Perceptions and experiences of blood pressure self-monitoring during hypertensive pregnancy: A qualitative analysis of women's and clinicians’ experiences in the OPTIMUM-BP trial

TY - JOUR

T1 - Perceptions and experiences of blood pressure self-monitoring during hypertensive pregnancy

T2 - A qualitative analysis of women's and clinicians’ experiences in the OPTIMUM-BP trial

AU - Pealing, L.

AU - Tucker, K. L.

AU - Fletcher, B.

AU - Lawley, E.

AU - Chappell, L. C.

AU - McManus, R. J.

AU - Ziebland, S.

N1 - Funding Information: This research was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford (CLAHRC Oxford) now recommissioned as NIHR Applied Research Collaboration Oxford and Thames Valley (ARC-OxTV). KT and RM also receive funding from the ARC-OxTV. RM and LC are supported by Research Professorships from the National Institute for Health Research: (NIHR-RP-R2-12–015 and RP-2014-05-019 respectively). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. Publisher Copyright: © 2022 The Authors

PY - 2022/12

Y1 - 2022/12

N2 - Background: Self-monitoring of blood pressure (BP) has been shown to be effective at improving BP control in the general population. The OPTIMUM-BP feasibility study was a prospective randomised controlled trial of self-monitoring of BP (SMBP) during hypertensive pregnancy. Objective: To explore experiences, perceptions, and use of the OPTIMUM-BP self-monitoring intervention. Study design. Qualitative study within the OPTIMUM-BP feasibility trial. Semi-structured interviews with a purposive sample of pregnant women with chronic hypertension (n = 24) and their clinicians (n = 8) as well as 38 ethnographic observations of antenatal visits. Results: Women found self-monitoring of BP feasible and acceptable and were highly motivated and pro-active in their monitoring, reporting greater control and knowledge of BP and reassurance. Women's persistence with SMBP was driven by a perceived need to safeguard the pregnancy, particularly among those taking antihypertensive medication. Clinicians also described the intervention as acceptable, though BP variability could cause uncertainty. Clinicians used different heuristics to integrate home and clinic readings. Observations suggested close working relationships between women and clinicians were key for confident integration of self-monitoring. Conclusions: Self-monitoring of BP was acceptable both to pregnant women with hypertension and their clinicians. More research is needed to understand BP variability within pregnancy to help interpret and integrate home BP readings for improved BP management. Clinical pathways that use BP self-monitoring should aim to maintain the continuity of care and relationships that are valued and appear pivotal for the confident and safe use of self-monitoring in pregnancy.

AB - Background: Self-monitoring of blood pressure (BP) has been shown to be effective at improving BP control in the general population. The OPTIMUM-BP feasibility study was a prospective randomised controlled trial of self-monitoring of BP (SMBP) during hypertensive pregnancy. Objective: To explore experiences, perceptions, and use of the OPTIMUM-BP self-monitoring intervention. Study design. Qualitative study within the OPTIMUM-BP feasibility trial. Semi-structured interviews with a purposive sample of pregnant women with chronic hypertension (n = 24) and their clinicians (n = 8) as well as 38 ethnographic observations of antenatal visits. Results: Women found self-monitoring of BP feasible and acceptable and were highly motivated and pro-active in their monitoring, reporting greater control and knowledge of BP and reassurance. Women's persistence with SMBP was driven by a perceived need to safeguard the pregnancy, particularly among those taking antihypertensive medication. Clinicians also described the intervention as acceptable, though BP variability could cause uncertainty. Clinicians used different heuristics to integrate home and clinic readings. Observations suggested close working relationships between women and clinicians were key for confident integration of self-monitoring. Conclusions: Self-monitoring of BP was acceptable both to pregnant women with hypertension and their clinicians. More research is needed to understand BP variability within pregnancy to help interpret and integrate home BP readings for improved BP management. Clinical pathways that use BP self-monitoring should aim to maintain the continuity of care and relationships that are valued and appear pivotal for the confident and safe use of self-monitoring in pregnancy.

KW - Blood pressure

KW - Ethnography

KW - Hypertension

KW - Pregnancy

KW - Qualitative

KW - Self-monitoring

UR - http://www.scopus.com/inward/record.url?scp=85138788417&partnerID=8YFLogxK

U2 - 10.1016/j.preghy.2022.09.006

DO - 10.1016/j.preghy.2022.09.006

M3 - Article

AN - SCOPUS:85138788417

SN - 2210-7789

VL - 30

SP - 113

EP - 123

JO - Pregnancy Hypertension

JF - Pregnancy Hypertension

ER -