Table 2. Barriers and Facilitators to Implementing Self-Measured Blood Pressure Monitoring Programs (BPMPs) at 5 Hawaiʻi-based Federally Qualified Health Centers.

Category	Action
Barrier
Availability and limitations of blood pressure monitors
Monitors costly for patients, clinics Older monitors not Bluetooth-enabled, led to hand calculating blood pressure averages, which was time consuming	Used donated monitors, create monitor loan program for patients
Patient-related issues
Disabilities, family, finances, houselessness, immigration status, fear of hypertension or worsening of condition, and transportation	Staff implemented readiness assessments to identify patients willing and able to participate Some sites implemented pre-enrollment education before distribution of monitors Institute monitor loan agreements Assist patients in their homes
Staffing challenges
Provider turnover and other patient needs led to a lack of referrals	Self-monitored BPMP staff had to train refresh physicians to remind them of the service
Systemic challenges
No single “out-of-the-box” self-measured BPMP program available Lack of integrated data management between monitors and electronic health records Uniform data system reporting Disagreement about hypertension diagnostic cutoffs led to delayed referrals at one center Funding and reimbursement for program sustainability	Staff constructed programs from existing materials, recommendations One site used Bluetooth-enabled monitors to transfer data to electronic health record
Facilitator
Systemic
Grant funding	Allowed sites to hire staff for self-measured BPMPs, access technical assistance to build programs
Shared technical assistance	Sites helped each other and shared tips and ideas
Existing resources	American Heart Association resources, other educational programs materials, capacity-building assistance
Patient-related
Program word-of-mouth	Patients let others know about the program and availability of blood pressure monitors
Hypertension education	Patients helped diffuse information about hypertension to families/friends
Clinical practice–related
Patient-centered/team-based approaches	Clinics used a variety of staff, including clinicians, pharmacists, and CHWs, who employed patient-centered approaches (eg, lifestyle change, home visits)
Integrating self-measured BPMPs into clinic practice	Integration of self-measured BPMPs into clinical workflows, including into the electronic medical record for referral and entering blood pressure readings

Abbreviations: CHWs, community health workers; BPMPs, blood-pressure monitoring programs.