Upgrading Global Hypertension Management through Self-Monitoring and a Culturally Adapted BASNEF Model: A Mixed-method Study in a Resource-Limited Setting

Worldwide, 1.28 billion adults have hypertension, with suboptimal control rates, especially in low- and middle-income countries. This study addresses the challenge of developing innovative, culturally appropriate, cost-effective interventions in resource-limited settings. In this mixed-method study, which was conducted for 10 months in rural Philippines and involved 50 participants, the intervention of SMBP combined with a culturally adapted and modified BASNEF model was evaluated. Participants received home blood pressure monitors and attended five individualized intervention sessions. Primary outcomes measured included changes in SBP and medication adherence using the modified Morisky Medication Adherence Scale. Other secondary outcomes included quality of life assessment using the EQ-5D-5L questionnaire, cost-effectiveness using the WHO-CHOICE methodology and qualitative experiences. Data analysis was conducted in IBM SPSS Statistics v26 and MAXQDA 2020. A significant decrease in mean SBP was seen from 146.50 mmHg at baseline to 134.92 mmHg at postintervention, with an SD of 19.59 and 15.24, using a paired t-test: p < 0.001. The medication adherence rate increased from 14 percent to 72 percent (p < 0.001). Quality of life scores improved by 22 percent (p < 0.01). The intervention was cost-effective at an ICER of PHP 5,000 per participant, much less than the WHO-CHOICE threshold for the Philippines. Qualitative analysis showed themes that included empowerment, support from family, cultural resonance, habit formation challenges, and benefits perceived by people. This culturally adapted SMBP-BASNEF intervention significantly improved BP control, medication adherence, and quality of life. It thus offers a cost-effective strategy for the management of hypertension in resource-limited settings globally. Hence, this approach could contribute towards attaining Sustainable Development Goal 3.4 by explicitly addressing the rising burden of NCDs in LMICs.