Feroz Anam Shahil, De Vera Kristina, D Bragagnolo Nadia, Saleem Sarah, Bhutta Zulfiqar, Seto Emily
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Community Health Sciences Department, Aga Khan University, Karachi, Pakistan.
JMIR Form Res. 2022 Feb 24;6(2):e32428. doi: 10.2196/32428.
Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan.
This study aims to explore the needs of TM for pregnant women at high risk for pre-eclampsia in Karachi, Pakistan, to inform a potential future feasibility trial of a mobile phone-based TM program.
An interpretive qualitative description approach was used to conduct and analyze 36 semistructured interviews with 15 (42%) pregnant women and 21 (58%) key informants, including clinicians; nurses; maternal, neonatal, and child health specialists; and digital health experts to explore the perspectives, needs, and preferences of a mobile phone-based TM program to support pregnant women at high risk for pre-eclampsia. Pregnant women were identified through heterogeneous sampling, whereas key informants were selected through purposive sampling. The interview transcripts were analyzed using a conventional content analysis technique.
The following four themes emerged from the analysis of the transcripts: poor use of antenatal care during pregnancy, the value of a TM program in high-risk pregnancy, barriers influencing the adoption of TM programs and potential strategies, and considerations for implementing TM programs. The pregnant women and health care providers were willing to use a TM program as they perceived many benefits, including early identification of pregnancy complications, prompt treatment, convenience, cost-effectiveness, increased sense of empowerment for one's health care, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns regarding 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 building the capacity of patients and providers on TM program use, sensitizing the community and family members on the usefulness of the TM program, using an approach incorporating user-centered design and phased implementation to determine the clinical workload and whether additional staff for the TM program is required, and ensuring greater levels of co-design and the engagement of consumer representatives.
Our findings highlight the perceived feasibility of a mobile phone-based TM program for pregnant women at high risk for pre-eclampsia and provide insights that can be directly used for the design of future TM programs with the aim of reducing mortality and morbidity from pre-eclampsia and eclampsia in LMICs.
子痫前期高危孕妇缺乏早期风险检测、诊断和治疗，不仅在巴基斯坦，在其他低收入和中等收入国家（LMICs）也会导致孕产妇高死亡率和高发病率。远程监测（TM）是支持子痫前期高危孕妇进行早期检测的一种潜在工具。然而，关于最终用户需求和偏好的证据有限，无法为子痫前期高危孕妇的TM项目设计提供参考，特别是在巴基斯坦这样的LMICs国家。
本研究旨在探索巴基斯坦卡拉奇子痫前期高危孕妇对TM的需求，为未来基于手机的TM项目的可行性试验提供参考。
采用解释性定性描述方法，对15名（42%）孕妇和21名（58%）关键信息提供者进行了36次半结构化访谈，关键信息提供者包括临床医生、护士、孕产妇、新生儿和儿童健康专家以及数字健康专家，以探讨基于手机的TM项目支持子痫前期高危孕妇的观点、需求和偏好。孕妇通过异质性抽样确定，关键信息提供者通过目的抽样选择。访谈记录采用传统内容分析技术进行分析。
对访谈记录的分析产生了以下四个主题：孕期产前护理利用不足、TM项目在高危妊娠中的价值、影响TM项目采用的障碍和潜在策略以及实施TM项目的考虑因素。孕妇和医疗服务提供者愿意使用TM项目，因为他们认为有许多好处，包括早期识别妊娠并发症、及时治疗、方便、成本效益高、增强对自身医疗保健的掌控感、改善护理连续性以及减轻临床工作量。然而，一些提供者和孕妇提到了采用TM项目的一些担忧，包括设备故障和安全问题、血压计可能不准确、临床工作量增加以及对学习新技术的抵触情绪。我们的研究建议增强患者和提供者使用TM项目的能力，提高社区和家庭成员对TM项目有用性的认识，采用以用户为中心的设计和分阶段实施的方法来确定临床工作量以及是否需要为TM项目增加额外人员，并确保更高水平的共同设计和消费者代表的参与。
我们的研究结果突出了基于手机的TM项目对子痫前期高危孕妇的可感知可行性，并提供了可直接用于未来TM项目设计的见解，旨在降低LMICs国家子痫前期和子痫的死亡率和发病率。
