Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal deaths globally and require close monitoring of blood pressure (BP) to mitigate potential adverse effects. Self-monitoring of blood pressure (SMBP) in pregnancy among women with HDPs is an emerging approach to supplement facility-based monitoring, reduce missed opportunities for detection of complications, and offer women the ability to proactively manage their health.
The goal of this thesis was to examine the acceptability and feasibility of self-monitoring of blood pressure (SMBP) by pregnant women, including using a smartphone-based blood BP application. This research analyzed (i) perceptions and operational considerations for SMBP among pregnant women and their husbands and (ii) perceptions and operational considerations for SMBP among health workforce actors across all levels of the health system involved in the delivery of antenatal care (ANC). This body of work contributes to a prioritized research gap within the WHO guidelines on self-care interventions, in which evidence is lacking on the feasibility of SMBP for pregnant women in low- and middle-income settings and was recommended as a research question for further exploration.
The thesis applied qualitative methods through focus group discussions (FGDs) and in-depth interviews (IDIs) to understand the attitudes, barriers, and facilitators for pregnant women to self-monitor their blood pressure. The feasibility and acceptability implications were assessed from the perspective of pregnant women (n=56), their husbands (n=9), and members of the health workforce (n=48) within the catchment area of six primary healthcare facilities in Lombok, Indonesia, ranging from community health workers, midwives, doctors, and district health officers. The study also introduced a smartphone BP measurement application to gain practical insights into the operational requirements for SMBP among pregnant women.
The research demonstrated that some pregnant women perceived SMBP as beneficial for convenience and reassurance in monitoring their BP and overall health. However, participants also expressed reluctance to self-monitor BP due to factors such as the fluctuating nature of BP, lack of clarity on how to control their BP, the gravity of consequences for them and their babies’ health, trust in devices, and being a new diagnosis for some women. The health workers’ perspectives highlighted the importance of clear protocols for SMBP follow-up actions and reporting, as well as liability concerns due to sharing clinical responsibilities with pregnant women. Across pregnant women and health workers, digital communication channels were cited as ways to promote the uptake of SMBP by communicating results, facilitating referrals and actions, bolstering counseling, and accessing health information on BP and pregnancy broadly. Key recommendations include: (i) differentiating SMBP among pregnant women with chronic hypertension versus those with newly onset gestational hypertension; (ii) codeveloping protocols for SMBP that clarify procedures for pregnant women and health workers; (iii) exploring financing mechanisms to ensure equitable access to smartphone-based medical applications/software as a medical device, as well as building trust in the use of these technologies; and harnessing low bandwidth technologies to address pregnant women’s health information and communication needs.
