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      Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity

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          Abstract

          Purpose of Review

          To evaluate how self-measured blood pressure (SMBP) monitoring interventions impact hypertension equity.

          Recent Findings

          While a growing number of studies have recruited participants from safety-net settings, racial/ethnic minority groups, rural areas, or lower socio-economic backgrounds, few have reported on clinical outcomes with many choosing to evaluate only patient-reported outcomes (e.g., satisfaction, engagement). The studies with clinical outcomes demonstrate that SMBP monitoring (a) can be successfully adopted by historically excluded patient populations and safety-net settings and (b) improves outcomes when paired with clinical support. There are few studies that explicitly evaluate how SMBP monitoring impacts hypertension disparities and among rural, low-income, and some racial/ethnic minority populations.

          Summary

          Researchers need to design SMBP monitoring studies that include disparity reduction outcomes and recruit from broader populations that experience worse hypertension outcomes. In addition to assessing effectiveness, studies must also evaluate how to mitigate multi-level barriers to real-world implementation of SMBP monitoring programs.

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          Most cited references80

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          2018 ESC/ESH Guidelines for the management of arterial hypertension

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            Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

            This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
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              An Ecological Perspective on Health Promotion Programs

              During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.
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                Author and article information

                Contributors
                elaine.khoong@ucsf.edu
                Journal
                Curr Hypertens Rep
                Curr Hypertens Rep
                Current Hypertension Reports
                Springer US (New York )
                1522-6417
                1534-3111
                24 August 2022
                24 August 2022
                : 1-15
                Affiliations
                [1 ]GRID grid.416732.5, ISNI 0000 0001 2348 2960, Division of General Internal Medicine at Zuckerberg, Department of Medicine, , San Francisco General Hospital, UCSF, ; Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA 94110 USA
                [2 ]GRID grid.416732.5, ISNI 0000 0001 2348 2960, UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, ; San Francisco, USA
                [3 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Johns Hopkins School of Nursing, ; Baltimore, MD USA
                [4 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Epidemiology, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA
                Author information
                http://orcid.org/0000-0002-2514-3572
                Article
                1218
                10.1007/s11906-022-01218-0
                9399977
                36001268
                187bb347-d7ae-4689-b58f-9fb3a3b47afc
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 5 August 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100017540, NHLBI Division of Intramural Research;
                Award ID: K23HL157750
                Award Recipient :
                Categories
                Implementation to Increase Blood Pressure Control: What Works? (J Brettler and K Reynolds, Section Editors)

                Cardiovascular Medicine
                hypertension,blood pressure,disparities,self-measured blood pressure,telemonitoring

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