Perceived barriers and facilitators of implementing a sustained smartphone-based telemonitoring program for pregnant women at high-risk for pre-eclampsia in the public and private sectors in Pakistan.

BACKGROUND

In Pakistan, a smartphone-based telemonitoring (TM) program (Raabta) has been designed to support pregnant women with high risk for preeclampsia (HRPE) in Pakistan. However, implementing TM interventions is often challenging, particularly in low-resource settings, given the complexity of healthcare environments and variations in public and private health sectors. This study explores the potential barriers and facilitators for a sustained implementation of the Raabta program in public and private sector hospitals in Pakistan.

METHODS

Using a qualitative description design, 57 semi-structured interviews with a diverse group of participants including patients from the public (15) and private sector hospitals (17), obstetricians from the public (5) and private sector hospitals (7), decision-makers (7) and telehealth experts (6). Participants were recruited using purposive and snowball sampling techniques. Interview transcripts were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) domains.

RESULTS

Based on the CFIR domains, the findings included: (1) Raabta being perceived as user-friendly even for patients with low digital and language literacy; (2) Outer settings: Limited health and digital literacy, poor language proficiency, and cultural norms can influence the willingness and ability of public sector patients to use the Raabta; (3) Inner settings: The private health sector is well-equipped for the Raabta implementation, while the public health sector faces challenges related to physical space, limited human and financial resources, and physician resistance; (4) Individual characteristics: Majority participants demonstrated positive attitudes toward the Raabta program and expressed confidence in using it (5) Process: Recommendations included adopting a nurse-led model for the private sector, leveraging paramedics for monitoring the Raabta dashboard, integrating Raabta with existing digital platforms, and establishing an advisory committee for program sustainability.

CONCLUSION

Raabta implementation may be more feasible in the private sector due to patient demographics, health and digital literacy, cultural norms, financial resources, physician readiness, and hospital infrastructure.