Identifying personalized barriers for hypertension self-management from TASKS framework

Abstract

Objective
Effective management of hypertension requires not only medical intervention but also significant patient self-management. The challenge, however, lies in the diversity of patients' personal barriers to managing their condition. The objective of this research is to identify and categorize personalized barriers to hypertension self-management using the TASKS framework (Task, Affect, Skills, Knowledge, Stress). This study aims to enhance patient-centered strategies by aligning support with each patient's specific needs, recognizing the diversity in their unique circumstances, beliefs, emotional states, knowledge levels, and access to resources. This research is based on observations from a single study focused on eight patients, which may have been a part of a larger project.

Results
The analysis of transcripts from eight patients and the Global Hypertension Practice Guidelines revealed 69 personalized barriers. These barriers were distributed as follows: emotional barriers (49%), knowledge barriers (24%), logical barriers (17%), and resource barriers (10%). The findings highlight the significant impact of emotional and knowledge-related challenges on hypertension self-management, including difficulties in home blood pressure monitoring and the use of monitoring tools. This study emphasizes the need for tailored interventions to address these prevalent barriers and improve hypertension management outcomes.

Full text

Yangetal. BMC Research Notes (2024) 17:224
https://doi.org/10.1186/s13104-024-06893-7
RESEARCH NOTE
Identifying personalized barriers
forhypertension self-management fromTASKS
framework
Jiami Yang1,2, Yong Zeng1,2*, Lin Yang3,4, Nadia Khan5, Shaminder Singh6, Robin L. Walker1,
Rachel Eastwood1 and Hude Quan1*
Abstract
Objective Effective management of hypertension requires not only medical intervention but also significant patient
self-management. The challenge, however, lies in the diversity of patients’ personal barriers to managing their condi-
tion. The objective of this research is to identify and categorize personalized barriers to hypertension self-manage-
ment using the TASKS framework (Task, Affect, Skills, Knowledge, Stress). This study aims to enhance patient-centered
strategies by aligning support with each patient’s specific needs, recognizing the diversity in their unique circum-
stances, beliefs, emotional states, knowledge levels, and access to resources. This research is based on observations
from a single study focused on eight patients, which may have been a part of a larger project.
Results The analysis of transcripts from eight patients and the Global Hypertension Practice Guidelines revealed
69 personalized barriers. These barriers were distributed as follows: emotional barriers (49%), knowledge barriers
(24%), logical barriers (17%), and resource barriers (10%). The findings highlight the significant impact of emotional
and knowledge-related challenges on hypertension self-management, including difficulties in home blood pressure
monitoring and the use of monitoring tools. This study emphasizes the need for tailored interventions to address
these prevalent barriers and improve hypertension management outcomes.
Keywords Hypertension, Self-management, Personalized, Barriers, TASKS framework
Introduction
Hypertension is a leading global health risk, significantly
contributing to cardiovascular diseases such as stroke
and heart failure and affecting mortality and morbidity
rates worldwide [1–3]. Despite the effectiveness of life-
style modifications and antihypertensive medications [4],
patient adherence varies widely, with nonadherence rates
between 10 and 80%, challenging the achievement of
optimal blood pressure control [5, 6]. Self-management is
critical in managing hypertension [7], requiring patients
to take an active role in their health care, yet nearly 40%
of patients discontinue crucial treatments, and over half
fail to adhere to necessary behavioral changes [8]. Factors
such as cultural beliefs and past healthcare experiences
Open Access
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BMC Research Notes
*Correspondence:
Yong Zeng
yong.zeng@concordia.ca
Hude Quan
hquan@ucalgary.ca
1 Department of Community Health Sciences, Faculty of Medicine,
University of Calgary, Calgary, AB, Canada
2 Concordia Institute for Information Systems Engineering, Concordia
University, Montreal, QC, Canada
3 Department of Cancer Epidemiology and Prevention Research, Cancer
Care Alberta, Alberta Health Services, Calgary, AB, Canada
4 Departments of Oncology and Community Health Sciences, University
of Calgary, Calgary, AB, Canada
5 Department of Medicine, Faculty of Medicine, University of British
Columbia, Vancouver, BC, Canada
6 School of Nursing and Midwifery, Faculty of Health, Community
and Education, Mount Royal University, Calgary, AB, Canada
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Yangetal. BMC Research Notes (2024) 17:224
heavily influence patient attitudes toward self-manage-
ment [9, 10].
Recognizing personalized barriers to hypertension
self-management is essential for the successful imple-
mentation of interventions, aiming to bridge the evi-
dence-to-practice gap in healthcare [11]. Personalized
barrier identification allows for a deeper understand-
ing of individual needs, preferences, and contextual fac-
tors, facilitating targeted interventions [12]. Traditional
qualitative methods, like thematic analysis [13, 14], have
been used to code interview transcripts in hypertension
research, identifying common themes [15] across patient
experiences. is method begins with interviews, letting
themes emerge organically through deductive or induc-
tive reasoning. Various frameworks like Consolidated
Framework for Implementation Research (CFIR) [16],
eoretical Domains Framework (TDF) [17], Capabil-
ity Opportunity Motivation Behavior (COM-B) [18], and
Barriers and Facilitators in Implementation of Task-Shar-
ing Mental Health Interventions (BeFITS-MH) [19] have
provided predefined coding schemes. However, these
methods often struggle to capture the diverse and per-
sonalized needs of patients [20].
To address these challenges, this study introduces
the TASKS framework [12], which focuses on Task (T),
Affect (A), Skills (S), Knowledge (K), and Stress (S), offer-
ing an approach to understanding the interplay between
an individual’s mental capabilities, external resources,
and the demands of managing hypertension. e frame-
work categorizes barriers into emotion, logic, knowledge,
and resource-related, providing insights into the specific
reasons behind patients’ actions and decisions in self-
managing hypertension. Originally applied in various
fields such as education [21], engineering [22], sustain-
ability [23] and beyond, the TASKS framework’s adapt-
ability presents a novel avenue for exploring personalized
barriers in hypertension self-management. is research
aims to evaluate the framework’s effectiveness in identi-
fying these barriers, marking a significant step towards
enhancing patient-centered care and improving self-
management outcomes in hypertension.
Methods
Study design anddata information
is study employs the TASKS framework to identify
personalized barriers from interview transcripts. Data
were sourced from Global Hypertension Practice Guide-
lines [4] and anonymized interview transcripts from a
prior study [13], with ethical clearance from the Univer-
sity of British Columbia’s Clinical Research Ethics Board.
Originally, nine patients from two focus groups were
considered, but due to inefficiency in one patient’s data,
eight were ultimately analyzed.
Five transcript analyzers, comprising both medical
and non-medical students, underwent intensive train-
ing on the coding process, which included defining the
coding scheme and jointly coding 20 sentences. ey
then independently applied the TASKS framework to
the transcripts of eight patients, resolving any coding
discrepancies through discussion. e analyzers’ agree-
ment was assessed by independently coding two shared
transcripts. is research aimed to validate the TASKS
framework’s utility in pinpointing personalized barriers
to hypertension self-management.
Coding hypertension guideline
We referred to the Global Hypertension Practice Guide-
lines [4] to identify the required TASK components:
affect skills, knowledge (ASK), and resources necessary
for specific workload/tasks (T). Workload, in this con-
text, denotes the external load assigned by experts or
governmental entities, such as recommendations made
by physicians for patients. To break down this pro-
cess, four key steps were undertaken: (1) extracting all
required workloads specified in the Global Hyperten-
sion Practice Guidelines; (2) determining the life cycle
associated with each workload [24]; (3) coding the ASK
and resource requirements for each workload based on
its life cycle; and (4) consolidating all stages of ASK and
resource elements related to a particular workload.
Identifying personalized barriers using theTASKS
framework
Coding aect, skills, knowledge (ASK), andresource
In this step, we streamlined unstructured interview
transcripts into a semi-structured format for detailed
analysis. is involved classifying text by speaker and
evaluating each sentence adhering to analyze underly-
ing messages behind the interviewee’s message including
Affect (A), Skills (S), Knowledge (K) and Resource. Multi-
ple analysts independently undertook this task to ensure
a thorough examination of the data.
e TASKS framework differentiates between ASK and
Resource. Affect relates to emotional experiences affect-
ing task engagement, including attitudes, beliefs, feelings,
and ethics. Skills involve cognitive and affective capabili-
ties, emphasizing logical reasoning—deductive, induc-
tive, abductive, and recursive [25] -to use knowledge in
practical scenarios. Knowledge refers to understanding,
including facts and cause-effect relationships related to
the task at hand. Resources are considered as external
aids like time, money, or physical tools.
For instance, in the provided transcript: "My run mara-
thons I’ve done 18 of them, I do yoga, I do everything that
is possibly able to reduce blood pressure and has not been
able to do that," the patient exhibits (Affect) frustration
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Yangetal. BMC Research Notes (2024) 17:224
and disappointment due to their extensive efforts not
yielding the anticipated blood pressure reduction. ey
employ (Skills) deductive logic, assuming activities like
running marathons and yoga would lower blood pressure
based on common knowledge. is patient demonstrates
(Knowledge) experience in activities linked to blood
pressure reduction.
Evaluating andsynthesizing coded ASK andresource
In the evaluation phase, an experienced TASKS frame-
work analyst compares the conclusions drawn by multi-
ple analysts, resolving conflicts and ensuring a definitive
interpretation. ese synthesized findings are combined
to form a coherent result. During synthesis, the ana-
lyst categorizes and integrates the analyzed ASK and
resource elements specific to each patient. e credibility
of these findings is then verified by a hypertension spe-
cialist. is synthesis process provides a comprehensive
view of patients’ personas by encompassing their skills,
knowledge, resources, and emotional and psychological
factors. is approach offers a holistic understanding of
their inner mental capabilities, defined as a composition
of Affect, Skills, and Knowledge (ASK) according to the
TASKS framework [26].
Barrier detection
e barrier detection employs a predictive approach,
contrasting the requirements outlined in the Global
Hypertension Practice Guidelines with individual
patients’ ASK (affect, skills, knowledge) and resources.
For each workload, the analyst evaluates the ASK and
resources to discern workload-specific barriers cat-
egorized to the TASKS framework (see Table 1). ese
workload-specific barriers are then grouped, forming a
understanding of the barriers associated with each work-
load and individual patient. is detailed comprehen-
sion paves the way for crafting precise interventions and
tailored support mechanisms, effectively addressing the
identified barriers. is approach ensures that interven-
tions are not generic but finely tuned to the unique self-
management needs of each patient.
Results
Hypertension guideline results
In our analysis, we systematically extracted and cat-
egorized all essential workloads outlined in the Global
Hypertension Practice Guidelines [4] into four primary
types: (1) Having a healthy lifestyle; (2) Monitoring blood
pressure (BP) regularly at home, (3) Taking medication(s)
regularly as prescribed, and 4) Creating a hypertension
support system: family, friends, and healthcare profes-
sionals (HCPs). e comprehensive breakdown of neces-
sary ASK and resources for each workload is detailed in
Table 2. is table serves as a valuable implementation
resource, aligning with the recommendations laid out in
the Global Hypertension Practice Guidelines.
Barriers
Using the TASKS Framework, we compared the required
Affect, Skills, and Knowledge (ASK) components outlined
in the guidelines (Table2) with each patient’s individual
ASK profile. Our analysis identified a new workload cat-
egory, "2a. Using Blood Pressure Tools," emphasizing
tool usage. Personalized barriers for eight patients were
identified, each denoted by ( ). Supple-
mentary file 1 provides more detailed patient-specific
barriers information. We also categorized all barriers into
emotion, logic, knowledge, and resource types, detailed
in Table3.
Discussion
What istheadded value ofpersonalized barriers
forhypertension self‑management?
Our research delved into personalized barriers in hyper-
tension self-management, utilizing descriptive statis-
tics to highlight common themes while acknowledging
individual differences. Among the eight patients inter-
viewed, a total of 69 barriers were identified, with emo-
tion barriers being the most prevalent (49%), followed
by knowledge (24%), logic (17%), and resource barriers
(10%). Emotion barriers were the most prevalent, indicat-
ing significant stress and anxiety related to self-manage-
ment tasks, such as monitoring blood pressure at home,
which presented the highest challenge (34.78%). is was
Table 1 Implementation barrier classification in the TASKS framework
Barriers Content
Emotion barriers Motivation, attitudes (such as cognitive/awareness, expectation, value), beliefs
(such as acceptance, optimism), feelings (such as anxiety, pressure, fear), or ethics
Logic barriers Thinking styles, thinking strategies, or reasoning methods
Knowledge barriers The structure of knowledge, cognitive resources that are persons’ past knowledge
Resource barriers All environment components (such as time, money, and cognitive capacity)
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Yangetal. BMC Research Notes (2024) 17:224
Table 2 Required ASK and resources for each workload in Global Hypertension Practice Guidelines
Workload Aect Skills Knowledge Resource
1. Having a healthy lifestyle
Adhere to a balanced diet
Restrict sodium intake and limit alcohol
consumption
Abstain from smoking and avoid envi-
ronments where others smoke
Engage in regular physical activity
and maintain a healthy weight
Strive for a stress-free lifestyle
1. Motivation to make the necessary
effort in a healthy lifestyle
2. Patience in adhering to recom-
mendations such as reducing sodium
intake, limiting alcohol consumption,
not smoking, and maintaining a healthy
weight
Long-term thinking strategic
Deduction logic
Logical thinking
Calculation
Organization
3. Dietary Approaches to Stop Hyper-
tension (DASH) diet and the impor-
tance of a balanced diet for managing
hypertension
4. Limitations on sodium intake (alcohol
intake, smoking) to control blood
pressure
5. Healthy weight goals in relation
to hypertension management
6. Different types of exercises are ben-
eficial for managing hypertension
7. Knowledge about stress relaxation
techniques
8. Friends and family
9. Time
10. Hypertension guidelines
11. DASH resources
12. Relaxation techniques
13. Take note of ways and health-related
apps
2. Monitoring blood pressure (BP) regu-
larly at home 1. Motivation to record daily readings
2. Willingness to confront their own BP
readings
3. Patience with regular BP check-ups
4. Information about their BP
5. Knowledge of BP terminology
and interpreting measurement
6. Realistic goals for hypertension level
7. Instructions for using the blood pres-
sure monitor
8. Blood pressure monitor machine
9. Take note of ways
10. Time
3.Taking medication(s) regularly as pre-
scribed 1. Motivation to take daily medications
2. Willingness to confront their own
health conditions
3. Patience with consistently taking
medications as prescribed
4. Trust in the effectiveness of medica-
tion or treatment
5. Professional knowledge regard-
ing medication and prescribed informa-
tion
6. Knowledge about side effects
and adverse reactions
7. Medications
4. Creating a hypertension support
system: family, friends, and healthcare
professionals (HCPs)
Regularly visit your HCP for checkups
Seek immediate medical attention
from your HCP in case of emergencies
1. Motivation to visit HCP for checkups
2. Patience with regularly visiting HCP
for checkups
3. Trust in the physicians or HCPs
4. No white coat syndrome, which refers
to elevated blood pressure in a medical
setting due to anxiety or stress
5. Communication with oth-
ers (friends and family, HCPs) 6. Information about their BP
7. Signs of side effects, such as stroke
or heart attack
8. Friends and family
9. Physician/HCP
10. 911
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Table 3 All hypertension self-management barriers using the TASKS framework
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Yangetal. BMC Research Notes (2024) 17:224
closely followed by difficulties in using blood pressure
monitoring tools, medication management, and adopting
a healthier lifestyle, each presenting substantial obsta-
cles due to emotion and knowledge barriers. e least
encountered barriers involved creating a support system
with healthcare professionals (10.14%), yet still predomi-
nantly emotional.
By ranking these barriers (see Supplementary file
2), we aim to provide healthcare professionals with a
clear understanding of the primary barriers faced by
patients, guiding the development of targeted strategies
to improve self-management outcomes. Determining the
overall intervention approach and incorporating behav-
ior change techniques have proven effective in alter-
ing behavior patterns within the target population [18,
27]. Emotional support, information provision, and
enhancing patient-healthcare professional relationships
emerge as key areas for intervention in hypertension
management.
Emotional support Emotion barriers in hypertension
self-management stem from fears and uncertainties
about medication effects, as well as anxiety over blood
pressure readings. Impatience and lack of motivation
further hinder lifestyle changes and routine check-ups,
creating a vicious cycle of stress and negative perception.
Effective interventions foster trust and resilience. Cogni-
tive-Behavioral erapy (CBT) changes negative thought
patterns and behaviors, and has been proven to positively
impact hypertension outcomes, especially when group-
based and long-term [28]. Mindfulness-Based Stress
Reduction (MBSR) also helps manage stress and anxi-
ety, improving outcomes in chronic disease management
[29].
Information provision Understanding fluctuating blood
pressure standards and medication side effects is chal-
lenging for patients. Personalized educational tools,
available through digital platforms and brochures, will
be essential. ese resources offer clear insights into
evolving standards and medication details, empowering
patients to set realistic goals and manage potential side
effects confidently. Encouraging peer-support groups and
conducting regular knowledge assessments can further
enhance understanding. By providing comprehensive,
easy-to-understand information, patients can proactively
navigate hypertension management, fostering a more
informed and confident approach.
Enhancing patient-healthcare professional relationships
Limited access to healthcare professionals is a significant
hurdle. Motivational interviewing and shared decision-
making, tailored to individual needs, can improve com-
munication, boost engagement, and enhance self-efficacy
[30, 31]. Telehealth services, such as community tele-
paramedicine (CTP), and outreach programs further
support patients by empowering them and transform-
ing their journey from isolation to a sense of community,
particularly for those in rural and remote areas [32–34].
Regular follow-ups and personalized communication also
strengthen patient-provider relationships and improve
adherence, highlighting the importance of empathetic
and patient-centered care.
Is theTASKS framework applicable forguiding data
analysis?
In health research, qualitative studies aim to compre-
hend the motivations and perceptions influencing health
behaviors [35]. Employing a theoretical framework, like
the TASKS framework, enhances the grounding of find-
ings in robust theory, enriching the field’s knowledge
base. is framework uniquely focuses on the complex
interplay between an individual’s tasks and their mental
capabilities—Affect, Skills, and Knowledge—and how
this interplay is affected by mental stress, following an
inverted U-shaped curve [36]. Patient’s performance
relies on their mental effort, which depends on their
mental stress. is dynamic demonstrates how mental
effort correlates with mental stress, wherein both low and
high stress levels can diminish mental effort, but moder-
ate stress may optimize it [12] (see Fig.1 left).
e TASKS framework categorizes implementation
barriers into emotion, logic, knowledge, and resource
Fig. 1 The relationship and information behind mental stress [12, 26]. (Left: an inverted U-shaped curve between mental stress and mental effort;
Right: mental stress modeled by the ratio of perceived task workload to mental capability)
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Yangetal. BMC Research Notes (2024) 17:224
types through a precise equation involving the ratio of
perceived tasks workload to mental capability [26] (see
Fig. 1 right). It systematically aligns guideline require-
ments with individual circumstances through a top-
down to bottom-up method for coding and modeling
mental capabilities (ASK) and resources. is process
identifies hypertension self-management barriers by
comparing guideline requirements with personal situa-
tions, both structured by ASK and resources. is align-
ment naturally extends the four types of barriers into
disease- and patient-specific corresponding barriers,
such as emotional responses (e.g., concerns about long-
term medication effects), logical barriers (e.g., ineffective
communication with healthcare providers), knowledge
gaps (e.g., lack of necessary medication knowledge), and
resource limitations (e.g., insufficient tools or support).
Integrating this data enables a comprehensive analysis
and supports tailored interventions.
Furthermore, the framework explains the interactive
relationship between the perception of workload and
the application of skills and knowledge. It underscores
the significance of understanding emotional responses
to perceived workloads, thereby establishing a recursive
logic in behavioral performance [25]. Achieving a bal-
ance between workload and mental capability is essential
[37], underscoring the need for an in-depth analysis of
the cause-and-effect relationships among various barriers
[38]. Such detailed analysis can uncover valuable insights,
enabling the development of targeted intervention strat-
egies that meet the unique needs of patients, ultimately
improving self-management outcomes.
Limitation andfuture works
Our study, focusing solely on hypertension self-manage-
ment barriers, may not apply to other disease contexts,
suggesting the need to test the TASKS framework more
broadly. With a limited sample of eight patients, findings
might not capture the full diversity of self-management
experiences; thus, a larger sample is recommended for
greater reliability. Moreover, conducting interviews only
in English could introduce cultural biases and exclude
non-English speakers.
Future research should include multiple languages or
translation services to address linguistic and cultural dif-
ferences in self-management barriers. A key direction is
developing tools to streamline the analysis of personal-
ized barriers. While the TASKS framework is effective,
it is time-consuming and labor-intensive. Integrating
the TASKS framework with technologies like natural
language processing (NLP) and large language models
can create automated or semi-automated tools, reduc-
ing subjective judgment and enhancing scalability and
efficiency in personalized healthcare research. is
advancement could significantly improve personalized
healthcare, making it more accessible and effective for a
broader range of diseases. Additionally, research should
explore the impact of various intervention techniques for
different barriers, such as cognitive-behavioral therapy
and motivational interviewing, and expand the TASKS
framework’s application in diverse healthcare settings.
Conclusion
In conclusion, our study highlights the critical impor-
tance of personalized barriers in the self-management
of hypertension, with emotion and knowledge barriers
identified as the most significant. By applying the TASKS
framework, we have unraveled the interplay between
individual mental capabilities and the demands of self-
managing hypertension. Emotion barriers were the most
significant, followed by knowledge, logic, and resource
barriers, emphasizing the need for tailored interventions.
e TASKS framework guided our data analysis, effec-
tively categorizing barriers and facilitating the develop-
ment of precise interventions. While our focus was on
hypertension, the framework’s adaptability suggests its
broader applicability in healthcare research. Nonetheless,
limitations such as a small sample size and linguistic bias
warrant further investigation. Overall, our research con-
tributes to promoting patient-centered care and refining
hypertension management strategies.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s13104- 024- 06893-7.
Supplementary Material 1.
Supplementary Material 2.
Acknowledgements
We extend our deep thanks to the diligent summer students for their valuable
work in the initial coding rounds.
Author contributions
J.Y.—design of the work, analysis and interpretation of data, implementation
of all processes, manuscript writing and revision; H.Q.—conception, design
of the work, interpretation of data, manuscript revision, and oversight of
healthcare knowledge integration; Y.Z.—conception, design of the work,
analysis and interpretation of data, manuscript revision, and supervision of the
consistent application of the TASKS framework; L.Y.—analysis of data, guided
a team of summer students to code the first-round coding and manuscript
revision; N.K.—acquisition and interpretation of data, provided hypertension
professional support, and manuscript revision (clinic physician specializing in
hypertension); S.S.—interpretation of data in the early stages and manuscript
revision; R.W.—assisted in drafting the paper and revised it; R.E.—analysis of
data and manuscript revision.
Funding
This work was funded by the Chiu Family/AstraZeneca Chair in Cardiovascular
Health Promotion in Alberta, Disease Prevention and the Michael Smith Health
BC Support Unit PCM-001, NESRC Discovery Grant (RGPIN-2019- 07048), and
NESRC Vanier Canada Graduate Scholarship (202311CGV-514014-89535).
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Yangetal. BMC Research Notes (2024) 17:224
Availability of data and materials
The datasets used during the current study are available from the Prof. Nadia
Khan upon reasonable request. Analyzed data is provided within the sup-
plementary information files.
Declarations
Ethics approval and consent to participate
Ethics approval for this study was obtained from the University of British
Columbia’s Clinical Research Ethics Board. Informed consent was obtained
from all patients prior to interview.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Received: 13 February 2024 Accepted: 7 August 2024
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