Strengths and limitations
STS
This study was conducted within a quasi-experimental trial using qualitative methodologies. It provided insights into the views of patients and HCPs on the implementation and use of BP telemonitoring system with teleconsultation in a real-world setting. Integration with routine clinical practice and the ability to adapt features of the intervention encouraged uptake by both patients and HCPs. Using semi-structured interviews allowed us to build rapport with the participants and obtain rich data about their experiences. We interviewed patients and HCPs to obtain a diversity of views as they played different roles in the process.Applying the STS model in the analysis allowed us to study the intervention on a more holistic level and identified some complexities and important considerations as we plan and improve the implementation and use of telemedicine interventions in primary care. The dimensions of “external rules, regulations and pressures” and “system measurement and monitoring” were not addressed in this study as participants did not express any related views. Future research could consider interviews with developers of the intervention and healthcare administrators to understand the impact of any external forces and the expected outcomes of the intervention.There have been several other models developed to study health technologies [Notwithstanding the efforts to obtain a representative sample of patients to reflect demographics of the clinic, ethnic diversity was limited. Self-selection might also have occurred from voluntary participation. Compared to other participants in the PTEC-HT pilot trial, patients in this study were younger (mean age 50.5 vs 56.3 years) and a larger proportion attained tertiary education qualification (53.8% vs 25.2%), and they might have been more willing and able to share their views.The patient interviews were conducted when the patients had completed the 6-month trial in hope to maximize their experience and elucidate their perspectives of what did or did not work. However, there was a possibility that some patients could not recall details from the early months of their participation accurately. Future research may also involve views from patients who rejected participation or withdrew from the trial to understand their reasons and concerns. As the HCPs were part of the teamlet tasked to implement the intervention, they might have been supporters of the intervention so their views might not be representative of other primary care HCPs.As this was a qualitative study conducted in one public primary care clinic in Singapore before the COVID-19 pandemic, transferability of findings to other primary care clinics or non-primary care settings is limited as operational procedures may differ between institutions. However, the challenges identified from this study, such as digital literacy and data security, are still largely relevant even as we are adapting our healthcare services since the pandemic happened [