home blood sugar monitoring (HBSM) as adjuncts to prevent adverse effects of hypertension and diabetes.^{[14],[15],[16],[17],[18]} The third Indian guidelines on hypertension have encouraged HBPM due to its usefulness at follow-ups.^[19] The Indian Council of Medical Research (ICMR) guidelines for the management of type 2 diabetes have indicated self-monitoring of blood glucose to achieve better control of diabetes.^[20] A previous study had shown that social status did not affect the probability of home-based blood sugar testing and the frequency of testing decreases with age.^[21] Another previous study has shown HBPM as a means for facilitating the patient-clinician relationship.^[16] knowledge about the diabetes and hypertension management is vital for HBPM and HBSM.

The present study was conducted to understand the perceptions of diabetic and hypertensive individuals regarding the HBPM and HBSM.

This cross-sectional study was conducted from August through November 2013 at Saveetha Medical College, Chennai city, located in South India. A convenient sample of 100 individuals was enrolled in this study. Individuals having hypertension or diabetes and visiting to the Internal Medicine, outpatient department (OPD) of Saveetha Medical College were approached for inclusion in the study. Individuals with mental or physical challenges, making them difficult to participate, and individuals who were enrolled in other clinical trials were excluded from the study. The purpose of this study was informed to the participants before their enrollment and those who gave consent were enrolled in the study. The protocol of this study was approved by the Institutional Review Board of the Foundation of Healthcare Technologies Society, New Delhi (IRB#FHTS/020/2013) and it confirmed the provision of the Declaration of Helsinki (as revised in Seoul 2008).

Data collection tools

A modified questionnaire was prepared from existing validated tools. It consisted of following contents.

Sociodemographic characteristics

Information was gathered about age (years), gender, educational status (Grade 1-5, Grade 6-8, Grade 9-10, Grade 11-12, Graduate or above, and no education), marital status (single/married/divorce or separated/widow), annual household income (INR), type of family (joint, nuclear, broken, and extended), family size, occupation status (professional, business, skilled worker, housewife, retired, unemployed) and work shift timings (morning, evening, night, alternate, and day).

Diabetes and hypertension history and their information-seeking behavior

Information was gathered about the family history of diabetes and hypertension. Additional information was gathered about the various sources of health-care information.

Knowledge, attitude, and practices related to blood pressure and blood sugar management

Information was gathered by using 13 items in the blood pressure and blood sugar related knowledge, attitude, and practice questionnaire, which included self-rated knowledge, proceedings required during measuring of blood pressure, measures followed for keeping blood pressure and blood sugar in normal limits, heard about home-based blood pressure and blood sugar monitoring devices and use of them by the participants in their homes, type of blood pressure and blood sugar monitoring device being used, frequency of monitoring blood pressure and blood sugar, measures taken on finding the high blood pressure reading, and measures taken on abnormal blood sugar reading.

Financial aspects

Information was gathered about the prices of blood pressure and blood sugar monitoring devices being used at homes of the participants. In addition, information on the price of blood sugar strip pack was also gathered.

Challenges and suggestions

Information was gathered regarding the challenges faced by the participants while using blood pressure and blood sugar monitoring devices. Additional information was gathered about the suggestions for the improvements in home-based blood sugar monitoring device.

The average age of the participants was 59 years (SD = 11). Half of them were males (52%) from urban locations (89%). Majority of them were married (85%) living in nuclear family (75%) with an average family size of 4 (SD = 2). One-third of the participants had education level up to graduation or above (34%). Twenty-three percent of them were businessmen with an average annual household income of 409,392 INR ($ 682 USD) [Table 1].

Majority of the participants had family history of diabetes (82%) and/or hypertension (78%). The participants reported health-care professionals (48%) as the most important source of health information [Table 2].

The proportion of participants who have rated their knowledge about hypertension and diabetes above average were 41% and 57%, respectively. Half of the participants reported the use of medication (53%) for keeping normal blood pressure, while more than half of them have followed some form of dietary measures (58%) to keep the blood sugar level within normal limits. Majority of them have heard about home-based blood sugar monitoring device (99%) and 71% of them have heard about home-based blood pressure monitoring devices (electronic or manual). Forty-seven percent of the participants were monitoring their blood pressure and 90% of them were monitoring their blood sugar at home. Sixty-six percent of the participants monitoring their BP at home agreed on relaxing during the time of measurement. Fifty-three percent (N = 25) of them reported no set pattern in monitoring blood pressure while 11% (N = 5) were monitoring BP in every 2-3 days. Near about two of the three participants monitoring blood pressure at home call physician (34%; N = 16) or visit hospital (30%; n = 14) in case of high blood pressure reading. Forty percent of the participants were testing their blood sugar in every 2-3 days and in case of abnormal blood sugar reading self-medication was reported by 26% of the participants [Table 3].

Results have shown that among the 53% (N = 25) of the HBPM participants the price of the monitoring device was more than 1,500 INR (25 $ USD). Half of the participants were using blood sugar monitoring devices of 1,001-2,000 INR (17-33 $ USD). One of the three participants were using blood sugar strips of more than 1,000 INR (17 $ USD) [Table 5].

In both HBPM and HBSM, common concern shown by the participants was difference in reading in comparison to physician’s clinic and laboratory test, respectively. Accuracy similar to laboratory test (49%) and development of cost-effective devices (42%) were the two main suggestions for improvement in blood sugar monitoring devices. Forty-five percent of the participants wanted painless blood sugar measuring devices [Table 4].

Home-based monitoring of blood pressure and blood sugar is one of the effective measures in reducing the burden of complications associated with hypertension and diabetes. This study was conducted to understand the perceptions of individuals about the home-based monitoring of blood pressure and blood sugar.

In the present study, self-rated knowledge of hypertension and diabetes was above average in 41% and 57% of the participants, respectively. However, half of them were not aware about the proceeding required during measurement of blood pressure (52%). Previous study had shown that the individuals performing HBPM were familiar with their hypertension treatment.^[14]

Forty-seven percent of the participants were monitoring their blood pressure at home and 90% of them were monitoring their blood sugar at home. Eleven percent of the HBPM and 40% of the HBSM were measured in every 2-3 days. Previous study had shown daily testing of blood sugar by 39.3% of the individuals.^[21] In case of high blood pressure reading, two-third of the participants approached physician or visited hospital. Among the diabetics, abnormal blood sugar reading was managed by self-medication (26%). Previous study had shown that HBPM had increased the compliance to the advice given by the health-care professional.^[14]

The cost of home-based blood pressure monitoring device was more than 1,500 INR (25 $ USD approx.) that is used by 53% of the users. Forty percent of the HBPM were using manual blood pressure measuring device. This can be attributed to their cheaper cost. The cost of sugar testing strip pack was more than 1,000 INR (17 $ USD approx.) as reported by 35% of the users. Previous study had shown that 50% reduction in the cost of blood testing strips leads to considerable increase in the likelihood of cost-effective HBSM.^[22]

The difference in reading from physician and/or laboratory measurements was the most important concern of the participants. Previous study has shown that due to pain and discomfort individuals perform SMBG infrequently.^[23] Our findings have shown that half of the individuals practicing HBSM suggested for painless procedures.

Our study had certain limitations including the cross-sectional design and smaller sample size. As the study was performed in one geographical area its results cannot be generalized.

Results of the study have shown that very few participants inclined toward dietary and physical activity measures on finding abnormal blood pressure or blood sugar readings. It shows that alone HBPM and/or HBSM cannot bring lifestyle changes for effective control of blood pressure and blood sugar. There is a need of further research on a large scale to evaluate the knowledge, attitudes, and practices of hypertension and diabetes among the HBPM and HBSM individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.205553

[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]