Tamrat Tigest, Setiyawati Yuni Dwi, Barreix Maria, Madani Nya'Jeumpa, Geissbühler Antoine, Shankar Anuraj H, Tuncalp Ozge
UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Institute of Global Health, University of Geneva, Geneva, Switzerland.
BMC Pregnancy Childbirth. 2025 Feb 8;25(1):131. doi: 10.1186/s12884-025-07174-2.
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal deaths and require close monitoring of blood pressure (BP) to mitigate potential adverse effects. The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) among women with HDP; however, there is limited research on its acceptability and feasibility in low- and middle-income contexts. We explored pregnant women's perceptions and attitudes towards SMBP, as well as practical considerations for SMBP by leveraging a smartphone-based BP measurement application in Lombok, Indonesia.
Pregnant women with a current or history of HDPs were randomized to participate in focus group discussions (FGDs) regarding their attitudes towards SMBP or provided with a smartphone BP application to provide feedback on conducting SMBP. In-depth interviews (IDIs) were conducted among a subset of FGD participants to further explore perceptions. A second group of participants were provided with a smartphone application to familiarize themselves with SMBP and invited to IDIs to discuss their experiences. Husbands of this second group also participated in separate FGDs. Interviews were double transcribed in Bahasa Indonesia and translated to English for thematic analysis using inductive and deductive approaches.
We enrolled a total of 71 pregnant women, across 11 FGDs and conducted 15 IDIs with participants who used the smartphone for SMBP. Themes emerged related to (i) understanding of and experiences related to BP; (ii) facilitators and motivations for SMBP; (iii) barriers and concerns with SMBP; and (iv) experiences of using a smartphone-based BP application. While SMBP was perceived favorably by some women for convenience and reassurance in monitoring their BP, participants also expressed their reluctance to self-monitor BP due to factors, such as limited understanding of BP and controlling it, gravity of the consequences for their and fetus' health, self efficacy in conducting SMBP appropriately, trust in BP measurement devices, and being a new diagnosis for some women.
For SMBP to be implemented in line with WHO recommendations, efforts are needed to strengthen counselling among women with HDPs, clarify protocols for SMBP and subsequent actions, and provide continued support to pregnant women. Considering varying levels of BP knowledge, future research should examine the implications of introducing SMBP among pregnant women with chronic hypertension versus those with newly onset gestational hypertension, as well as the potential conflation between BP and blood haemoglobin.
妊娠高血压疾病（HDP）是孕产妇死亡的主要原因，需要密切监测血压（BP）以减轻潜在的不良影响。世界卫生组织（WHO）建议HDP女性进行自我血压监测（SMBP）；然而，在低收入和中等收入环境中，关于其可接受性和可行性的研究有限。我们通过在印度尼西亚龙目岛利用基于智能手机的血压测量应用程序，探讨了孕妇对SMBP的看法和态度，以及SMBP的实际考虑因素。
有HDP病史或当前患有HDP的孕妇被随机分配参加关于她们对SMBP态度的焦点小组讨论（FGD），或获得智能手机血压应用程序以提供关于进行SMBP的反馈。对一部分FGD参与者进行了深入访谈（IDI），以进一步探讨看法。第二组参与者获得智能手机应用程序以熟悉SMBP，并被邀请参加IDI以讨论他们的经历。第二组参与者的丈夫也参加了单独的FGD。访谈在印度尼西亚语中进行了双重转录，并翻译成英语，使用归纳和演绎方法进行主题分析。
我们共招募了71名孕妇，分11个FGD进行研究，并对使用智能手机进行SMBP的参与者进行了15次IDI。出现的主题包括：（i）对血压的理解和相关经历；（ii）SMBP的促进因素和动机；（iii）SMBP的障碍和担忧；（iv）使用基于智能手机的血压应用程序的经历。虽然一些女性认为SMBP方便且能让她们放心监测血压，但参与者也因对血压及其控制的理解有限、对自身和胎儿健康后果的严重性、正确进行SMBP的自我效能感、对血压测量设备的信任以及对一些女性来说这是新诊断等因素，表达了她们不愿自我监测血压的态度。
为了按照WHO的建议实施SMBP，需要努力加强对HDP女性的咨询，明确SMBP及后续行动的方案，并为孕妇提供持续支持。考虑到不同的血压知识水平，未来的研究应探讨在慢性高血压孕妇与新发性妊娠期高血压孕妇中引入SMBP的影响，以及血压与血红蛋白之间的潜在混淆。
