Patient personas exemplifying behavioural barriers and enablers to patient education across the hypertension journey: A qualitative framework analysis.

Only one in five people with hypertension achieve blood pressure control below 140/90 mmHg.

• The blood pressure control threshold referenced is <140/90 mmHg.
• This statistic is cited as motivation for improving patient education approaches.
• The low control rate is framed as a persistent public health problem addressable through better-tailored education.

Qualitative interviews were conducted with 27 patients who self-monitor blood pressure and 12 primary care practitioners to explore barriers and enablers to patient education for blood pressure management.

• Patient participants were adults aged 18 or older who self-monitor blood pressure.
• Practitioner participants included general practitioners, nurses, and pharmacists (n=12).
• Framework analysis was used as the analytic method.
• The study explored experiences at key time-points: diagnosis, treatment initiation, and long-term management.

Key barriers to patient education identified by both patients and practitioners included patient overwhelm, inconsistent guidance across providers, and perceived patient disengagement.

• Patient overwhelm was identified as a barrier particularly at diagnosis and treatment initiation stages.
• Inconsistent guidance across providers was identified as a systemic barrier affecting coordinated messaging.
• Perceived patient disengagement was noted by practitioners as a challenge to delivering effective education.
• Both patient (n=27) and practitioner (n=12) perspectives contributed to identification of these barriers.

A strong desire to self-manage was identified as a consistent enabler to patient education across the hypertension journey.

• This enabler was reported consistently across both patient and practitioner interviews.
• The desire to self-manage was observed across multiple time-points in the hypertension journey.
• Self-monitoring of blood pressure was a characteristic of the patient sample, which may reflect this self-management orientation.

Six clusters of behavioural barriers and enablers were synthesised into patient personas capturing distinct patterns and education needs across the hypertension journey.

• Personas were developed using a three-step process: thematic analysis of patient interviews, clustering via the Capability, Opportunity, Motivation-Behaviour (COM-B) model, and validation through consumer consultation feedback.
• Behavioural factors were mapped at three key hypertension journey time-points: diagnosis, treatment initiation, and long-term management.
• Personas were refined using practitioner interview data.
• Consumer consultation feedback was used to validate the final personas.
• Each persona captures shared behavioural drivers and education needs among groups of patients.

The hypertension journey was conceptualised as three key time-points—diagnosis, treatment initiation, and long-term management—each associated with distinct education needs.

• Structured support was identified as a specific need at the diagnosis stage.
• Coordinated messaging across providers was identified as a need during treatment initiation.
• Strategies to sustain adherence were identified as a need in long-term management.
• This stage-specific framing informed both the thematic analysis and the persona development process.

Patient personas were identified as a practical framework applicable to clinician training, co-design of resources, and integration into primary care workflows and digital tools.

• Proposed applications include use in clinician training programmes.
• Personas are suggested for co-design of patient education resources.
• Integration into primary care workflows is identified as a potential application.
• Integration into digital tools is also proposed as an implementation avenue.
• The framework is characterised as enabling 'context-specific, person-centred education interventions.'

Future research is needed to evaluate implementation of persona-informed interventions in routine care and assess their impact on patient engagement and blood pressure control.

• The authors call for implementation studies in routine primary care settings.
• Outcome measures proposed include patient engagement and blood pressure control.
• The current study is qualitative and does not itself measure clinical outcomes.
• This recommendation reflects the gap between persona development and evidence of clinical effectiveness.