Table 1. Workflow of Self-Measured Blood Pressure Monitoring Programs at 5 Hawaiʻi Community Health Centers.

Health Center Number/Location/Sizea	Interviewees	% of Patients With Hypertension (2018)a	Activities
			Recruitment	Intake, Program Delivery, and Follow-Up	Hypertension Education and Lifestyle Change
1. Rural/large	2 CHWs	27.8	• Recruitment: DPP, EHR • Referral: physician • Outreach: community, FQHC physicians	• Intake: readiness assessment and introduction • Enrollment location: office or home • Measurement training: office or in home • Monitor set-up: in home • Program length: target, 3–6 months • Log collection: office or home • Calculation: manual, entered into EHR for physician	• Counseling and goal setting • Physical activity: planning, off-site group activities (eg, hula, bicycle rides) • Diet: healthy eating • Referrals: DPP, care management
2. Urban/large	Program coordinator	16.0	• Recruitment: DPP • Referral: physician	• Intake: readiness assessment, introduction, hypertension education before enrollment (3 sessions) • Enrollment location: office • Measurement training: office • Monitor set-up: office • Program length: target, 5 months • Log collection: office • Calculation: manual	• Physical activity: planning, on-site trainer/gym • Diet: DASHb education • Referrals: dietician, tobacco cessation
3. Rural/large	Pharmacist, 2 CHWs	25.7	• Recruitment: EHR • Referral: physician	• Intake: readiness assessment and introduction • Enrollment location: pharmacy • Measurement training: office • Monitor set-up: office • Program length: 3 months • Log collection: office once per month • Calculation: manual, entered into EHR for physician	• Physical activity: planning, on-site gym • Diet: nutritionist/dietitian referral • Incentive program: diet/physical activity–related incentives • Referrals: tobacco use cessation, sleep studies
4. Rural/small	APRN, physician	20.9	• Recruitment: EHR • Referral: physician	• Intake: readiness assessment and introduction • Enrollment location: office or home • Measurement training: office or home • Monitor set-up: office or home • Program length: unlimited • Log collection: at home or in office, transferred by tablet to health information system • Calculation: electronic, health information system	• Counseling and goal setting • Physical activity: planning, on-site wellness program • Diet: planning, PILI ‘Ohana (existing culturally adapted diabetes curriculum for Native Hawaiians and other Pacific Islanders)
5. Urban/large	Program coordinator	38.7	• Recruitment: EHR • Referral: physician • Outreach: patients and FQHC physicians	• Intake: readiness assessment and introduction • Enrollment location: office • Measurement training: office or home • Monitor set-up: office or home • Program length: 3 months • Log collection: at home or in office • Calculation: manual, entered into EHR for physician	• Physical activity: on-site group activities (eg, hula) • Diet: food demonstrations • Ola Hou lessons (culturally adapted existing self-measured blood pressure monitoring program curriculum) • Referrals: medication payment assistance

Abbreviations: APRN, advanced practice registered nurse; CHW, community health worker; DASH, Dietary Approaches to Stop Hypertension; DPP, National Diabetes Prevention Program classes; EHR, electronic health record; FQHC, federally qualified health center.

^a A small health center had <10,000 clients on average during 2016–2018; large centers had ≥10,000 on average for the same period. Source: US Department of Health and Human Services, Health Resources and Services Administration (13).

^b Source: National Heart, Lung, and Blood Institute (14).