TY - JOUR
AU - L. Tieu
AU - E. C. Khoong
AU - N. D. Shah
AU - M. M. Gosdin
AU - S. J. Wang
AU - A. Sharma
AU - N. Abtahi
AU - R. J. Stern
AU - C. Zhou
AU - U. Sarkar
AU - C. R. Lyles
A1 - 
AB - BACKGROUND: Self-measured blood pressure (SMBP) monitoring is an evidence-based practice effective for improving the diagnosis and control of hypertension. Healthcare settings face challenges integrating it into clinical care. PURPOSE: This study applied behavior change theory to design a clinic-based intervention to integrate SMBP within safety net primary care settings. METHODS: We conducted multi-phase, mixed methods research to adapt a clinic-level intervention across 25 safety net primary care clinics within three California public healthcare systems as part of the Championing Hypertension Remote Monitoring for Equity and Dissemination (CHARMED) Study. From February to August 2024, clinic champions participated in surveys and focus groups to assess: (i) current practices in hypertension management, (ii) implementation barriers, and (iii) strategies for optimizing the use of SMBP within clinics. Using the Behavior Change Wheel, we designed and tailored the intervention to improve clinical practices for SMBP. RESULTS: Over 50 clinicians/staff participated. Surveys revealed varying SMBP use due to knowledge gaps, lack of standardized processes, and insufficient financial and human resources. Focus groups highlighted the importance of increasing SMBP knowledge among patients and care teams (capability); promoting structured workflows/templates for documenting and acting on SMBP data (opportunity); and building care team buy-in for SMBP (motivation). These insights guided the final intervention activities. CONCLUSIONS: Using behavior change theory and stakeholder-engaged methods, we developed a multi-component clinic-focused intervention to promote tailored SMBP implementation within safety net primary care clinics. This evidence-based, adaptable approach may inform future efforts to implement SMBP at multiple levels of care. CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT06113458.; High blood pressure (also called hypertension) is a common health problem that can lead to serious conditions like heart disease and stroke. A proven way to help manage high blood pressure is for patients to regularly check their blood pressure at home. This is called self-measured blood pressure (SMBP) monitoring. However, safety net primary care clinics that often serve low-income communities and patients with public (e.g. Medicaid and County-run programs) or no health insurance face challenges in using SMBP as part of routine care. This study aimed to create a practical approach to help clinics better use SMBP. We worked with 25 safety net primary care clinics across California and gathered input from over 50 clinic staff and providers. Through surveys and group discussions, we learned about current practices, challenges, and what support clinics need. We found that clinics often lacked training, tools, and resources for using SMBP effectively. Using behavior change theory and feedback from clinic staff, we developed a multi-part program to support SMBP use. This includes training, workflow tools, and strategies to build team support. The final approach is flexible and designed to fit the needs of busy, resource-limited clinics. It may also be useful for others trying to improve blood pressure care in similar settings.; eng
AD - Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, United States.; Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, United States.; UCSF Action Research Center for Health, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, United States.; School of Medicine, University of California, San Francisco, CA, United States.; Department of Family and Community Medicine, University of California, San Francisco, CA, United States.; Contra Costa Health, Martinez, CA, United States.; Ventura County Health Care Agency, Ventura, CA, United States.; Department of Clinical Pharmacy, University of California, San Francisco, CA, United States.; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
AN - 41723583
BT - Transl Behav Med
C5 - Education & Workforce
CP - 1
DA - Jan 7
DO - 10.1093/tbm/ibaf094
DP - NLM
IS - 1
JF - Transl Behav Med
LA - eng
N2 - BACKGROUND: Self-measured blood pressure (SMBP) monitoring is an evidence-based practice effective for improving the diagnosis and control of hypertension. Healthcare settings face challenges integrating it into clinical care. PURPOSE: This study applied behavior change theory to design a clinic-based intervention to integrate SMBP within safety net primary care settings. METHODS: We conducted multi-phase, mixed methods research to adapt a clinic-level intervention across 25 safety net primary care clinics within three California public healthcare systems as part of the Championing Hypertension Remote Monitoring for Equity and Dissemination (CHARMED) Study. From February to August 2024, clinic champions participated in surveys and focus groups to assess: (i) current practices in hypertension management, (ii) implementation barriers, and (iii) strategies for optimizing the use of SMBP within clinics. Using the Behavior Change Wheel, we designed and tailored the intervention to improve clinical practices for SMBP. RESULTS: Over 50 clinicians/staff participated. Surveys revealed varying SMBP use due to knowledge gaps, lack of standardized processes, and insufficient financial and human resources. Focus groups highlighted the importance of increasing SMBP knowledge among patients and care teams (capability); promoting structured workflows/templates for documenting and acting on SMBP data (opportunity); and building care team buy-in for SMBP (motivation). These insights guided the final intervention activities. CONCLUSIONS: Using behavior change theory and stakeholder-engaged methods, we developed a multi-component clinic-focused intervention to promote tailored SMBP implementation within safety net primary care clinics. This evidence-based, adaptable approach may inform future efforts to implement SMBP at multiple levels of care. CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT06113458.; High blood pressure (also called hypertension) is a common health problem that can lead to serious conditions like heart disease and stroke. A proven way to help manage high blood pressure is for patients to regularly check their blood pressure at home. This is called self-measured blood pressure (SMBP) monitoring. However, safety net primary care clinics that often serve low-income communities and patients with public (e.g. Medicaid and County-run programs) or no health insurance face challenges in using SMBP as part of routine care. This study aimed to create a practical approach to help clinics better use SMBP. We worked with 25 safety net primary care clinics across California and gathered input from over 50 clinic staff and providers. Through surveys and group discussions, we learned about current practices, challenges, and what support clinics need. We found that clinics often lacked training, tools, and resources for using SMBP effectively. Using behavior change theory and feedback from clinic staff, we developed a multi-part program to support SMBP use. This includes training, workflow tools, and strategies to build team support. The final approach is flexible and designed to fit the needs of busy, resource-limited clinics. It may also be useful for others trying to improve blood pressure care in similar settings.; eng
PY - 2026
SN - 1869-6716 (Print); 1613-9860
ST - Applying behavior change theory to intervention design: promoting clinic-level implementation of self-measured blood pressure monitoring in safety net primary care settings
T1 - Applying behavior change theory to intervention design: promoting clinic-level implementation of self-measured blood pressure monitoring in safety net primary care settings
T2 - Transl Behav Med
TI - Applying behavior change theory to intervention design: promoting clinic-level implementation of self-measured blood pressure monitoring in safety net primary care settings
U1 - Education & Workforce
U3 - 10.1093/tbm/ibaf094
VL - 16
VO - 1869-6716 (Print); 1613-9860
Y1 - 2026
ER -