JMIR Publications

ABSTRACT

Background:

Hypertensive disorders of pregnancy (HDP) are worldwide a primary cause of adverse maternal and neonatal outcomes. For those women at risk for hypertensive complications, guidelines recommend frequent surveillance of blood pressure and preeclampsia signs. Clinic visits range from every two weeks up to several times a week. Given the wide ubiquity of smartphones and computers in most countries and a growing attention for self-management, digital technologies are a promising component of monitoring (self-measured) blood pressure during pregnancy. Currently, little is known about the experiences of women using such platforms and how these digital tools can be aligned with their needs and preferences.

Objective:

The objective was twofold: (1) To explore the experiences of Dutch women with increased risk of HDP of a blended care approach (digital technologies combined with face-to-face care) for remote self-monitoring of blood pressure and preeclampsia symptoms, and (2) to formulate recommendations for the use and integration of digital technologies in clinical care.

Methods:

Alongside a prospective blended care study (SAFE@home study) that monitors pregnant women at increased risk of HPD with digital health technology, a mixed-methods study was conducted, including questionnaires (n=52) and interviews (n=11). Results were analyzed thematically.

Results:

Four themes were found, two themes relate to the technologies itself and two themes that relate to the interaction and use of the digital health technology: 1 expectations, 2 usability, 3 autonomy and responsibilities of patients, and 4 responsibilities of health care professionals. First, the digital health platform lived up to the expectations of patients, which contributed to user satisfaction. Second, the platform was considered user-friendly and patients favoured different moments and frequencies for measuring their blood pressure. Third, patient autonomy was mentioned in terms of increased insight about their own condition and being able to influence clinical decision-making. Fourth, clinical expertise of health care professionals was considered essential to interpret the data which translates into subsequent responsibilities for clinical management. Data from the questionnaires and interviews corresponded.

Conclusions:

Blended care using a digital health tool to monitor blood pressure in pregnancy was positively evaluated by its users. Insights from participants led to seven points of recommendations for designing and implementing similar interventions and to enhance future use of digital technologies in clinical care.