Through the Communities Preventing Chronic Disease (CPCD) grant, Richland Public Health (RPH) began a project to expand residents’ access and ability to self-monitor their blood pressure. To address the county’s significant incidence of high blood pressure, RPH collaborated with the county’s library systems and the District 5 Area Agency on Aging to create a kit containing a blood pressure monitor/cuff, instructions, educational material about blood pressure, and a blood pressure tracking card. At all libraries in the county, patrons are able to check out a kit for two weeks at a time and keep the resources that are supplied in the kits at no cost. After being returned to the library, employees replenish any resources that have been taken and clean the monitor and cuff. Eight months after the initial launch, an additional kit was added to one of the libraries due to a high demand and long waiting lists. There is also a kit at the District 5 Area Agency on Aging for onsite usage. The libraries and RPH continue to work collaboratively to maintain the kits.

In Richland County, Ohio, the incidence of diagnosed high blood pressure has increased to affect 40% of the adult population, thus surpassing both the statewide (34%) and nationwide (31%) incidence. In 2016, heart disease and stroke accounted for 28% of deaths in Richland County. The program allows for blood pressure monitors to be accessible to any resident in Richland County over the age of 18. Because it is a free resource, people who may be unable to purchase their own monitors or would otherwise rely on a single reading from their health care providers now have the opportunity to use a kit at home. Checking a kit out of the library creates opportunities for more frequent and consistent readings, thus allowing users to learn about blood pressure issues sooner than if they were to wait until a physician visit. This program also allows people to take their blood pressure in the comfort and privacy of their own homes, which is not the case with most of the other free public blood pressure monitors.

Through the CPCD grant, local health departments are encouraged to promote self-monitored blood pressure (SMBP) and find ways to increase access to the necessary resources. The CPCD staff at RPH worked to find ways to make blood pressure monitors and cuffs free and accessible to the public. CPCD staff thought of using the library system as a means for patrons to check them out, just as a patron would check out a book. However, since the grant’s focus was population based, grant funds could not be used on the monitors and cuffs. Another partner was needed. Meetings were held to find another partner, and the District 5 Area Agency on Aging came forward as an interested partner in the project. With this collaboration, the blood pressure kits were developed and distributed to every library in the county, making this the only county or library system in Ohio to have this program. Patrons are able to check out blood pressure kits for two-week periods using their library cards and can renew them if they wish to keep them longer, provided there are no waits or holds. The kits contain instructions, a link to an instructional website, educational material about high blood pressure from the American Heart Association, a prediabetes risk test from the American Diabetes Association, information about the local Diabetes Prevention Program, and a blood pressure tracking card. Patrons may keep any of the educational material for their own future use. Between checkouts, library employees inspect and clean the monitors and replenish the resources as needed.

The kits allow for Richland County residents to take control of their blood pressure monitoring and be aware of their blood pressure. Having the kits available at the library allows access to more residents than a stationary monitor at a location such as a drug store. It also encourages self-monitoring of blood pressure and reaffirms the importance of checking your blood pressure. With the encouragement of self-monitored blood pressure, residents can keep track of their numbers and share a two-week snapshot with their physicians and other health-care providers. Having the two-week snapshot allows residents to see a more accurate picture of their blood pressure and take into account the variables that can affect it, such as exercise, stress, caffeine, and “white-coat syndrome.” Such variables are difficult to discern through a single reading at one time or in one setting, such as during a health care visit. The use of a self-monitoring blood pressure kit allows residents to monitor high blood pressure, keep track of blood pressure between physician visits, and potentially discover a blood pressure issue that otherwise would have gone undetected until visiting a health-care provider.

Saw it advertised... really nice to be able to check this out at the library! Very useful and I was able to give my healthcare provider a 2 week snapshot of my blood pressure! Anonymous, Survey Response

An optional and anonymous survey contained in the kit generates a majority of the qualitative data about this program. It has been found that people who previously did not have access to SMBP now have access. We have also received comments about people who discovered they have high blood pressure through using one of the library kits. Primary care physicians have also commented on the usefulness and importance of SMBP, in addition to the benefits of having patients come in with a two-week snapshot. Quantitative data is tracked through the library’s check-out statistics. The program launched in April 2016 and over a 21-month period the blood pressure kits have been checked out a total of 292 times. Due to one library’s long wait lists and high demand, an additional kit was added nine months into the program, bringing the total number of available kits to 21 across 10 libraries.

Number of Checkouts

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The program is the result of work set in place for the CPCD grant, which encourages SMBP. Because the grant is for population-based services, it could not be used to support costs associated with individual care. RPH and the libraries had to search for another stakeholder to support the purchase of the monitors and cuffs. In searching for partners, several agencies were not interested in participating. One agency did not see the idea as feasible and was unable to comprehend a lay person’s ability to perform SMBP without immediate supervision of a medical professional. Fortunately, these barriers were eventually overcome when a partnership was formed with the District 5 Area Agency on Aging, which was able to provide the monitors and cuffs while RPH provided the container and educational materials included in the kits.

Having a formal referral system with health-care providers would have been a beneficial tool throughout this process. Right now there is no way to ensure patrons are sharing the results with their health-care providers. There is also no official way for a health-care provider to refer a patient to the blood pressure kits at the library. Health educators promote the resource and provide informational material to physicians but there isn’t currently a way to track or confirm that the information is being passed on to patients. While many physicians say they are promoting the resource to patients, and patrons are saying they are sharing results, it would be helpful to have a more organized and formal referral process. There have also been some issues involving kits being returned with broken or missing pieces. Such incidents made it clear the kits would need to be inspected more thoroughly upon their return, with patrons charged a fee for damages if back-up pieces needed to be purchased.

The collaboration between the library system and the District 5 Area Agency on Aging is what makes this project work. Through that collaboration and combination of resources, this program was not only able to come to life, but has also expanded more than originally planned. Collaborating with other agencies has allowed a partnership to grow and flourish. The partnership with the library has grown to create other projects. The partnership with the District 5 Area Agency on Aging has sustained through the program.

I had been feeling ill recently and wasn't sure what it was, I just knew I felt "not right." I thought it may be my BP, but wasn't sure. I checked out the BP kit, and this actually saved my life... had I not been able to borrow it from the library, I may have not known until it was too late. Anonymous, Survey Response

Through the CPCD grant, the health department is currently working with the library to provide resources and collect and analyze the data. At the conclusion of the grant, the health department will provide all data to the libraries to ensure continuation of data collection by both parties. The health department will continue to provide hard copies of the educational resources included inside the kits, as well as electronic versions for the libraries to have on hand. RPH and the libraries will continue to work together and collaborate on this project. The library now charges patrons who return kits with missing or broken parts to ensure sustainability of the equipment, which helps to ensure that the equipment will continue to be available for patrons.

  • The mission of Richland Public Health is to assess, maintain, and improve the health and safety of the environment and community through quality public health services.