The added value of the midwife in the prenatal remote monitoring follow-up of women at risk for gestational hypertensive disorders: a mixed methods study

Abstract

Background Women with an elevated risk of developing gestational hypertensive disorders (GHD) are more intensively followed up than women with an uncomplicated pregnancy. The follow-up of women with GHD might be improved by adding remote monitoring (RM) to the prenatal care path of those women. There is insufficient research executed about RM in obstetrics as an innovative approach to follow-up the patients at home who needs to manage their own health (i.e. a patient self monitoring (PSM) group without supervision by a midwife) in comparison with the patients who got the help of the midwife to manage their own health (i.e. the RM group). This study, as a part of the Pregnancy REmote MOnitoring (PREMOM) II study aimed to investigate if there is a significant difference in compliance rate by women with an elevated risk of GHD who are divided in an RM group (and who received supervision by a midwife), vs. women with an elevated risk on GHD who are divided in a PSM group (who didn’t receive supervision by a midwife). Additionally, factors influencing patient compliance in RM for GHD among participants of the PREMOM II study will be identified by using semi-structured, in-depth interviews. Methods A convergent parallel mixed methods approach was performed. For the quantitative part of the study were the patients from the PSM group (n = 244) and the RM group (n = 262) included. For the qualitative part of the study patients were included from the RM group. Stratified sampling was used, wherein participants were categorized into four different compliance rate strata ((1) low adherence below 30%, (2) moderate adherence between 30% and 80%, (3) good adherence between 80% and 100%, and (4) overadherence exceeding 100%). The strata were based on previous data of the PREMOM II study. The interview guide was structured around two theoretical models designed to propose behavior change such as e.g. therapy compliance: 1) the Capability, Opportunity, Motivation and Behavior model (COM-B); and 2) the Theoretical Domains Framework. Results Significant difference can be between the RM group and PSM in blood pressure measurements in the morning (RM group: 71.72% vs. PSM group 53.02%; p < 0.0001), blood pressure measurements in the evening (RM group: 74.79% vs. PSM group 58.30%; p < 0.0001) and for the weight measurements (RM group: 53.90% vs. PSM group: 33.60%; p < 0.0001). Participants generally did perceive RM as manageable and were motivated to prioritize their own well-being and the well-being of their child. They also exhibited commitment to the study by consistently measuring their blood pressures. However, additional support is needed to address forgetfulness and the lack of psychological counseling, as well as social and environmental support. The support of the midwife during the RM process seems indispensable. Discussion The insights gained from these interviews provide valuable information for targeted interventions. By strategically focusing on areas requiring improvement, we can enhance the effectiveness of RM programs and ultimately improve patient compliance. The added value of an AMP seems indispensable, but further research has confirmed or rejected this statement. Trial registration: This study was registered on clinicaltrials.gov, identification number NCT04031430. Registered 24 July 2019, https://clinicaltrials.gov/ct2/show/NCT04031430?cond=premom+ii&draw=2&rank=1.