PATIENT THEMES
DIAGNOSIS 10
ROUTINE CHECK UP / OUT OF BLUE 4
We came back, in order to get my medication I went along to see the local doctor, and lo and behold
my blood pressure was up. And I think because I had not been living a fit, active lifestyle, I had a
healthy lifestyle, but I wasn’t fit, I’d lost the athletic fitness from work and from playing a lot of
squash. And that’s the point at which...and it wasn’t very high, it was something like 150 over 90, 95,
and it’s fluctuated up and down from there. So that’s when I was first aware of it, and I’ve been aware
of the fact that I’ve gone in regularly to be monitored by the practice nurse, and done this and that,
and basically it hasn’t really changed. I’ve gone on to adjust my diet...
Aye, a letter said “Would you come..?
(BB_f_nm)
High blood pressure? How did I first…probably a doctors’ surgery I would imagine. I can’t really
remember it. I’ve been on medication for quite a while you see so I think it would have been
probably an annual check up or something
PB_m_nm(2)
It was just taken by chance one day. And it was ridiculous, it was a hundred and eighty over a hundred
and ten or something and I just saw the nurse's face sink and then take again, and the second time
around it was a hundred and seventy over a hundred and ten and that was it. But pretty vague as
to…well totally, as I say, totally vague as to where it could have come from because I wasn't say like
grossly overweight, I wasn't…didn't smoke at all, it was difficult to……I mean I did have a more difficult
lifestyle at the time, a lot of commuting, a lot of driving, so whether it was down to that to an extent.
But they just don't know because there was such a gap between the okay measure in two thousand
and three and two thousand and four
(PB3_m_m)…
I mean I think my surgery contacted me when they did an audit of the people that had had blood
pressure and I didn’t know I had blood pressure problems until they sent me the monitor and I
phoned up and they said “Oh we’ve checked everybody’s file and everybody that’s got it, mentioned
in the file” and mine just mentioned when I was pregnant like, my youngest daughter’s now eighteen
so I was a wee bit…so say it was maybe like I don’t know, maybe it had been twelve years before and
I’m thinking that’s strange them calling me now, however my blood pressure was borderline high so
they just…they gave me benzoflumethiazide tablets and that was what I had been on and that alone
until I got this monitor for the six months. And now I’m on candesartan as well.
(BB_f_m)
DIAGNOSIS IN RELATION TO OTHER CONDITION / STUDY 1
I found out that I had hypertension probably about six years ago and I think…no, I think it was…it
might have been…I’m part of a health study called the Stress and Health Study of ten thousand people
taken around…from the Civil Service and I’ve been doing that for the last twenty years. And I think
during that perhaps that it was noted that I had had high blood pressure and I should go and see my
1
GP which I did so they started treating me with various tablets and…which have been changed from
time to time over the years
(PB_m_nm)
POSITIVE PERCEPTION OF USUAL CARE 5
Oh yeah, yeah, they’ve been really good. The nurses are just marvellous and they’re very good with
my bloods as well. “We’ll just check your bloods and make sure that all your readings, your liver and
your kidney functions…” because I’m on the tablets. So I find yeah, they’re very, very good at looking
after you.
(BB2_m_nm)
I mean basically I get my blood pressure checked sort of when it’s…when the GP considers it is
necessary and they…if it’s higher then they…they’ll adjust the tablets so if I have problems with the
tablets that I’m taking which I have done on a number of occasions that I had atenolol which I found
made me very, very tired and they changed to another, basically, which I had some problems with
that, then changed to another one and then they do check the blood pressure reasonably regularly
and it has been increased, the dosage of my most recent one has been increased twice so
So quite a lot of changing of medication and…?
Yes there has been over the years, that’s right, so every…not every few weeks or anything but I’d
maybe sort of go for three or four years and then start to get some problems and then sort of...
(PB_m_nm)
The doctors are that nice....Oh – they’re all good doctors. We are very lucky. Och – they’re all that
nice
(BB_f_nm)
Hmm mm, well my blood pressure was fairly well controlled and generally only having it maybe
checked once a year….So for me it wasn't really an issue, a concern
(MK_f_m)
I think…I have to say I think that I am very happy with the way that the GP has…and the way in which
she’s dealt with them... Yes. No I get very good treatment from the GP …
(PB_m_nm)
INFORMATION ABOUT BP (FROM GP AFTER DIAGNOSIS) 16
RECEIVED/NOT RECEIVED/ 10
I think that probably the only thing I got was I did get an awful lot of bumf, not in any way difficult to
understand, but a lot of it was repetitive, there was a lot of it that was duplicated on documents and
this, that and the other. And I’m a big one for sort of …..So I did get a lot of bumf but, yeah, I mean it
talked about low salt, more exercise, watch your weight etc. So it was fine from that point of view.
(BR3_m_m)
Well yeah, because they gave pretty good…they gave me a sort of two sort of printed sheets on
hypertension and how I could help it with IU weight loss. So that was quite good and I go regular and
2
they’ve been very good at the surgery and they send me the letter for my formal check ups to come in
and get my BP checked
(BB2_m_nm)
Yeah we’re bombarded nowadays on television and newspaper and pamphlets here and there about
not smoking, and taking a proper balanced diet and not too much fat and all these sort of things. But
it’s strange if anyone doesn’t know about that nowadays.
BR4_m_m
I believe I did, I mean I did
(PB_m_nm)
Oh aye. I mean we were told a lot and then we got a lot of information, aye.
(BB_f_nm)
I don’t think they ever did (give information on BP management)
BR_m_m.
I think the advice was…they were looking for a drug to prevent it
(BB2_m_m)
I can’t remember if they…if I was advised to go and buy a home monitoring machine but I decided to
do it anyway.
(PB2_m_nm)
It’s always good to get information on dietary stuff - get a reminder - because it changes
(BB2_m_nm)
Well obviously they tell you to try and watch your diet, watch your weight, watch your alcohol intake.
(PB_m_nm)
PERCEPTION OF ADVICE / (HELPFUL/VAGUE/NEGATIVE/EXCESSIVE) 6
ALREADY KNEW/SENSIBLE/USEFUL
I already knew about trying to live a reasonably healthy lifestyle, sort of…I do actually love fruit and
vegetables, I already eat quite a lot of fruit and vegetables.
(PB_m_nm)
No, I don’t think so. I don’t think so. I couldn’t think of anything that sort of…that was suggested that
I disagreed with. I mean it all made sense to me …./…..I think I know, like most people have…I would
like to think like most people but I think I know what I should be doing. I know very well I’m not
always doing that, I know that. ….I know that the weight is…weight has had quite an effect on blood
pressure and so does lifestyle, there’s no doubt about it, if you’re going to abuse your body, a life of
cigarettes and so on and alcohol and so on
(PB_m_nm2)
3
Yes, oh yes, I found it very useful, I was given a booklet about dietary…suggesting dietary things and,
no, it was all very useful, I think the information that's now available and that you're given in a
practice when there is some problem that you need medication for is actually excellent and, of
course, there's stuff widely available on the Web as well but, you know.
(PB_m_nm2)
VAGUE
I would say it (advice) was probably a bit vague, I wasn't told the different…or in any great detail other
than one, two, three, the different groups of medication that were involved or might be involved, the
other options that might be involved in terms of exercise and that sort of thing which it was really…
A bit vague on how to manage it, totally vague on where it came from, it was all just a bit frightening
in a way because it just sort of appeared, it had never been raised before, I think I'd had just by
chance a blood pressure…
(PB3_m_m)
NEGATIVE
F1: Did you get information about how to manage it, and was it useful information or not?
M1: Well ..the truth good service. Right. How do I put this quietly? Yes, they told me, they
gave me all the information, all things that I’m not supposed to do.
F1: So it was all very negative.
M1: And they gave me that much information about what I don’t do, and they didn’t give me
that much information about what I should do.
F1: Yes. That’s an interesting way of putting it. Yes. So it was all very negative.
M1: And it was everything, ‘don’t do this, don’t do that.’ It was like being a wee ‘un again.
So, ‘You don’t do this, you don’t do that and you don’t do the next thing.’
I says, ‘That’s fine. What do I do?’
(PB _m _m)
HOME MONITOR TO GET MORE INFORMATION
I can’t remember if they…if I was advised to go and buy a home monitoring machine but I decided to
do it anyway. (Yeah. Why was that?)
Why did I decide it? Because I knew that my blood pressure would be checked every time, regularly
at the surgery but certainly twice a year, possibly more, I think it…probably about twice a year but
until that I would like more information than that and I had had…I had been told that these home
monitoring machines are actually now…they weren’t always at one time, but they’re actually quite
accurate and I found when I have checked my blood pressure, let’s say on a morning when I knew I
was going to go to the surgery, I found that the figures were quite close.
(PB_m_nm2)
4
IMPACT (OF DIAGNOSIS) ON SELF CARE/LIFESTYLE 26
CARRIED ON AS USUAL/REGULAR CHECKS/POSITIVE ABOUT CARE STAFF 12
No, I just take the tablets and that’s me, I’ve done it for the day so…and I know it’s helping me. I’ve
got my wee blood pressure machine, the wee cuff on.
(BB2_m_nm)
High blood pressure? Of course it tends to be symptomless doesn’t it?
(PB_m_nm)
Aye. Because I hear some folks saying “Oh my blood pressure’s a bit up ken” but I don’t feel any
effects of it at all.
(BB_f_nm)
I feel very much in control having lived with AIDS, brucella induced acquired immune deficiency, I’m
very in tune with how my body works and how I respond to this and that. And my blood pressure, it’s
never been an embarrassment; I’ve never felt it was of importance.
MK_m_m/D/Out
So, yeah, is there anything, I mean how else does it impact on your life, I mean how do you…?
Not really, I mean I just, I retired twelve years ago, I just take my own time, right now I’ve been
stripping wallpaper and that. So I…but no, I would say I manage fine.
So it hasn’t sort of changed your life too much?
No, no.
I’m not the worrying kind. If I was I would get something done about it[laughter]
(BB_f_nm)
Hmm mm, well my blood pressure was fairly well controlled and generally only having it maybe
checked once a year….So for me it wasn't really an issue, a concern
(MK_f_m)
Oh I just take my tablet. I don’t think about it…..I’m not the worrying kind so probably if I was a wee
bit, probably be better for me. (Later) I don’t see the point in worrying over things. I’d like to lose
weight but I can’t seem to get in the right frame of mind
(BB_f_nm)
Oh yeah, yeah, they’ve been really good. The nurses are just marvellous and they’re very good with
my bloods as well. “We’ll just check your bloods and make sure that all your readings, your liver and
your kidney functions…” because I’m on the tablets. So I find yeah, they’re very, very good at looking
after you.
(BB2_m_nm)
5
I mean basically I get my blood pressure checked sort of when it’s…when the GP considers it is
necessary and they…if it’s higher then they…they’ll adjust the tablets so if I have problems with the
tablets that I’m taking which I have done on a number of occasions that I had atenolol which I found
made me very, very tired and they changed to another, basically, which I had some problems with
that, then changed to another one and then they do check the blood pressure reasonably regularly
and it has been increased, the dosage of my most recent one has been increased twice so
So quite a lot of changing of medication and…?
Yes there has been over the years, that’s right, so every…not every few weeks or anything but I’d
maybe sort of go for three or four years and then start to get some problems and then sort of...
(PB_m_nm)
The doctors are that nice....Oh – they’re all good doctors. We are very lucky. Och – they’re all that
nice
(BB_f_nm)
I think…I have to say I think that I am very happy with the way that the GP has…and the way in which
she’s dealt with them... Yes. No I get very good treatment from the GP …
(PB_m_nm)
IMPACT OF DIAGNOSIS AS TRIGGER FOR CHANGE IN LIFESTYLE 7
STARTING TO/TRYING T O MAKE CHANGES 5
Well, the first time I ever found out I’d got high blood pressure was years and years ago, it was about
12 years ago actually, because it was for a life policy to cover a mortgage, and the life company – who
I worked for at the time – turned me down for life cover……Well, I was knocked sideways by that. So I
dieted and I got it down and I reapplied and I was accepted on standard terms. So I’m aware obviously
that diet does affect it. I mean I was hugely overweight, I was 16 stone and a bit.
(BR2_m_m)
So I’m looking to get it down. I’m dieting as well, I’ve lost eight pounds in the last three weeks, I’m
trying to lose about a stone and a half before Christmas and it seems to be doing okay. Because I’m
obviously aware that that brings it down as well.
(BR2_m_m)
Well – I’ve changed my diet….and the nurse said, ‘well, cut out salt.’ And that was no problem, I went
to stop cooking with salt, and that brought it down considerably. And I had put on a bit of weight,
again living this indolent life, shall we say. *laughter+….but I’ve changed you see, because again,
because that was not a good thing, I lost some weight. But it still left me moderately.
MK_m_m /D/Out)
No, I just take the tablets and that’s me, I’ve done it for the day so…and I know it’s helping me. I’ve
got my wee blood pressure machine, the wee cuff on.
(BB2_m_nm)
And I’m conscious of it because what I’m looking to do you do have to have a medical, and blood
pressure is one of the key things that they don’t want, if you have high blood pressure you’re out. So
I’m looking to get it down. I’m dieting as well, I’ve lost eight pounds in the last three weeks, I’m trying
6
to lose about a stone and a half before Christmas and it seems to be doing okay. Because I’m
obviously aware that that brings it down as well.
(BR2_m_m)
IMPACT ON WORK PROSPECTS MOTIVATE CHANGE 2
Well, the first time I ever found out I’d got high blood pressure was years and years ago, it was about
12 years ago actually, because it was for a life policy to cover a mortgage, and the life company – who
I worked for at the time – turned me down for life cover……Well, I was knocked sideways by that. So I
dieted and I got it down and I reapplied and I was accepted on standard terms. So I’m aware obviously
that diet does affect it. I mean I was hugely overweight, I was 16 stone and a bit.
(BR2_m_m)
And I’m conscious of it because what I’m looking to do you do have to have a medical, and blood
pressure is one of the key things that they don’t want, if you have high blood pressure you’re out. So
I’m looking to get it down. I’m dieting as well, I’ve lost eight pounds in the last three weeks, I’m trying
to lose about a stone and a half before Christmas and it seems to be doing okay. Because I’m
obviously aware that that brings it down as well.
(BR2_m_m)
BARRIERS TO LIFESTYLE CHANGES 3
OTHER CONDITIONS 1
I had a severe injury to an ankle and I’ve basically got a metal ankle and I can’t do as much as I would
like to do now so I’m fighting stuff from the past if you know what I mean.
(B2_m_m)
HARD TO FIND THE MOTIVATION 1
Oh I just take my tablet. I don’t think about it…..I’m not the worrying kind so probably if I was a wee
bit, probably be better for me. (Later) I don’t see the point in worrying over things. I’d like to lose
weight but I can’t seem to get in the right frame of mind to do something about it.
(BB_f_nm)
KNOWING WHAT BUT NOT HOW 1
Well you’re using a strange word, managing your blood pressure.
Well I don’t know how to manage my blood pressure.
What I did do and I’ve stuck to it, I’ve cut out salt.
I was overweight a few years ago and I cut out butter, so now I don’t have butter and I don’t have salt.
(I) just (use) general knowledge, just tried to reduce salt, reduce weight. And salt brings up your blood
pressure so…
I think they know I’m beyond redemption *both laugh+.
I still fly when I can. I’m quite happy to be up in an aeroplane and fly.
I keep bowling. I don’t do much walking because my legs don’t let me walk, they’re not sore but I
don’t seem to be able to get the nice flow of walking.
(BR_m_m)
7
BOUGHT USE OF OWN HOME-MONITOR TO INFORM BP MANAGEMENT 4
FOR MORE INFORMATION 1
I can’t remember if they…if I was advised to go and buy a home monitoring machine but I decided to
do it anyway.
Yeah? Why was that?
Why did I decide it? Because I knew that my blood pressure would be checked every time, regularly
at the surgery but certainly twice a year, possibly more, I think it…probably about twice a year but
until that I would like more information than that and I had had…I had been told that these home
monitoring machines are actually now…they weren’t always at one time, but they’re actually quite
accurate and I found when I have checked my blood pressure, let’s say on a morning when I knew I
was going to go to the surgery, I found that the figures were quite close.
(PB_m_nm1)
TO MONITOR VARIATION/ EVIDENCE FOR ACTION 2
I’ve got my wee blood pressure machine, the wee cuff on.
Okay. Is this your own one?
Yes, I take that maybe once a week just to sort of keep an eye on it if you like.
Ahah, do you find that quite useful?
Oh aye, very, very. I…it gives you peace of mind if you…if it were to go up high then I would know to
go and see the nurse or the doctor, and say I was a wee bit concerned then. But obviously it will go
higher at certain times of the day, as you go through your daily work and you might be a wee bit
stressed and it’ll climb a wee bit but I know that and so I sort of keep it at you know…
(BB2_m_nm)
I’ve got a home monitoring kit, so when I actually went for the final blood checks, sorry not blood
checks, blood pressure checks, the twenty-four hour thing, I was quite disappointed by the reading. I
thought my blood pressure had been very, very good during most of the programme. I think possibly
the reason why it was so high, it just coincided with returning from a couple of holidays, I’d had a very
busy time. Well I mean obviously if the bloods, if the…I keep saying blood, the blood pressure…if the
blood pressure readings are what I would consider to be quite healthy -and I’m only stabbing at that-
but as far as I’m concerned for a man of my age, I assume that any blood pressures round about the
hundred and forty over ninety, would be quite considered okay. If I get readings at any time much
higher than that, then I watch it and I think it would make me contact the doctors’ surgery.
Yes. So do you…sorry ah ah, I’m quite interested in what you’re saying just now. So you think having
the feedback makes you a bit more proactive about…?
Absolutely, absolutely. I mean they do call it the silent killer as well, I know that.
(PB-m_nm2)
TO MONITOR/ COMPARE/DISCUSS BP AT HOME & IN SURGERY 1
I have to say that during the period of it, I had visited my GP and got my blood pressure checked as
sort of part of a routine thing and she had got her own blood pressure, little blood pressure monitor
which she got…bought from Amazon for fifteen pounds. So…and previously I’d spoken to a friend of
8
mine who had been diagnosed with high blood pressure and then his GP had suggested that he got
one of these monitors and he’d found that during…sort of find that his blood pressure was high when
he was at the surgery but normally during the day it was fine so I… And so anyway I bought one as
well and so the next time I had to got to the GP, I checked my blood pressure over the day and a
number of…so I was able to show her the readings apropos so
I was surprised at the variation but I thought that I had a high pulse rate but I was surprised that…how
high my pulse rate was and that was slightly more of a concern to me and I did…I was able to discuss
that with the GP so it’s nearly always over ninety and sometimes goes into the hundreds so…
I mean when I first got it I used it sort of probably quite often over the first week but then after I’d
taken the readings and shown them to the GP I probably haven’t have used it again since but I’m still
very pleased that I bought it and on the odd occasion I’ve maybe had palpitations or something of
that sort and I’ve sort of “Oh I’ll check my blood pressure” and you tend to
I think…I don’t think that…yeah, I’d say that there hasn’t really been any change.
(PB_m_nm 1)
COMPLIANCE WITH MEDICATION 7
HAS A ROUTINE 4
I do find it quite easy. I was asked in a questionnaire whether I would forget the tablets and really,
I’ve almost…I would say that I don’t. I have the tablets on the bedside table and when we go off to
bed I always go through it just to…it’s just…it’s almost automatic, I just take them, I take the statin and
the blood pressure tablets, I just do, so they’re right there so, you know, I can’t…
(PB_m_nm)
Oh aye, it’s easy to remember. I put all my…I lay all my tablets out at night, I get all the wee dishes
and then I cannae forget them.
(BB_f_nm)
Every morning, well as soon as I get up in the morning I take it right away, with a glass of water.
Yeah, the…the same time every, I mean if I’m up a wee bit later I still take it then, it’s always in the
morning.
Aye that’s it, so I remember it that way. I know before I have my cup of tea, I’ve took my glass of
water with my tablets .
(BB_f_nm)
Oh yes I certainly have a routine. It’s morning, I take all my medication in the morning
(PB_n_m(2)
COMPLIANCE MOTIVATED BY FEAR OF STROKE 3
Well, my mum died of it, my grandfather died of it, my uncle on my mother’s side died of it, and what
have you. So there’s evidently something there. My mum had high blood pressure for years, I don’t
really know about the medication and what have you but she was only 70 when she died, and I don’t
particularly want to be popping my clogs at 70, so it’s something I know I’m always going to have. I’m
9
religious with taking my tablets, I take my tablets every day. And it probably has, before I ignored it,
even when I had that operation I ignored it, whereas now I’m looking at it and I’m thinking I don’t
want a stroke, I don’t want a heart attack, I don’t want thrombosis or whatever else it can cause, I just
want to get it down as much as possible. And sometimes if I don’t particularly feel like doing any
exercise I go out and do it because I think…
(BR2_m_m)
Yeah. And I try and take them at the same time, and I keep them by the kettle actually so when I get
up in the morning and make a coffee my tablets are there
Well actually the pills I’ve got, there’s a calendar, Monday, Tuesday, Wednesday, Thursday, Friday,
Saturday, and I’ve been very good at trying to stick to it but occasionally you miss them. So effectively
if you miss the…I’ve missed a few, but I mean who cares
(BR_m_m)
Everybody must be the same, you’re motivated to try and be as healthy as possible aren’t you? You
don’t want to sort of pop your clogs sooner than you have to so…
(PB_m_nm)
PERCEPTIONS OF CAUSES / TRIGGERS FOR BP 9
STRESS/WORK STRESS 4
….when I’m at work and I get…like yesterday a lady got locked in the lift and you become stressed
trying to deal with that and getting the lady back out again. So you know that your blood pressure’s
going up if you like.
(BB2_m_nm)
Now, frustration. If you get annoyed with yourself then you can feel it. You can feel your head going,
the temples start to beat a bit, things like that.Right. I think you could say stress causes most of the
problems don’t you? Really at the end of the day people have got mortgages to pay, they’re not
working. They do this, they do that.
And depending on where you live, the conditions you live in -This is terrible. I lived in a house where
this was the size of one of my cupboards
(PB_m_m)
Since then I’ve given up work *laughingly+ and I think it’s gone down. Well, yeah, I mean I won’t go
into the reasons but I think that’s basically that has helped. I mean it hasn’t gone down like 20 points
as a result .
I do too much and don’t look at the work/life balance. I know that whatever reason, whether I’ve got
it or if it’s major or anything or whatever it may be, at this life I can’t do fifteen hour days, so why try?
And I also think that it helps you work with colleagues as well because I can see people doing it and I
can say to them “You don’t want to do that”. Because you think about your own health and you can
do it from a point of view…a supportive point of view, to say to your colleagues.
(BB2_m_m)
10
I mean when you’re retired you’re not running about, you’re not going to meetings, you’re not getting
all hot and bothered, but if I go down…if I do a blood pressure, if I go down to the bowling green and I
get involved in a tight match, then that’s where it is.
(BR_m_m)
WEIGHT/LACK OF EXERCISE 2
Well I would say my weight’s got a lot to do with it really ....I would say that’s my main thing because I
never used to have blood pressure and there was a bit in the paper and it was saying about one of the
inhalers that I take for my asthma and it was saying it causes high blood pressure and I got it out the
paper and I was at M’s, the practice nurse, and I says to her “M, have you heard any word through
about this?” and she says “I saw that in the paper, but we have not had any feedback” and I was to
take that inhaler two plus four times a day. I says “Well M is it a coincidence? I’ve got blood pressure
now”. I said “Well I’m going down to twice today” Because…so whether it’s a coincidence. ..Aye. I’d
like to have lost about three stone. It would help my asthma so it’s probably helped my blood
pressure too.
Aye, if I was worrying enough I would do something about it. ….I was alright when I was needing a gall
bladder operation, when I couldn’t eat any dairy and of course I’m into butter and the cheese and
everything now so I’ve just ballooned.
(BB_f_nm)
I would just…they did mention exercise but I do that every day anyway in my job, I do a lot of walking
so I know that my problem’s my weight. I’m sitting at fourteen stone and I would like to bring that
down to say thirteen. I know it should be lower than that again but physically I’m fit but I could still
do with losing that…a stone I would say
GENETICS 1
I think my…well my blood pressure, my higher blood pressure is probably related…based on genetics
really, I've got a slightly…I've got an elevated cholesterol despite having a virtually fat free diet which
I'm sure it's inherited, I have a…I don't use salt at all but I have actually quite a low tolerance of salt
and I think…I don't think I excrete salt perhaps particularly efficiently, which is good that I'm on a
diuretic so that obviously helps get rid of that. But I do feel that probably if I took a high salt intake
my blood pressure would be a lot, lot higher because I don't…I mean I don't salt vegetables now and I
don't…I avoid processed food and I find if I have had, for whatever reason, either a processed meal or
prepared meal or something, not a smoked salmon or something……with a lot of salt in I do feel it
afterwards and I feel I really need to get rid of this salt, I feel a bit… The things that make you, well,
things that probably put your blood pressure up are things that make you angry, cross or frustrated, I
would say that's probably sitting in a traffic jam, in a bus that isn't moving when you've got
somewhere you're supposed to be and you've got no control over it. I'm sure…I think my blood
pressure probably goes up then as probably most people's does.
(MK_f_m)
SMOKING 2
So the doctor there, when he first told me that, he was on about the smoking and things like that as
well. I said, there’s no way to really stop smoking. I’m just on it too long. And I’ve cut it down. But
it’s… I’ve not really… I cannot actually put my hands up and say, I’ve tried to stop smoking. I’ve never
11
put myself through hell yet to stop smoking. It’s something that I do and that’s it. Possibly this
doesn’t help your blood pressure
(PB4_m_m)
Yeah we’re bombarded nowadays on television and newspaper and pamphlets here and there about
not smoking, and taking a proper balanced diet and not too much fat and all these sort of things. But
it’s strange if anyone doesn’t know about that nowadays.
BR4_m_m
IMPACT OF MONITORING/READINGS ON CARE/ SELF CARE 28
GREATER AWARENESS/ GREATER ACCEPTANCE OF PROBLEM. 4
I take a diuretic every morning and… think I've been taking it for years, years and years, and earlier on
in that period, probably about fifteen years ago or something, I was taken off it to see what…whether
it…
But, in fact, my blood pressure went up and much to my amazement, I mean I was very sceptical
because I thought there were lots of reasons why perhaps there was…my blood pressure had been up
at that, there's always lots of stress and pressure in my family for different reasons and that had gone,
so I thought that's all right, I don't need to carry on, I'm sure I won't need to take…carry on with
these. ….But actually when I stopped them in the surgery and had my blood pressure taken……I was
astonished. You see, when it was first diagnosed I didn't feel that I had any higher blood pressure.
And it was a hundred and seventy, I mean it really was…and I just couldn't believe it, but I have a
family history of cardiovascular disease so I was keen to minimise anything, minimise any risk that I
could.
(MK_f_m)
…when I had the second twenty four hour monitoring I just had a normal day and I was here working
on the computer and then about five o'clock I was doing car insurance quotes and it was quite
intensive filling in the information, getting the quote, going onto the next one, filling it in again, and
there was actually a spike up at five thirty.
I was doing an Excel sheet on Sunday and because I was I'm thinking; I can feel my blood pressure
going up……and actually the person from the…who was doing the trial at that stage, the six month
monitoring, she said to me; what were you doing at five thirty because there was a real spike in your
blood pressure which was inconsistent with the fall during the day? And it was when I was half way
through this car insurance exercise.
(PB3 _m_m)
I even tried holding a cigarette before I done it, to help me to try to relax. That didn’t work .(I’m just
giving you some useless information/ No No)…Well I tried everything. I had it on the table, I had my
arm on a pillow and I was trying to relax as much as I could, but there’s no way you’re going to cheat
the machine so it’s… it is a good thing like. You cannot kid yourself on with it.
Yes. What is it, when you say it’s a good thing, in what sense?
Well, if your reading is too high, then you’ve got to do something. You understand? Then you’ve got
to say to yourself what have I been doing that’s making this go high, against what my reading was this
morning? You know? And then you’ve really got to try and relax within yourself
(PB4_m_m)
12
READINGS PROMPT /CHALLENGE/ REINFORCE CHANGE 3
When I was taking the blood pressure I couldn't bear looking at a hundred and forty, a hundred and
fifty over a hundred and ten and I wanted to just be able to see better readings in a way. So over the
summer as well, starting to get more walking exercise, that kind of thing….Yeah, definitely, yeah,
because I remember I think the first evening I had it, we had a guy here setting up the TV with the
satellite dish and so on and I was just…I got a reading like a hundred and sixty over a hundred and
twenty and I was just completely gobsmacked by that and really not pleased at all. And he was asking
me questions about the satellite and I just couldn't concentrate on what he was saying because by
then I was starting my evening readings and I just thought; no, I can't go on like that. And also I kind
Like a trigger for a change..?
Yeah, exactly, yeah, and also I wanted to get things resolved more quickly than the practice could in a
way…..Because they would come back to me and say; increase your Amlodipine because I guess that's
all they would say or add in something else, but I couldn't have other things added in like diuretics
because that wouldn't have sat very well with my daily routine at the time. I didn't want beta
blockers because they had various side effects which……they say interfering with sleep and that sort
of thing which would just have created all kinds of other problems.. I kind of felt the conventional
medicine options were maybe a bit limited in terms of what I wanted out of it or in terms of avoiding
side effects, so it did spur me on to look for alternative…
(PB3_m_m)
Because I never bothered about it before *laughs+. My blood pressure went up…I can’t remember why
I went down to the surgery and the nurse said, “Oh I’ll take your blood pressure,” and she found it
was up at about 170, over whatever. So she said, “Oh, we need to put you onto all sorts of pills,” so
effectively I’m not a pill based person, I don’t take pills for the sake of taking pills, so they started
taking my blood pressure and then this thing came in with this hypertension from the university so
what’s the odds, I’ll have a go at it. So I’m not greatly worried. If my blood pressure was up at 190
over 60.
BR_m_m)
It’s there as a sort of constant reminder for me so it doesn’t make me anxious and it doesn’t make me
reassured, it’s a prompt to be reactive, just so as to be proactive rather than reactive.
So I like having the machine there because it prompts me, and I’ve done things like I’ve done some
exercise and then I’ve taken my blood pressure to see whether it has made an impact, and it did, it
does, every time. So as far as I’m concerned *laughingly+ it’s a shame I’m going to have to hand it
back. and also if it creeps up again I think, ‘Oh, I’d better do something about this’, whereas previously
I’d known about the blood pressure, I’d got back to normal and then I found out again because I was
due to have an operation …………….
And I feel that it’s useful from the fact that it’s there so I just take a reading to see how I’m getting on,
and, yeah, it’s great from that point of view.
It’s a prompt for me to do something to get the blood pressure down. It’s there, I leave it on a shelf in
my office where I work and it sits there. (
13
BASIS FOR UNDERSTANDING OWN PATTERNS/ FACTORS 8
AWARENESS OF VARIATION IN CONTEXT 5
..I can say, “Well, look, it was down here”, and I can associate that with being away on holiday, or it’s
up here and I can associate that with a period when I was under extreme pressure at work or
whatever
(BR2_m_m)
Yes, I think mostly mine is between a hundred and…in the morning and between a hundred and thirty
and a hundred and forty five or a hundred and thirty five, a hundred and forty five, and occasionally it
did…(Later) F2: I think in…well you know when you're keyed up about something?
But sometimes that doesn't always translate to a rise in blood pressure, I've sometimes been
quite…felt I was quite tense and actually my blood pressure reading's been……almost one of the lower
ones. So there's no real…I must admit it's not been…it hasn't perfectly matched actually…
(MK_f_m)
You know, I was coming up in the morning, I found it first thing in the morning it was ideal. You could
see something happening there, but as the day went on, the afternoon one or the evening one,
something like that, you could see that that was a bit high. So it’s different what happens during the
day isn’t it? ..What happens in your body and how your head thinks
(PB4-m-m)
And I think for the first two or three days I did it three or four times a day, and I noticed there was
quite a significant variation throughout the day.
MK_m_m/D/Out
I find that if I take it, my blood pressure at about ten o’clock I get a lowish type of reading. If, as
today, well we were out, we were down to [inaudible 04:08] this morning and then we came back and
we did a bit of gardening, my blood pressure automatically is a bit higher, what’s the ideal time
(BR_m_m)
VARIATION BETWEEN READINGS AT HOME/IN THE SURGERY 3
Yes, I think mostly mine is between a hundred and…in the morning and between a hundred and thirty
and a hundred and forty five or a hundred and thirty five, a hundred and forty five, and occasionally it
did…
How did it compare with the measures they were taking in the surgery?
It was probably the same, maybe slightly lower, but then when I come to the surgery it's never first
thing in the morning and……..
But obviously when you have it done in the surgery it depends on the time of day and whether there's
a lot going on in the waiting room that's maybe concerning you, but I would say you're not…you're
never quite as relaxed as you might be at home
(MK_f_m)
14
I’ve come to appreciate the fact that when you go into the doctor’s surgery and they take your blood
pressure, whether it be up, down and different ten minutes later, and I suppose really, you’ve got to
kind of look at the larger picture for blood pressure.
(BR4_m_m)
The only reassuring thing was that when I did the twenty four hour monitoring the average wasn't as
nearly as bad as the surgery measurements which, in turn, might have had an element of, and I think
did have an element of, white coat hypertension around it………
And, sure enough, what I did find was that between one and three it was usually going down, or if it
wasn't going to go down, if it was high for any reason it stuck between one, two and three
(PB3 _m_m)
READINGS CAN BE REASSURING AND/OR INTRUSIVE & ANX IETY PROVOKING 6
SOMETIMES WORRYING 4
And I didn't actually travel with it, I managed to do roughly weekly things just before I went away,
because the very thought of packing that into a suitcase and getting onto a plane and would the
mobile phone work depending on where you were, there were things like that. So that's just…that's
one…that's the technical thing is less important to me than the fact that it made an ever present
"medical problem". ……… Where I felt that on treatment I was actually perfectly normal, my blood
pressure was sort of okay.
…it's a constant reminder that's the thing. It's a reminder and that may have…for some people that
might actually elevate their blood pressure [laughs]. No, well you feel a patient. I think that you're a
patient with a disease [laughs].Or a disorder or with an ailment and that's…
(MK_f_m)
I think it definitely…it definitely makes you more aware of it and it did make you want to see what it
was. I’d often…I know that on the twenty-four hour one you can’t see what it is, it doesn’t tell you
what it is but on the actual machine that went through to the website, it gives…it was displayed quite
well, it was displayed what it was and I thought that was quite good to have……..Just because you
know…and I knew the parameters of what was high and what was low. And I know everybody’s blood
pressure does go up and down during the course of a day but it was sometimes worrying and
sometimes comforting
(BB_f_m)
It’s always in the back of your mind. The thing I always dread is a stroke. You can have a heart attack
and sort of get over it to a certain degree but a stroke is so debilitating and depressing and frustrating
(BB2_m_nm)
Anyway, but the main thing was, that while I was doing it over these few weeks, I felt it was intrusive.I
started worrying about my blood pressure.I don’t normally worry about it because I know I’m going to
go to the nurse, and whenever I go to the nurse she’ll take my blood pressure. I can go at any time to
see them, if I need to pick up medication or I feel my medication I’m on and I have a few good
relationship with my doctor and practice nurse, and I can go in and in very short notice I can get an
appointment, and I don’t find that in any way intrusive in my life. But what I began to find was I was
thinking, if I do such and such, what will be the effect when I monitor myself?
15
Yes, and I thought this is never right, because I’m actually making my lifestyle constrained by this, and
I’ve never done that before. As long as I’ve felt well I’ve done anything I wanted, everything in
moderation. And I thought well this is actually counterproductive. I’m actually worrying about
something that I should be relaxed about. Yes, and so I talked with the nurse about it and I basically
decided to come off the trial, because I felt that if I didn’t do it properly it wasn’t going to be any help
to you, and if I did it properly it was actually no help to me! [laughter] So that was the reason I came
off it. But in some ways it’s interesting because I have a very good friend down in the Midlands
who has got a significant blood pressure problem, and he’s been monitoring himself for a long time
and recording it. And when I’m down visiting him I happily use his
If I was a heavy drinker, if I was a smoker, if I was abusing what I’ve got in the way of a body, then it
might be reassuring to know what the trend was. But I don’t see that my lifestyle is causing a problem
which could not very well be monitored with my two or three, or four visits to the doctor every year
But for something that had not been an intrusion it was something I knew about, I controlled to the
best of my ability, it suddenly became something bigger than that. It intruded- it made me worry
about something that I didn’t think it was proper to be worrying about.
MK_m_m_Drop /Out
CLINICAL BENEFITS VS PERSONAL ANXIETY 1
I didn't feel ill or anything like that…So it wasn't obvious that there was something wrong with
me.And I can appreciate that they want to bring the blood pressure down and clearly it should do me
some good. But I can't say I ever felt ill from having too high blood pressure. So in that sense this is
probably good.
And you kept on taking it (taking blood pressure) and the mere fact that you are taking it your blood
pressure was going up.?
The only change, in fact, is from my point of view they have increased the…no sorry, so he's also given
me another Amlodipine I think you call it, another drug
(BR3_m_m)
DIFFICULTY UNDERSTANDING READINGS 1
It doesn’t mean nothing to me, as a layman. I…I had to ask her (daughter) what a level was
PB_m_m
MORE RAPID ORGANISATION OF MEDICATION 3*
I mean obviously if this had come up with readings of a hundred and fifty to a hundred and sixty
regularly I would have been back here actually probably saying; this is…I don't know, I feel maybe I
need to have my medication adjusted but, no, it didn't.
(MK_f_m)
I’ve got…your monitor will pick this up, Lisinopril for high blood pressure which the doctor gave me
and I started off and I had 0.25 milligrams a day, I think he’s put me onto 0.5 now, he’s doubled the
dose.…and I just take one a day.Well on…before I went onto this I was on the Lisinopril. But he
wanted to get me down low figures, so he doubled the dose but I think it’s 0.5. No, it was 2.5
milligrams, now its 5 milligrams I think. But that’s one a day.
BR_m_m)
16
NO CHANGE/ (NO BUT YES BUT NO) 4
Has it changed the way you either feel about your blood pressure, or the way you manage it?
Not at all.
Why is that?
Yeah, did you find it changed the way you viewed your blood pressure at all knowing…
No. No, well not really, there was one…yeah, I did have a headache that morning and I made a wee
note of that in case. …(Later)….. This day for no good reason it went a little bit high…….Yes, I think
mostly mine is between a hundred and…in the morning and between a hundred and thirty and a
hundred and forty five or a hundred and thirty five, a hundred and forty five, and occasionally it did.
MK_f_m)
I've actually been taking a note of my own blood pressure readings over the last…
Good, that's interesting, so it's actually changed the way you're manage in a sense, yes.
Well not really, I'm just interesting in recording it, I can't even read my own writing here.It hasn't…by
the way, I haven't changed the handset thing to GMT from British Summer Time because I thought I'm
not going to bother with that so
(MK_f_m)
So you did…in the course of using this then you didn't find you were changing how you managed your
blood pressure or…
No, I'm afraid not, no.I didn't see any indication to do so actually really…
(MK_f_m)
Mine’s hasn’t ever reached that. Obviously I’m overweight, I’m trying to do something about that but
it just doesn’t happen.
(PB4_m_m)
IMPACT OF MONITORING ON SHARED CARE 28
BASIS FOR UNDERSTANDING OWN PATTERNS/ FACTORS 8* 1
AWARENESS OF VARIATION IN CONTEXT 5
..I can say, “Well, look, it was down here”, and I can associate that with being away on holiday, or it’s
up here and I can associate that with a period when I was under extreme pressure at work or
whatever
(BR2_m_m)
1
Three themes appear in more than one category. They are marked with asterisks.. In the schematic
map they are in grey.
17
Yes, I think mostly mine is between a hundred and…in the morning and between a hundred and thirty
and a hundred and forty five or a hundred and thirty five, a hundred and forty five, and occasionally it
did…(Later) F2: I think in…well you know when you're keyed up about something?
But sometimes that doesn't always translate to a rise in blood pressure, I've sometimes been
quite…felt I was quite tense and actually my blood pressure reading's been……almost one of the lower
ones. So there's no real…I must admit it's not been…it hasn't perfectly matched actually…
(MK_f_m)
You know, I was coming up in the morning, I found it first thing in the morning it was ideal. You could
see something happening there, but as the day went on, the afternoon one or the evening one,
something like that, you could see that that was a bit high. So it’s different what happens during the
day isn’t it? ..What happens in your body and how your head thinks
(PB4-m-m)
And I think for the first two or three days I did it three or four times a day, and I noticed there was
quite a significant variation throughout the day.
MK_m_m/D/Out
I find that if I take it, my blood pressure at about ten o’clock I get a lowish type of reading. If, as
today, well we were out, we were down to [inaudible 04:08] this morning and then we came back and
we did a bit of gardening, my blood pressure automatically is a bit higher, what’s the ideal time
(BR_m_m)
COMPARING READINGS AT HOME VS READINGS AT THE SURGERY 3
Yes, I think mostly mine is between a hundred and…in the morning and between a hundred and thirty
and a hundred and forty five or a hundred and thirty five, a hundred and forty five, and occasionally it
did…
How did it compare with the measures they were taking in the surgery?
It was probably the same, maybe slightly lower, but then when I come to the surgery it's never first
thing in the morning and……..
But obviously when you have it done in the surgery it depends on the time of day and whether there's
a lot going on in the waiting room that's maybe concerning you, but I would say you're not…you're
never quite as relaxed as you might be at home
(MK_f_m)
I’ve come to appreciate the fact that when you go into the doctor’s surgery and they take your blood
pressure, whether it be up, down and different ten minutes later, and I suppose really, you’ve got to
kind of look at the larger picture for blood pressure.
(BR4_m_m)
The only reassuring thing was that when I did the twenty four hour monitoring the average wasn't as
nearly as bad as the surgery measurements which, in turn, might have had an element of, and I think
did have an element of, white coat hypertension around it………
And, sure enough, what I did find was that between one and three it was usually going down, or if it
wasn't going to go down, if it was high for any reason it stuck between one, two and three
(PB3 _m_m)
18
GREATER AWARENESS/ GREATER ACCEPTANCE OF NEED TO ACT. 4*
I take a diuretic every morning and… think I've been taking it for years, years and years, and earlier on
in that period, probably about fifteen years ago or something, I was taken off it to see what…whether
it…
But, in fact, my blood pressure went up and much to my amazement, I mean I was very sceptical
because I thought there were lots of reasons why perhaps there was…my blood pressure had been up
at that, there's always lots of stress and pressure in my family for different reasons and that had gone,
so I thought that's all right, I don't need to carry on, I'm sure I won't need to take…carry on with
these. ….But actually when I stopped them in the surgery and had my blood pressure taken……I was
astonished. You see, when it was first diagnosed I didn't feel that I had any higher blood pressure.
And it was a hundred and seventy, I mean it really was…and I just couldn't believe it, but I have a
family history of cardiovascular disease so I was keen to minimise anything, minimise any risk that I
could.
(MK_f_m)
…when I had the second twenty four hour monitoring I just had a normal day and I was here working
on the computer and then about five o'clock I was doing car insurance quotes and it was quite
intensive filling in the information, getting the quote, going onto the next one, filling it in again, and
there was actually a spike up at five thirty.
I was doing an Excel sheet on Sunday and because I was I'm thinking; I can feel my blood pressure
going up……and actually the person from the…who was doing the trial at that stage, the six month
monitoring, she said to me; what were you doing at five thirty because there was a real spike in your
blood pressure which was inconsistent with the fall during the day? And it was when I was half way
through this car insurance exercise.
(PB3 _m_m)
I even tried holding a cigarette before I done it, to help me to try to relax. That didn’t work .(I’m just
giving you some useless information/ No No)…Well I tried everything. I had it on the table, I had my
arm on a pillow and I was trying to relax as much as I could, but there’s no way you’re going to cheat
the machine so it’s… it is a good thing like. You cannot kid yourself on with it.
Yes. What is it, when you say it’s a good thing, in what sense?
Well, if your reading is too high, then you’ve got to do something. You understand? Then you’ve got
to say to yourself what have I been doing that’s making this go high, against what my reading was this
morning? You know? And then you’ve really got to try and relax within yourself
(PB4_m_m)
READINGS PROMPT /CHALLENGE/ REINFORCE CHANGE 3*
When I was taking the blood pressure I couldn't bear looking at a hundred and forty, a hundred and
fifty over a hundred and ten and I wanted to just be able to see better readings in a way. So over the
summer as well, starting to get more walking exercise, that kind of thing….Yeah, definitely, yeah,
because I remember I think the first evening I had it, we had a guy here setting up the TV with the
satellite dish and so on and I was just…I got a reading like a hundred and sixty over a hundred and
twenty and I was just completely gobsmacked by that and really not pleased at all. And he was asking
19
me questions about the satellite and I just couldn't concentrate on what he was saying because by
then I was starting my evening readings and I just thought; no, I can't go on like that. And also I kind
Like a trigger for a change..?
Yeah, exactly, yeah, and also I wanted to get things resolved more quickly than the practice could in a
way…..Because they would come back to me and say; increase your Amlodipine because I guess that's
all they would say or add in something else, but I couldn't have other things added in like diuretics
because that wouldn't have sat very well with my daily routine at the time. I didn't want beta
blockers because they had various side effects which……they say interfering with sleep and that sort
of thing which would just have created all kinds of other problems.. I kind of felt the conventional
medicine options were maybe a bit limited in terms of what I wanted out of it or in terms of avoiding
side effects, so it did spur me on to look for alternative…
(PB3_m_m)
Because I never bothered about it before *laughs+. My blood pressure went up…I can’t remember why
I went down to the surgery and the nurse said, “Oh I’ll take your blood pressure,” and she found it
was up at about 170, over whatever. So she said, “Oh, we need to put you onto all sorts of pills,” so
effectively I’m not a pill based person, I don’t take pills for the sake of taking pills, so they started
taking my blood pressure and then this thing came in with this hypertension from the university so
what’s the odds, I’ll have a go at it. So I’m not greatly worried. If my blood pressure was up at 190
over 60.
BR_m_m)
It’s there as a sort of constant reminder for me so it doesn’t make me anxious and it doesn’t make me
reassured, it’s a prompt to be reactive, just so as to be proactive rather than reactive.
So I like having the machine there because it prompts me, and I’ve done things like I’ve done some
exercise and then I’ve taken my blood pressure to see whether it has made an impact, and it did, it
does, every time. So as far as I’m concerned *laughingly+ it’s a shame I’m going to have to hand it
back. and also if it creeps up again I think, ‘Oh, I’d better do something about this’, whereas previously
I’d known about the blood pressure, I’d got back to normal and then I found out again because I was
due to have an operation …………….
And I feel that it’s useful from the fact that it’s there so I just take a reading to see how I’m getting on,
and, yeah, it’s great from that point of view.
It’s a prompt for me to do something to get the blood pressure down. It’s there, I leave it on a shelf in
my office where I work and it sits there. (
READINGS AS EVIDENCE FOR PATIENTS IN CONSULTATION/EMPOWERMENT 4
Yeah, well, I mean I’m on three tablets now, I was on two before. I’m on three now. I don’t know if it’s
helped with the medication but it’s certainly given me more meaningful data to speak to the doctor
rather than, “Well, I think my blood pressure has probably gone up.”
Yeah, because I…rather than just appearing at the doctors, sometimes they fancy taking your blood
pressure and sometimes they don't and it's a bit haphazard, and also you're measured on just that
moment in three months and a decision is taken on the basis of that moment or that one or two or
three measurements in that consultation. I could see a lot more happening and also the twenty four
hour monitoring, I don't know about the first time because I wasn't given the results of it, but the
second time around, for example, it seemed that my blood pressure was higher in the morning than
in the evening and, sure enough, right over the time since I changed medication the evening blood
20
pressures were actually pretty good, very good some of them, even to the extent that ‘what's all the
fuss about’ type thing
(PB3_m_m)
Yes. I mean on the occasions I’ve been in to speak to the doctor – because there were a couple of
occasions where it just seemed to plateau and it wasn’t going down – and I came in and I said, “Well,
look, these are my readings and I’m concerned”, but since then I’ve given up work *laughingly+ and I
think it’s gone down
(BR_m_m)
Were they reviewing your medication or changing it more often than they would otherwise have done
or…
Yes, I think definitely because I…a couple of weeks into it, as I say, I got a call from the practice nurse
to come and review matters and that put the Amlodipine up, which was the standard default setting
that you…or reaction that you'd expect, but around about that time I was also starting on the herbal
tablets for my own research.
I was going to ask if having that kind of information available made any difference to the kind of...I
don’t know, evaluation, or response to your blood pressure?
Well I’d be very surprised if it did. I know that you sent me one or two messages on my mobile phone
to say just continue with it and I’ll speak to your doctor about your medication, and I haven’t seen
him, although as I say I’m going to see him on another matter altogether on Thursday, nothing to do
particularly anyway with blood pressure
(BR4_m_m).
Example of process from readings to review and stabilisation
F1: Did it change the way you manage your blood pressure or…?
M1: I think it did because I think it made you alert to when it was high and I think that made
you think about “Why was it high?” Whether it stress related or trying to do too much
at one time or whatever it may be, it just made you think “Well why is it high?”.
F1: Yes. So you found it useful then getting that feedback?
M1: I think it was because it then almost like said “Slow down, have a break, take a rest, chill
out a bit”.*laughter+
F1: And did…have you seen your doctor at all since you’ve had it, I mean has it made any
difference to sort of consultations with the doctor, having that extra information?
M1: Yeah, because what he does now when I see him, he’ll just take my blood pressure and it
just shows you how much it’s changed. It certainly helped get my medication regime put
together.
F1: Okay, so they’ve kind of modified it a bit then on the basis of that?
M1: Yeah, they did but they…what they did was they were looking at…they had sort of set
themselves…the nurse had developed her own set herself where they wanted to see it
being…
F1: Okay, so you did a sort of individualised target sort of thing?
M1: Yeah and during the process I think my drugs were changed about four times.
21
F1: Oh wow! That’s a big difference then!
M1: So to make sure and now I’m on a situation where I take just the standard tablets every
day now and I don’t feel as if I’m…and certainly any time it’s been checked it’s been fine.
RETHINKING ROLES AND RELATIONSHIPS IN SHARED CARE 9
RETHINKING PATIENT ROLE/RESPONSIBILITY INSHARED CARE 3
WHO IS RESPONSIBLE? 2
I’d just think that the…I think the benefit I see from this is that we go to the doctors for things but we
have a responsibility to ourselves to do things but this gives you…allows you to take a bit of
responsibility for…rather than…I mean I think I went to the doctors probably, maybe three times,
maybe four times during…when I was on…using the system and all that but that was directly because
of what the monitoring told me so I knew that I had to go to the doctor rather than…I mean really you
can’t tell if you’ve got high blood pressure at the time
If the monitoring system tells you straightaway, you’re out of order - you can’t do it…. It’s like I say, if
you’ve got a broken leg, you know you’ve got a broken leg, it’s obvious you’ve got a broken leg and
then what you do is don’t try to go and play football. If you’ve got high blood pressure and you don’t
know about it, probably the next thing you do is when you collapse or something. And if you…this is a
way…it takes responsibility.
(BB2_m_m).
Not at all. I mean I do not really see how I can do anything to manage as you say my blood pressure, I
just live as I live, and go about my daily business and just stop here and there to take my blood
pressure when I can remember, and that’s it. But I don’t in any way find that I’m able...I don’t even
know how you could manipulate...I should imagine you could manipulate it if you just lay down in a
comatose state and quietly breathing and doing nothing for half an hour, I dare say that would bring it
down. (Pauses).. As opposed to running up a hill and being out of breath, that no doubt, I imagine
anyway would bring it up
(BR4_m_m)
WHAT TYPE OF CARE DO I WANT? 1
I was going away to Venice for three or four nights and it was going to be quite warm and I didn't
want to have issues with blood pressure then and I…so I put up the Amlodipine but without the herbal
tablets, and I actually felt worse because I didn't feel it was improving, the thing was I felt quite
anxious, a lot of stuff I'd read on patients' reviews of the medicine.So when I came back I resolved
that I was actually feeling better from the herbal remedy rather than from the Amlodipine, and
certainly the herbal tablets were having an effect on the…a positive effect on the blood pressure
which I wasn't sure if the Amlodipine was doing. And there were other things I did, there's I got a
book on blood pressure but, unfortunately, it's an American one and what they don't tell you is that
the three things he suggests, the main thing, you can't get in the UK so……you're stuck with the other
two or three things which he suggests. But I might go onto that, I might look at that, it's lycopene
which is…one of them is lycopene which is made from tomato juice and…
(PB3_m_m)
22
CHANGING PATIENT:GP/NURSE ROLES: CHANGING CONCEPTS OF SELF-CARE 4
Has it changed the way you work with them or the way they respond to it or…
Yeah, I mentioned it to the GP, he said; what have you done, since been on the trial have you changed
anything? And I told him about these herbal tablets and he was happy enough for me to stay on them
if they were working and I didn't seem to have any adverse side effects.
Do you use the fact that you know what the readings are to make points or as evidence
Yes, because also I noticed what I was doing if they went up a wee bit, if I was going through a more
stressful time I would increase the dose of the tablets to
(PB3_m_m)…
I mean I could see, I could probably see my nurse sooner but then she then has to consult with the
doctor and that again takes time. ((I) can’t get an appointment with Dr B for some time). Or I could…I
think that's what's going through my mind. So the Candesartan was…I've got sixteen milligrams and
eight milligrams. And the last time I saw Dr B he said; the maximum you can have is thirty two. Well
what I probably could do is go and see the nurse and say; can I take it upon myself to move it up to
thirty two by taking another eight because he's given it to me in sixteen and eight milligrams. So I
could double up the eight to make it thirty two to see if it made any difference. I don't know whether I
should do that without me asking him.
(BR3_m_m)
Yes, that was one of my…practically my final question actually was did they give you quite a lot of
feedback about what causes blood pressure or would you have welcomed more perhaps?
In that sense, no, probably not…I didn't get too much feedback in that sense but it's…I'm not awfully
sure, I used to be a teacher and I think you could…if you were getting annoyed with the class you're
obviously…your blood pressure could go up and if you had a monitor on it at the same time…..So I can
understand that, from my understanding of it, that if you get into these kind of situations, yes, your
blood pressure will rise.
(BR m_m)
Because he was getting them as well. And then I would get a call in from the doctor or the nurse, or
‘come in and see the nurse, your readings have went up’. So I went to see them. They gave me this
tablet, so after a fortnight, as I says, I told them this tablet was not working. After three days I
stopped them. Trying to make an appointment with your doctor isn’t the easiest thing in the
world.….You’ve got to know you’re sick a fortnight before you really are. Here we are…….I believe this
will stop you having to go to the doctors all the time to do this, which obviously is a great thing
because if you can’t get an appointment it means that people aren’t going to the doctors
(PB5_m_m)
MORE EFFECTIVE GP:PATIENT RELATIONSHIP 1
Do you think it changed the way you and your doctor kind of managed your blood pressure, the fact
that you both had that access to that information?
23
Well I think because I was in more contact with the doctor on a weekly basis, even by email, I didn’t
have that doctor/patient thing when I went to see him. I get quite agitated when I go to the doctors, I
don’t like going to the doctors and talking about personal stuff but I didn’t…that helped my kind of
feelings towards that…that I didn’t find it…I didn’t find it so scary because I felt I had been talking to
him, albeit electronically……/…..I think I felt a bit more familiar with my doctor if you know what I
mean. Basically because there was more contact.
(BB_f_m)
RECONFIGURING NURSE:GP ROLES 1
Because I think it is gradually improving but when I see the nurse it's not necessarily…she's not
necessarily got the authorisation to change my medicines, my pills, so she has to consult with the
doctor before she can do that and…but the last one I saw was my doctor and he has increased one of
the…do you know the names of the Candesartan?
And it was…I was on sixteen and he's now put me on to twenty four, and I think there's another step
up to thirty two but that…I can't see him, unfortunately, until pretty much the end of the month.
(BR_m_m)
MORE RAPID TAILORING OF MEDICATION 3*
I mean obviously if this had come up with readings of a hundred and fifty to a hundred and sixty
regularly I would have been back here actually probably saying; this is…I don't know, I feel maybe I
need to have my medication adjusted but, no, it didn't.
(MK_f_m)
I’ve got…your monitor will pick this up, Lisinopril for high blood pressure which the doctor gave me
and I started off and I had 0.25 milligrams a day, I think he’s put me onto 0.5 now, he’s doubled the
dose.…and I just take one a day.Well on…before I went onto this I was on the Lisinopril. But he
wanted to get me down low figures, so he doubled the dose but I think it’s 0.5. No, it was 2.5
milligrams, now its 5 milligrams I think. But that’s one a day.
BR_m_m)
READINGS SUPPORT DIFFERENT MODELS OF EVIDENCED BASED SELF CARE 14
The readings provide a basis for action previously not available to most patients, and lacking the kind
of detail that would allow for consideration or discussion of the impact of either lifestyle factors or
medication. While the assumption may be that this will support greater acceptance of and
compliance with both medication and lifestyle changes, it can (and was) used to support individual
patients in the adoption of alternative medication. (See Schermer 2009)
CHANGES MADE TO LIFESTYLE (STANDARD) 7
So you think it’s changed the way you manage your blood pressure a wee bit?
Yes. Aye. Definitely it’s given me feedback on what I should be doing. I still think I’m 28 years old,
and I’ve got to understand that I’m not. And as I say, with different pressures, the readings went up.
24
Yes. So there’s quite a few things you say you’re doing to try and lower your blood pressure. Is that
trying to relax, going to the gym, trying to lose weight. Anything else? You don’t smoke do you?
Well basically – I do smoke. In fact I haven’t quite stopped everything. I’m as well just phoning up the
nearest undertaker and saying take me away.
Drinking, I’ve cut down drinking. Maybe I’ll go on a Friday night and have a few beers on a Friday
night. Maybe on a Wednesday I’ll sit and watch the football with a couple of beers, or something like
that, you know?
Yes.
Or on a Saturday, if it’s a morning game that’s on the telly, I’ll maybe have a beer and watch that. It
depends on the day. If I’m driving later on in the day I’ll not bother. But I’ll sit and watch the football.
And things like that. Okay. Your temperature rises a wee bit when you’re watching, and you enjoy it.
It’s all just part and parcel of your life. Everybody goes through it. Everybody must have this.
Well, I go to the gym to try and keep myself reasonably fit anyway. We used to go to the gym quite a
lot at one time, and then when you stop again this is what happens. (Points to stomach)
Yes. I have the same thing. A fan of the baggy jumpers I am.
Yes. But definitely overweight doesn’t help, and if you don’t do anything, that will not help either.
(PB4_m_m)
And I’ve more or less cut salt out of my diet – I mean obviously crisps aren’t a good thing on a diet
anyway – but I’ve more or less cut salt out. I don’t tend to even cook with salt any more, and I very
rarely add it to food now because I’m conscious of that. And I use low-salt anyway, I don’t use full salt.
But for me as well I exercise more because that then allows me the odd treat, so I try and walk for 40
minutes a day or I’ll do some light weight training, or even brisk housework for an hour or so.
(BR2_m_m)
I’m actually…I was quite disappointed with the end result actually because when the survey was
finished because I’ve actually managed to lose quite a bit of weight in the last…during the period of
the research of the programme, I managed to lose over two stones in weight and I actually monitor
my blood pressure regularly anyway
(PB_m_nm )
It does obviously help because I had lost a stone in weight during the course of that six months as well
that I was being on the monitor and I think that did…I think that was a contributory factor to my blood
pressure balancing out.
(BB_f_m)
CHANGING LIFESTYLE (ALTERNATIVE) 3
Do you use the fact that you know what the readings are to make points or as evidence
Yes, because also I noticed what I was doing if they went up a wee bit, if I was going through a more
stressful time I would increase the dose of the tablets to
(PB3_m_m)…
25
We going down that route again so there's one, I think an Omron OM2 which is supposed to be pretty
good and clinically recommended. I feel a little bit lost without the blood pressure monitor at the
moment, yeah. And also I'm looking at something else but it's a couple of hundred pounds, it's
something called RESPeRATE which…is completely non-invasive
(PB3_m_m)
And do you think it changed the way it was…your perception of your blood pressure and how you
might manage it?
Yes, because it…well first of all it kind of gave me a challenge to see if in six months I could improve
something, sort it out a bit…..Because I was getting the feedback straightaway from my readings.
Ah huh, and were you able to do that, do you think, to an extent?
Oh definitely, yes, because if I was…like when I started in March they were quite high, the evening
readings, they would say like a hundred and forty five over a hundred and ten and obviously I wanted
to bring that down because that was…that is too high, I know it's not ridiculously high but it's still not
desirable. So I'd been on Amlodipine, a pretty standard medication, for a few months and obviously it
brought it to that level, so I wasn't keen from what I read on the internet to have the dose increased,
which was the obvious thing to do and which is what the nurse recommended after a couple of weeks
of readings went back to the website and she looked at them. So I did quite a bit of reading on the
subject, what else I could do and obviously……(I) started taking more exercise, I switched to some
Indian herbal tablets, they'd got very good write ups on various websites and then obviously the
people selling them they had testimonials on the websites of how they brought their blood pressure
down…..So I ordered some and tried some and, sure enough, within a few days adding those onto the
Amlodipine the blood pressure did come down and I was getting excellent readings, a hundred and
twenty over eighty four and things like that, so really no issue there with that kind of…
Were they reviewing your medication or changing it more often than they would otherwise have don?
Yes, I think definitely because I…a couple of weeks into it, as I say, I got a call from the practice nurse
to come and review matters and that put the Amlodipine up, which was the standard default setting
that you…or reaction that you'd expect, but around about that time I was also starting on the herbal
tablets for my own research.
I was going to ask if having that kind of information available made any difference to the kind of...I
don’t know, evaluation, or response to your blood pressure?
Well I’d be very surprised if it did. I know that you sent me one or two messages on my mobile phone
to say just continue with it and I’ll speak to your doctor about your medication, and I haven’t seen
him, although as I say I’m going to see him on another matter altogether on Thursday, nothing to do
particularly anyway with blood pressure
Obviously it gave you a basis for trying other things.
Because instead of going back to the doctor in three months' time working in a bit of a void I could
see within a matter of days these things working, to the extent that I've kept on these but got rid of
the Amlodipine.
(BR4_m_m).
STANDARD VS.INDIVIDUAL MODELS 4
NEED TO CONSIDER INDIVIDUAL VARIATION 1
26
….it comes down to you can’t do populations, you’ve got to individuals, and in order to do an
individual you’ve got to have this chip that lets...
It’s a complete change of thinking really. It is absolutely fascinating because at the moment there’s
this clash of two methodologies at the moment.
MK_m_m_D/Out
NEED TO CONSIDER VARIATION OVER TIME 3
That’s what it reminded me of, and I thought I could be two different people. If I monitored myself in
the morning, I could be two different people as far as my blood pressure was concerned. Because in
the morning, as I say, you would think, ‘why’s this guy on it?’ Because I was running around 90, 135.
MK_m_m_D/Out
How accurate it was of course I wouldn’t like to say, but it was available if you wanted it. But anyway,
yes, it’s no trouble and interesting, and it’s quite good. I think I would probably be concerned if after
a number of readings it was consistently up or down.
(BR4_m_m)
If it was high every day for a few days or something like that it might anticipate a possible problem. I
mean I would phone my doctor if that happened. …Because that means the pressure on the arteries
or something could cause a blow out or something like that.
Were you told when to phone the surgery or whether the surgery would contact you if the readings
were high?...No. But I m going to see Dr B on another matter entirely and I’ll ask him about my
readings. I imagine he has then all somewhere
BR4_m_m)
USE/USABILITY 38
GENERALLY STRAIGHTFORWARD 9
It was easy to operate, I found it easy to operate and I was interested to see the readings. To begin
with there was trouble because I don’t have a mobile phone and I thought, well how do you get this
phone on…….I didn’t realise I had to press so hard at the top so it took a wee while before I found that
and then I got a phone to say they weren’t getting the readings and the trouble was I was switching
the telephone off too quickly. …You know, that was it, the reading came up and so forth and I
thought, well fine, so I switched off and so she said, “Leave the phone laying beside the instrument
until it eventually said go to menu,” and I realised that was the end, then I switched off the measurer
and switched off the phone and that was it.
(Br5_f_m)
It was okay. There wasn’t a problem with it at all. In fact with J on the laptop you can check it up as
well.
(PB4_m_m)
None (problems) at all
(BR2_m_m)
27
My reader gets full, the readings got full and I had to reset it but I asked for advice on that and the
nurse gave me it.
(BB_f_m)
No. No. None whatsoever and it worked all the time, or sometimes when I did it at my caravan,
obviously I couldn’t get a signal until I came back and it would download everything .. No as I say, it
just becomes part of your routine so you just…I got up in the morning and just did it and then after
tea time, I just did it again and it was just getting into a routine
(BB2_m_m)
Easy enough
(BR4_m_m)
I mean it’s a very simple thing to do
MK_m_m)D/Out
I’ve not had any problems at all, I’ve had no teething troubles with it, apart from once when my son
did it without me knowing and sent that figure through to the computer, so obviously that one was
miles out
(BR3_m_m)
Soon as I pressed it to go through it’s a couple of seconds or something the mobile would light up, and
then if you left it enough it would light up again, sort of thing, and that would be it. So then you could
pack the stuff up and put it away again. So the system was straightforward.
(PB4_m_m)
SETTING UP AN EASY ROUTINE 4
AT SET TIME 1
Yes, what I normally had was a chosen time each day which was after I'd come home from work, later
in the evening usually but trying to keep it consistent so I could compare how the progress was going.
And it was just really taking two to three measurements because I did a bit of reading up on taking
blood pressure measurements and they suggested that you take three measurements to get a more
accurate reading rather than just one … So generally I did three readings with the mobile phone
switched on which then sent it to the website and then I could go onto the website to check if I
wanted to.
(PB3_m_m)
WHENEVER REMEMBERS 2
Oh really smoothly. I just kept it in the living room next to my chair and I did different times over
time, whenever I was near I would just take my blood pressure
(BB_f_m)
But other than that, no I just have it in a room in the house and when I remember I nip in and take it
and that’s it
(BR4_m_m)
28
ISSUE OF TIME/SPACE WITH NO INTERRUPTION 1
The only thing is I've got a five year, almost six year old. (he's about to be collected from school and
I'm going off to get her….. it was just trying to do it without any help/interference from her. And
having a quiet place which was the corner of the dining room over there.
COMMUNICATION/REMINDER ISSUES 5
MESSAGING ERROR 1
Fine, yes, the only thing…the only thing that I think I've noticed having gone on it is that I keep getting
messages, recorded messages, it's the same message from presumably a machine [laughs] which
doesn't help a lot. Because it's obviously coming from a machine and it tells me have I contacted my
medical practice or nurse, which I have but it doesn't seem to know that, you see?
( BR_m_m)
MESSAGES CAN BE ALARMING, NOT ENCOURAGING 3
And it might create a certain amount of alarm in some domestic situations if other members of the
family weren't really aware there was…or felt this, indicated there was some kind of a problem.
(MK_f_m)
Well, I’ve only ever had one letter, and it was pretty cursory, and I can’t even remember what it said.
It was basically stating the obvious stuff really. One thing that was of really good benefit was I got a
phone call to say, “We’ve been monitoring your blood pressure and we think it’s a bit high and we
want you to come in.”
Yeah, so they had been monitoring?
Yeah. So I came in, and that’s when my medication changed.
Excellent. So you know the system was at least going.
Yeah, it was, so I was pleased. I mean I was a bit alarmed when I got a phone call saying, “We want
you to come in”, but it’s a shame that it’s going to end, from my point of view because it’s been good.
(BR2_m_m)
The other thing that I have slightly stronger feelings about which I spoke to you about……was that the
emails that came, I haven't had emails for ages, maybe they've realised I'm not a good person to send
emails to…..I think this is an example of the email, let's take this one. That's you open up your email
and you see that…
And the first thing you see is alarm report.…big alarm report and you see…and then you see; this
report has been generated because of the following reason, your blood pressure is satisfactorily
controlled, continue to take your medication.
So that's that, now that was that one which was one three four over seventy four, two weeks later I
got this one, same heading, alarm report, but this said; your blood pressure is still not to target, if
you've not recently changed medication contact your practice, and it was one three six over seventy
three from one three four over seventy four.
29
Now I think one three five is the threshold which has presumably triggered this message through.
But I actually did contact the practice or phoned, it wouldn't be you I phoned….It was one of the other
numbers. And said; I've got this, and it was a Friday, of course, predictably so.So to hang over this to
the Monday, slightly, fractionally, slightly concerned but not unduly because I thought, well this is
nonsense. I probably wouldn't be treated for hypertension if I wasn't over a hundredand forty over
something or other. So, anyway, I really think if this is to go forward somebody has to pay a bit of
attention to the way this is framed. This is not appropriate, this is simply not appropriate, this is…
The word, alarm, is in itself alarming.
And it's a big of a shock to open up your email. And you get this and then by the time you read and
it's still; contact your practice…..Obviously I got this some time on a Friday and couldn't contact the
practice until Monday. Now, fair enough, I wasn’t unduly concerned but if that…even if that had been
something a bit higher than that……having to contact the practice…..So I think that's something that
should be able to be easily altered…..It's quite bald. .
(MK_f_m)
MESSAGES COULD BE MORE ENCOURAGING/LESS NEGATIVE 1
Well, no, I think…I'm not quite sure, you see if one could get another message that would tell me; oh,
you're making an improvement *laughs+… …it might encourage one…..Yes, something a bit more
positive than this repetitive message which tells you exactly the same thing and also, I should say, it
comes through about three minutes past one in the morning.
(BR3_m_m)
USABILITY FOR OLDER PATIENTS/ DEXTERITY/FAMILIARITY WITH IT/ 2
But the two things I would say about it is that it is slightly technical in that you've got to have the
space and opportunity to put the cuff on as well as the original twenty four hour recording and
keeping the phone charged up. .....
I can see in certain household situations and certain…certain household situations and perhaps with
certain age groups, and even little things like my hands are not as dextrous as they used to be, I don't
have any real disease, I suppose, it's just age, but if you weren't quite nimble there's the mobile
phone and there's the putting the cuff around
(MK_f_m)
CUFF 5
QUERY TIGHTNESS 1
No, the thing is that when you put it (cuff) on it’s…what is the tightness that it should be…. should it
be semi loose or should it be really tight?
(BR_m_M)
REINFLATION 1
Yeah, it was pretty easy to use, yeah, I had a…what I noticed that the only trouble I had I would say is
if I left it a bit longer, if it was like a week since I'd done the previous reading the blood pressure cuff
for the monitor would sometimes re-inflate three times. And I did have a replacement cuff but by
30
the time I got that, which was a few days' delay because I wanted to see if there really it…there was
something going wrong…….It was back to normal, but it did seem to be perhaps that all the air hadn't
gone out of it or something……
And I did wonder if it was giving inaccurate readings, but looking at the readings it didn't seem to
affect the readings because once it had done its third inflation and it was happy with that reading that
was taken then, that it was taking then, it really seemed to give you an accurate enough reading. But
when I asked for the replacement cuff I didn't know enough about it then and I thought maybe it
wasn't giving accurate readings on re-inflation, but it did seem to be.
The first time, the first couple of times I really wasn't that confident about what I was doing but it was
just a question of doing it more and then the readings seemed to make sense so…and they were
consistent, and then once I changed medication it seemed to improve. So it seemed to make sense
the way it was going to…
(PB3_m_m)
FINE NO PROB 3
No, no, no, it was fine, absolutely fine.
(BR3_m_m)
(Cuff) No problem at all. Uh huh. Yes, because they would come up if it wasn’t on properly, it would
come up on your machine that there was a fault so it wouldn’t send it. So what you done was just
took it off again and put it on again and then pressed the button. .
(PB4_m_m)
Yeah, it was pretty easy to use, yeah
(PB3_m_m)
MOBILE PHONE ISSUES 5
EASY AND INTERESTING 1
It was easy to operate, I found it easy to operate and I was interested to see the readings
(BR5_m_m)
TRANSMISSION FAILURE 2
I think I had one or two maybe that didn't transmit or, what's maybe more confusing, I didn't notice it
coming on to say; connected, the mobile phone came on, the screen came on and it said; connecting
to such and such, and then went off, and there were times I don't know whether it didn't come on
saying; connected…/…..If you don’t operate it correctly you get all sorts of things, but if you do
operate it it comes up C2, that means the trial’s been successful. But once or twice I’ve done the trial
and the whole thing has glitched, so I just put it down for half an hour and did it again and it worked.
….That’s why I was wondering if there was a battery in that that had slightly gone down or something.
It’s operating just now fine, I mean if I just press it it would be alright.
(BR_m_m)
31
SIGNAL FAILURE 1
They said, ‘why aren’t you using the machine?’ I said, ‘well...’ I think it was after two or three weeks,
I’m not sure, because it’s on Orange. Now, I know, because we’re on Orange and we don’t have a
signal here
MK_m_m/ D/Out
SWITCHING ON AND OFF 1
To begin with there was trouble because I don’t have a mobile phone and I thought, well how do you
get this phone on….I didn’t realise I had to press so hard at the top so it took a wee while before I
found that and then I got a phone to say they weren’t getting the readings and the trouble was I was
switching the telephone off too quickly.
(BR5_m_m)
INTEREST IN VARIATIO N 1
And there was once or twice I’ve put in an extra test in-between to see what was happening. In fact
there was one day I got a high blood pressure test and I thought it was wrong, so I did another one
and I did another one and I did another one, all about ten minutes apart.…you could be interested in
that because it went from high to low to lower to lower [laughs] and…by the time I’d done the four
tests, the higher reading had gone down quite considerably. I think I’d been…must have been het up
about something, but the blood pressure has gone down, but I didn’t transmit all four, I only
transmitted the first one.
(BR_M_m)
24 HOUR MONITORING INTRUSIVE, UNCOMFORTABLE 3
I did find it very uncomfortable…I didn’t enjoy it, it was…because it…every time it goes off, unless you
go and sit down and hold yourself still, it then doesn’t read it properly and has to redo it again and so
it…I didn’t find the…I didn’t…I was pleased that I was in control and not…
Yes, I mean it was intrusive. It was when…for instance, wearing it while I was driving, it would go off
and there was nothing you could do. You’re driving the car, you know it’s going to sort of do what it
does, failed to take the reading and then do it again and a couple of…but there’s nothing you can do
about it.
I mean I didn’t get any feedback yet. I did say that on the first visit, I said “Is it possible to get a print
out of the twenty-four hour monitor?” And they said “Perhaps at the end or it should be okay but
you’ll get it at the end”. And then I asked again at the end but I haven’t actually received it yet so…
(PB_m_nm)
The only thing, it was a wee bit uncomfortable because twice I had to have the twenty-four hour
monitor on. F1: Just because it’s bulky and you’re aware of it round your waist and the first time I
had to sleep with it, they had set it to go off every two hours first…at the beginning of the pilot and
then at the end when I got the next twenty-four hour one, I could take it off…I could…it was set to go
off at ten o’clock at night and come back on at eight…….So that wasn’t quite so bad but during the
night was a bit of a nightmare. Every two hours it would just make the noise and go off and it did
32
disturb your sleep, there’s no doubt about it. If that could maybe have been done in a distant sort of
way or with…make that…in this day and age, it’s quite a bulky bit of kit isn’t it?
(BB_f_m)
Yeah, it was pretty easy to use, yeah, I had a…what I noticed that the only trouble I had I would say is
if I left it a bit longer, if it was like a week since I'd done the previous reading the blood pressure cuff
for the monitor would sometimes re-inflate three times. And I did have a replacement cuff but by
the time I got that, which was a few days' delay because I wanted to see if there really it…there was
something going wrong…….It was back to normal, but it did seem to be perhaps that all the air hadn't
gone out of it or something……
And I did wonder if it was giving inaccurate readings, but looking at the readings it didn't seem to
affect the readings because once it had done its third inflation and it was happy with that reading that
was taken then, that it was taking then, it really seemed to give you an accurate enough reading. But
when I asked for the replacement cuff I didn't know enough about it then and I thought maybe it
wasn't giving accurate readings on re-inflation, but it did seem to be.
The first time, the first couple of times I really wasn't that confident about what I was doing but it was
just a question of doing it more and then the readings seemed to make sense so…and they were
consistent, and then once I changed medication it seemed to improve. So it seemed to make sense
the way it was going to…
(PB3_m_m)
VIEWS OF USE 5*
WOULD BE BEST FOR MONITORING FOR A PERIOD OF INSTABILITY 1
I think this scheme would be very useful if…for your changing medication or whether you have had or
there's been a period of instability in your blood pressure and instead of coming back and forwards to
the surgery and having it checked you can take this, you can have that set, you can take your own
blood pressure, maybe even just record it and not necessarily have the mobile phone business and all
the rest.
Would it have been easier just to have your own home monitor, for example
Yes, I would have been quite happy with that because, as you see, I noted down this….But I must say
that the phone's there for different purposes so you can collect and collate the data which is valuable.
.. But, no, I don't know whether if you're thinking that; well if that blood pressure was recorded and
beamed back to here would it be better, but I would have thought that actually having the blood
pressure monitor and then deciding yourself provided you were given clear guidelines - ‘Mrs M, if
yours goes over a hundred and sixty definitely ring the practice, we'll need to adjust things.’ Then I
think that'll be better, I think most people like to have quite a bit of control over what's happening to
them and I would have thought that would be…I would certainly be quite happy with that …It's
certainly, I think, worth offering to people in that category and accepting some people may not want
to be bothered with it, but probably quite a lot of people would be
(MK_m_m_D/Out)
WOULD PREFER AUTOMATIC MONITORING 1
I think if it was a situation where it was being monitored telemetrically without you having to do
something, that would be the thing. If you had a cuff that was on your arm, and it was their
33
permanently. And you could forget about it, and you thought well that’s it, and you didn’t know when
it was being monitored, the signal was just available to the researcher whenever they wanted and a
little chip or something like that would be...They worry about, ‘I’m going to be doing it in about an
hour’s time...
(MK_m_m_D/Out)
Well, the good thing about the one with the surgery is obviously I can go onto the web site and I can
download what my readings have been so I can see a patterns
(BR_m_m2)
DELIGHTED TO CONTINUE – WILL MISS IT 2
Well put it this way, I think now I’ve used it for quite a while, I would be delighted just to continue
using it, just on and on and on, it’s so easy to do and it sort of does I think make you aware that it’s
important.
Yeah, so it’s useful in view of awareness?
It was, and once you take it away and I have nothing, unless I get hold of something, I have nothing; I
will just have to be interested in what maybe the doctor does on the odd occasion when I go to see
him. I’ll miss the machine, I’ll tell you that much.
(BR4_m_m) (NB –slightly contradicts earlier indifference)
INTERESTING – BUT INTEREST TAILING OFF 1
While the whole thing has been interesting and I have no wish to withdraw before my trial is
completed but frankly it is now becoming a bit of a chore so I would be pleased to know how and
when it ends
(Email comment (ID 19211)
OVERALL PERCEPTION OF MONITORING SERVICE/STUDY 23
USEFUL/HELPFUL/ WORTHWHILE/INTERESTING 9
. I do like the idea of that, the technology kicking in like that so that you take your blood pressure
regularly and then send your results in. I was not in that…in that half of the group but I think that sort
of technology is fantastic. And I hope, I don’t know obviously, I don’t know the results of the
programme but I would like to think that everybody who was in that part of it, in that half of the
group, appreciated what they had to do. But obviously I don’t know if I’ll ever know the results of it.
(PB2_m_nm)
Yes. I really thought that it (system)was a brilliant idea. And it has helped me a lot, to understand
more
(PB4_m_m)
So as far as I’m concerned *laughingly+ it’s a shame I’m going to have to hand it back.
(BR2_m_m)
34
But anyway, yes, it’s no trouble and interesting, and it’s quite good. I think I would probably be
concerned if after a number of readings it was consistently up or down.
If it was high every day for a few days or something like that it might anticipate a possible problem. I
mean I would phone my doctor if that happened. …Because that means the pressure on the arteries
or something could cause a blow out or something like that.
Were you told when to phone the surgery or whether the surgery would contact you if the readings
were high?...
No. But I m going to see Dr B on another matter entirely and I’ll ask him about my readings. I imagine
he has them all somewhere
BR4_m_m)
I thought it was fine, it wasn't intrusive or anything because what I was doing was initially I think it
was four times a day or something ..(later)… No, I thought it was very worthwhile – it was very easy to
manage.
(PB3_m_m)
There was no bad thing about it from my point of view, it’s just all been good because it’s helped me
(BR3_m_m)
..as long as you got into a routine it was fine
.(BB2_m_m)
I found it quite interesting and I was probably using it far more than it was suggested I had to use
it…..At one time I was told...after the first week or two that if I used it once or twice a week, but I’ve
very often been using it every day, and finding it quite...as I say interesting to see how my blood
pressure can change, depending...even at the same time of day, every day, it can be different. Oh it’s
quite interesting
(BR4_m_m)
If I missed one at night, by the morning time there was a text on the machine here to remember me.
So the back up there was excellent as well. So everything, …as far as I’m concerned it was a
marvellous thing
(PB4_m_m)
INTRUSIVE /CREATES ANXIETY/ FEEL LIKE A PATIENT 3
One thing I would say about this study is it makes it a bit of a concern because you're…every week
you're taking your blood pressure and if it was slightly up you think; oh, well why is that, why isn't
that?
So I don't know whether I was expecting to find it useful because I didn't really have a need, you
know, I didn't have a need, I didn't have a major concern.
(MK_f_m)
Anyway, but the main thing was, that while I was doing it over these few weeks, I felt it was intrusive.I
started worrying about my blood pressure.I don’t normally worry about it because I know I’m going to
go to the nurse, and whenever I go to the nurse she’ll take my blood pressure. I can go at any time to
35
see them, if I need to pick up medication or I feel my medication I’m on and I have a few good
relationship with my doctor and practice nurse, and I can go in and in very short notice I can get an
appointment, and I don’t find that in any way intrusive in my life. But what I began to find was I was
thinking, if I do such and such, what will be the effect when I monitor myself?
Yes, and I thought this is never right, because I’m actually making my lifestyle constrained by this, and
I’ve never done that before. As long as I’ve felt well I’ve done anything I wanted, everything in
moderation. And I thought well this is actually counterproductive. I’m actually worrying about
something that I should be relaxed about. Yes, and so I talked with the nurse about it and I basically
decided to come off the trial, because I felt that if I didn’t do it properly it wasn’t going to be any help
to you, and if I did it properly it was actually no help to me! [laughter] So that was the reason I came
off it. But in some ways it’s interesting because I have a very good friend down in the Midlands
who has got a significant blood pressure problem, and he’s been monitoring himself for a long time
and recording it. And when I’m down visiting him I happily use his
If I was a heavy drinker, if I was a smoker, if I was abusing what I’ve got in the way of a body, then it
might be reassuring to know what the trend was. But I don’t see that my lifestyle is causing a problem
which could not very well be monitored with my two or three, or four visits to the doctor every year.
But for something that had not been an intrusion it was something I knew about, I controlled to the
best of my ability, it suddenly became something bigger than that.It intruded; it made me worry
about something that I didn’t think it was proper to be worrying about.
MK_m_m_D/Out
There was times as well where I have missed tablets I take…And that doesn’t help, but it’s just, things
happen when you get up in the morning. Your life’s not planned for you.
No. I’ve got kids. Tell me about it.
If you wake up every morning and have your breakfast and pop two tablets and then go in and do this
and do that and then pop another two at night, it would be a wonderful world, hey? But I always
maintain that if my life depended on me taking tablets I’d be dead; because I’m just terrible at it.
I’m the same. I’m just wondering if having the routine with the machine…
It does help. When I was doing the machine I was taking the tablets regularly…..When you get up in
the morning you were hitting the machine. You’d try and vary your times, obviously, but you know, I
tried to get them within an hour of when you’re supposed to do it, you know?
(PB4_m_m)
MORE AWARENESS/KNOWING WHAT IS HAPPENING (SEE SECTION ON IMPACT)1
Aye, knowing what’s happening is a good thing, as far as I’m concerned. Some people want to hide
their head in the sand. That’s up to them, but if you know it, then you know what to expect.
(PB4_m_m)
The best thing is that it keeps me in touch
(BR_m_m)
SAVES TIME ON APPOINTMENTS 2
Well yes, ahah. And any time there was…I got an email from the doctor every week from the readings
and he was able to advise me without me having to visit the doctor.
36
Ahah and how did you feel about that?
Well I was quite happy with that. I thought that was great. It was very time saving for me.
Ahah. So you find the time saving aspect then very useful?
Oh, yes, yes definitely. No effort making appointments, you just got an automatic email every week.
They give suggestions and like “Take more of the tablets. Take less of the tablets” and that’s how it
went until I got a good reading regularly, good readings.
(BB_f_m)
But yes, if it stops the doctors from doing silly things that people can do for themselves, then fair
enough. And it also keeps him on track with me. He said, when’s the last time I seen him? Six
months.
(PB5_m_m)
REASSURANCE 2
It’s good actually, I found it very useful, I’ve not had any problems at all, I’ve had no teething troubles
with it, apart from once when my son did it without me knowing and sent that figure through to the
computer, so obviously that one was miles out. But, no, it’s been good, and I like the fact that it’s
there because I was worried about my blood pressure. My personal circumstances have changed
quite a bit since I started, I don’t work at the moment, I left work. I’m looking to do something else
but it doesn’t start for a few months, but I feel generally pretty more relaxed. (BR2_m_m)
I found it very useful to know what your…your blood pressure was. It gave you a wee bit of piece of
mind
(BB_f_m)
Yeah, what did she (daughter) say? Why does she like it?
Yes, well you can keep tabs on it and you can see where you’re going and whatnot, and she just shook
her head at me like because mine were all over the place. It wasn’t a constant reading all the time.
(PB4_m_m)
CONTROL 1
I mean I’ve had cancer before so I have a routine now where I check my body. This to me, it was no
more than that. It is a monitoring facility that allows you to be in control
(BB2_m_m)
VIEWS OF USE 5*
WOULD BE BEST FOR MONITORING FOR A PERIOD OF INSTABILITY 1
I think this scheme would be very useful if…for your changing medication or whether you have had or
there's been a period of instability in your blood pressure and instead of coming back and forwards to
the surgery and having it checked you can take this, you can have that set, you can take your own
blood pressure, maybe even just record it and not necessarily have the mobile phone business and all
the rest.
Would it have been easier just to have your own home monitor, for example
37
Yes, I would have been quite happy with that because, as you see, I noted down this….But I must say
that the phone's there for different purposes so you can collect and collate the data which is valuable.
.. But, no, I don't know whether if you're thinking that; well if that blood pressure was recorded and
beamed back to here would it be better, but I would have thought that actually having the blood
pressure monitor and then deciding yourself provided you were given clear guidelines - ‘Mrs M, if
yours goes over a hundred and sixty definitely ring the practice, we'll need to adjust things.’ Then I
think that'll be better, I think most people like to have quite a bit of control over what's happening to
them and I would have thought that would be…I would certainly be quite happy with that …It's
certainly, I think, worth offering to people in that category and accepting some people may not want
to be bothered with it, but probably quite a lot of people would be
(MK_m_m_D/Out)
WOULD PREFER AUTOMATIC MONITORING 1
I think if it was a situation where it was being monitored telemetrically without you having to do
something, that would be the thing. If you had a cuff that was on your arm, and it was their
permanently. And you could forget about it, and you thought well that’s it, and you didn’t know when
it was being monitored, the signal was just available to the researcher whenever they wanted and a
little chip or something like that would be...They worry about, ‘I’m going to be doing it in about an
hour’s time...
(MK_m_m_D/Out)
Well, the good thing about the one with the surgery is obviously I can go onto the web site and I can
download what my readings have been so I can see a patterns
(BR_m_m2)
DELIGHTED TO CONTINUE – WILL MISS IT 2
Well put it this way, I think now I’ve used it for quite a while, I would be delighted just to continue
using it, just on and on and on, it’s so easy to do and it sort of does I think make you aware that it’s
important.
Yeah, so it’s useful in view of awareness?
It was, and once you take it away and I have nothing, unless I get hold of something, I have nothing; I
will just have to be interested in what maybe the doctor does on the odd occasion when I go to see
him. I’ll miss the machine, I’ll tell you that much.
(BR4_m_m) (NB –slightly contradicts earlier indifference)
INTERESTING – BUT INTEREST TAILING OFF 1
While the whole thing has been interesting and I have no wish to withdraw before my trial is
completed but frankly it is now becoming a bit of a chore so I would be pleased to know how and
when it ends
(Email comment (ID 19211)
38
RECRUITMENT 2
TOO MUCH BUMF 2
Well the initial, the original, initial letter that came about it, I mean it was quite detailed in what
would be involved, I think that there was quite a lot of reading material, I think that there'd b…a lot
put off…..Well I think there would be people…there could well be people, perfectly understandably,
who thought; I'm not ready to deal with this.…what is it going to mean and you've got this…I mean
the twenty four hour thing at the beginning as well was…Yeah, it depends, I can think for some people
that could be…that in itself would be a deterrent.
MK_f_m)
The literature I got with it initially when I brought the stuff home was more intimidating in terms of
You must have actually read it then [laughs].
Yeah, well tried to, I read it a few times and it was actually, I would say, simpler once you were
underway than…
PB3_m_m
TRAINING 5
SUFFICIENT 2
The girl that showed me how to do it explained how it ran. It was like training a muppet. She had
worked everything out and it was straightforward basic stuff
(PB4_m_m)
Yes, I went up to the health centre and met the nurse there who’s extremely helpful and
demonstrated the system and told me how to use it, told me why you were doing the trial, and I
would go into a pool and be divided into one of two groups. And yes, it was all very straight forward,
no problem at all. I went and collected the machine, brought it back, started on the trial
MK_m_m_D/Out
MORE NEEDED 3
I'm trying to think, I probably did get enough training but just to…yeah, because I'm one of those
people I've got to do things dozens of times……I've got to repeat things and read things and read
things and read things over and over again…..So maybe, yeah, maybe an initial session trying two or
three times to take your own blood pressure……and send the thing over for…Get a wee bit of practice
in, yeah, because I was quite nervous about doing it when I started off and that probably……(It) put
my blood pressure up as well to some extent, so maybe a wee bit more practice in the initial hooking
up session
(PB3_m_m)
I think mostly I met them the first time down at the surgery and I don’t remember anybody turning
round and saying, well let’s put it on for you and see how…see if we can get it put on and I think that’s
where the…
(BR_m_m)
39
Well yes I would say…actually now what happened, the first meeting I had she was running late, or
running out of time and by the time everything else was explained the…the phone…well of course she
would assume I would know a mobile phone.
(Br5_f_m)
MISCELLANEOUS 3
INTERPRETATION OF BP READINGS (FROM A VETERINARY EXPERIENCE) 1
I know the two situations are different from an historic point of view, but as a veterinary surgeon we
never ever monitor our patient’s blood pressure. We don’t do it, because A, it’s very difficult to
actually get them to relax and put on a cuff, because their limbs are not the right shape for doing it,
they’re all tapered. And we do very sophisticated long duration anaesthesia and operations, and all
the other things, and we haven’t a clue what our patient’s blood pressure is! We monitor them by
capillary bed activity, and that’s it. And I sometimes wondered is too much made of blood pressure….
So it might have been useful perhaps to have more information about the actual nature of the blood
pressure condition itself, rather than have an umbrella term that actually doesn’t tell you anything,
yes.
And it is for instance the consequences of having the arteriosclerotic...and something breaking off,
heart attack, stroke or whatever. But that’s the only thing that worries me, but I don’t know whether
everyone who has high blood pressure has arteriosclerosis, I don’t know!So I would be very keen to
know that, in case it might be better, rather than just monitoring blood pressure, would be actually
today to scan people’s hearts, because perhaps if they’ve got no arteriosclerotic problem, the blood
pressure is not perhaps...And know the consequences of it, because if you have got arteriosclerotic
build up, that’s something which is something to be aware of, and adjust your diet even more
perhaps. I don’t know, but I’d be very interested to find out.
MK_m_m_D/Out
IMPORTANCE OF TIMING IN ASSESSING BP FROM VETERINARY PERSPECTIVE 1
Introduced my clients to fairly sophisticated haematology to try and prevent them running their
horses when they were not 100 percent well. Now it was quite interesting...It bears closely
on...Exactly, and I could actually take the same horse and an hour apart in time and by using a
different methodology of removing the blood from the same vein, we always do it on the jugular vein,
I could produce results which looked like six different horses! We had to standardise, and this is one
of the things that nobody else had done, we had to standardise the time of day, the relationship to
feeding because if they took a hay net full of hay, their haemoconcentration within half an hour was
very significant. And the difference between taking an open vein blood vessel, a flowing vein
puncture, or an occluded, was two totally different animals.
So we had this system where we absolutely...done first thing in the morning before they ate, and it
had to be a flowing, non-occluded jugular vein, which is fine because the jugular vein is a fairly
big...And I was thinking of that in this.Are we allowing for the technology actually reflecting more
what the technology is able to do, rather than the reality of the patient?
MK_m_m_D/Out
IMPACT OF OTHER FACTORS ON BP 1
I would love to use the machine to check my wife’s blood pressure, particularly if we’ve had a row or
something, her blood pressure might go up.
40
Yes well I can remember years and years ago when on holiday, we went into a supermarket
somewhere in the United States, and you just passed this machine and you put your hand in and it
gave you your blood pressure. As you looked at the offerings on the counter you could check your
blood pressure. How accurate it was of course I wouldn’t like to say, but it was available if you
wanted it.
BR4_m_m
41