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

Abstract

One in five people with hypertension achieve blood pressure (BP) control (<140/90 mmHg). Patient education improves BP control, yet there is limited guidance to adapt to individuals' evolving needs across the hypertension journey. This study aimed to identify behavioural barriers and enablers to patient education, which were synthesised into patient personas that capture shared behavioural drivers and education needs among groups of patients. This study included qualitative interviews with adults (≥18) who self-monitor BP, and primary care providers, and explored experiences of accessing and delivering patient education for BP management. Using framework analysis, patient personas were developed in three steps: 1) thematic analysis of patient interviews to identify and map barriers and enablers to patient education at key time-points in the hypertension journey (diagnosis, treatment initiation, long-term management), 2) clustering behavioural factors via the capability, opportunity, motivation-behaviour model, which were synthesised as patient personas and refined using practitioner interviews and, 3) validation of personas by consumer consultation feedback. Patients (n = 27) and practitioners (n = 12; general practitioners, nurses, pharmacists) identified key barriers to patient education, including patient overwhelm, inconsistent guidance across providers, and perceived patient disengagement. A strong desire to self-manage was a consistent enabler. Six clusters of behavioural barriers and enablers were synthesised as patient personas, capturing distinct patterns and education needs across the hypertension journey. Patient personas identify opportunities for tailored, stage-specific education, including structured support at diagnosis, coordinated messaging during treatment initiation, and strategies to sustain adherence in long-term management. Patient personas provide a practical framework for designing context-specific, person-centred education interventions, including use in clinician training, co-design of resources and integration into primary care workflows and digital tools. Future research should evaluate implementation of persona-informed interventions in routine care and assess their impact on patient engagement and BP control.