SEMI-STRUCTURED INTERVIEWS TO ASSESS THE FEASIBILITY OF A SELF-MANAGEMENT APPROACH TO HYPERTENSION ASSOCIATED WITH CKD IN THE SMaRT BP CKD RANDOMISED FEASIBILITY TRIAL.

 

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SEMI-STRUCTURED INTERVIEWS TO ASSESS THE FEASIBILITY OF A SELF-MANAGEMENT APPROACH TO HYPERTENSION ASSOCIATED WITH CKD IN THE SMaRT BP CKD RANDOMISED FEASIBILITY TRIAL.

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Bethany
Lucas
Bethany Lucas bethany.lucas1@nottingham.ac.uk University of Nottingham Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine Nottingham United Kingdom * University Hospitals of Derby and Burton NHS Foundation Trust Department of Renal Medicine, Royal Derby Hospital Derby United Kingdom
Ashveer Randhay ashveer.randhay1@nottingham.ac.uk University of Nottingham Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine Nottingham United Kingdom - University Hospitals of Derby and Burton NHS Foundation Trust Department of Renal Medicine, Royal Derby Hospital Derby United Kingdom
Kelly White kelly.white@nhs.net University Hospitals of Derby and Burton NHS Foundation Trust Department of Renal Medicine, Royal Derby Hospital Derby United Kingdom -
Nicholas Selby nicholas.selby@nottingham.ac.uk University of Nottingham Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine Nottingham United Kingdom - University Hospitals of Derby and Burton NHS Foundation Trust Department of Renal Medicine, Royal Derby Hospital Derby United Kingdom
Maarten Taal M.Taal@nottingham.ac.uk University of Nottingham Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine Nottingham United Kingdom - University Hospitals of Derby and Burton NHS Foundation Trust Department of Renal Medicine, Royal Derby Hospital Derby United Kingdom
Heather Buchanan heather.buchanan@nottingham.ac.uk University of Nottingham 3. School of Medicine, Lifespan & Population Health Nottingham United Kingdom -
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Blood pressure (BP) control is a key therapeutic intervention in chronic kidney disease (CKD) but patients find meeting BP targets challenging. The SMaRT BP CKD trial aimed to assess the feasibility of supported self-management of BP for people with CKD in secondary care using an approach previously trialled successfully in primary care. In addition to the main trial, semi-structured interviews were conducted with participants to evaluate barriers and facilitators to adopting the intervention.

SMaRT BP CKD was a single centre randomised feasibility trial of a self-management intervention with home BP monitoring monthly alongside research team supported escalation of anti-hypertensive treatment. Inclusion criteria were: CKD stages 1-4, aged >18years, prescribed <4 anti-hypertensive agents and an average clinic BP in the preceding 12 months of >120mmHg, or >130mmHg systolic if they had diabetes. Participants were recruited from CKD outpatient clinics and were randomised 1:1 to intervention or standard care. Those in the intervention arm of the study were invited to participate in a semi-structured interview after at least six months of the intervention or upon withdrawal from the study. Interviews were conducted by telephone or in person and were intended to explore barriers and facilitators to adopting the intervention.  They were recorded and transcribed verbatim. Transcripts were imported into nVivo software and analysed using a thematic analysis (TA) approach. 

Thirteen interviews were conducted between February 2024 and August 2025 from a total of 23 participants in the intervention group. The median (IQR) age was 75 (65-81), the majority of participants interviewed were male (77%). At baseline the interview cohort had a median eGFR of 33 (29-53)ml/min/1.73m2, uACR of 9.4 (3-36.5)mg/mmol. Baseline median systolic and diastolic BP was 141 (133-147) mmHg and 77 (65-88) mmHg. At 12 months the median systolic and diastolic BP for the cohort was 135 (132-143)mmHg and 77 (65-88)mmHg.

Initial TA identified themes reflecting key barriers and facilitators to adopting the self management intervention. Themes included: factors related to individual participants—such as beliefs about BP, CKD, and medication—as well as themes specific to the study procedures and intervention itself. These included challenges with BP monitoring equipment and time constraints as barriers to participation, and trust in the research team and affinity to the local renal unit maintaining participation.

The interviews provided in-depth data from participants on factors influencing their adoption of the self management intervention for BP control in the SMaRT BP CKD feasibility trial. Potential approaches to improving adoption of the self-management intervention  include the development of targeted educational resources to address common misconceptions, use of automated prompts for home BP monitoring and assessing individual readiness to self-manage anti-hypertensive medications

Kewords