JMIR Publications

ABSTRACT

Background:

Lack of early risk detection, diagnosis, and treatment of pregnant women at high-risk for pre-eclampsia (HRPE) can result in high maternal mortality and morbidity not only in Pakistan but also in other low-middle-income countries (LMICs). A potential tool to support pregnant women at HRPE for early detection is through telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM program for pregnant women at HRPE specifically in LMICs such as Pakistan.

Objective:

To explore the needs of TM for pregnant women at HRPE in Karachi, Pakistan to inform a potential future feasibility trial of a mobile phone-based TM.

Methods:

An interpretive qualitative description approach was utilized to conduct and analyze 36 semi-structured interviews with pregnant women (n=16) and key-informants (n=21) including clinicians, nurses, maternal, neonatal, and child health specialists, and digital health experts to explore perspectives, needs, and preferences of a mobile-based TM program to support pregnant women at HRPE. Pregnant women were identified through heterogeneous sampling while key-informants were selected through purposive sampling. A primary researcher and two independent reviewers performed conventional content analysis to inductively analyze interview transcripts.

Results:

The following four themes emerged from the analysis of the transcripts: (1) poor utilization of antenatal care during pregnancy, (2) value of a TM program in high-risk pregnancy, (3) barriers influencing adoption of TM program and potential strategies, and (4) considerations for implementing TM program. The pregnant women and healthcare providers were willing to use a TM program because they perceived many benefits, including early identification of pregnancy complications and prompt treatment, convenience, and cost-effectiveness, increased sense of empowerment for one’s healthcare, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns to the adoption of a TM program including malfunctioning and safety concerns, potential inaccuracy of blood pressure machines, increased clinical workload, and resistance to learning new technology. Our study recommends:1) building the capacity of patients and providers on TM program use; 2) sensitizing the community and family members on the usefulness of the TM program; 3) using an approach incorporating user-centered design and phased implementation to determine the clinical workload and if additional staff for the TM program is required; and 4) considering the use of basic mobile phones and text messaging function for TM system.

Conclusions:

The findings from our study highlight the perceived feasibility of a mobile phone-based TM program for pregnant women at HRPE and provides insights that can be directly used for the design of future TM programs with the aim to reduce mortality and morbidity from PE/E in LMICs.