Health workers’ perspectives on self-monitoring of blood pressure by pregnant women

A qualitative study among community health workers, midwives, doctors and health system managers in Lombok, Indonesia

Bibliographic Data

ID21878652
AuthorsTaddesse Tamrat (0000-0001-8579-5698, University of Geneva), Yuni Dwi Setiyawati (University of Mataram), Raissa Manika Purwaningtias (University of Mataram), Nya Jeumpa Madani (0009-0000-9740-8149, University of Mataram), Maria Barreix (0000-0003-3613-9672, World Health Organization), Antoine Geissbühler (0000-0001-5039-3373, University of Geneva), Anuraj H Shankar (0000-0001-7268-6708, University of Indonesia), Özge Tunçalp (0000-0002-5370-682X, World Health Organization)
Year2025
Volume10
Issue3
Pagese017532
Publication date2025-03-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2024-017532
PMID40122527
OpenAlexW4408766836
LanguageEN
References cited45

INTRODUCTION: Hypertensive disorders of pregnancy (HDPs) are a leading cause of maternal mortality and morbidity globally but could be mitigated through accurate and timely blood pressure (BP) monitoring. Self-monitoring of blood pressure (SMBP) in pregnancy is an emerging approach for the management of HDPs but mainly studied from the perspectives of pregnant women, in high-income contexts, or tertiary care. This qualitative study explored health workers' perspectives on SMBP by pregnant women, including through using a smartphone application, within primary healthcare settings of Lombok, Indonesia. METHODS: We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with community health workers, community-based midwives, facility-based midwives from primary healthcare centres, obstetrician/gynaecologists and health system managers (including heads of facilities, midwife supervisor and District Health Office administrators). Themes were grouped according to the normalisation process theory, which includes (1) coherence/understanding of the intervention, (2) cognitive participation/perceived value and (3) collective action/how the intervention will affect processes and organisational practices. RESULTS: We recruited 68 participants across 8 FGDs and 26 IDIs. SMBP was perceived to improve timeliness of care and detection of high BP, but health workers expressed concerns about women's ability to accurately self-monitor, reliability and affordability of BP devices, and accountability and management of SMBP results. Embedding SMBP into routine antenatal care counselling, collaboration with family members, clarification on liability implications and protocols on SMBP follow-up actions, and use of digital communication channels were cited as potential ways to facilitate uptake of SMBP. CONCLUSION: For SMBP to be valued by health workers and effectively integrated into the health system as a strategy for addressing HDPs, it needs to be accompanied by clear clinical and data management protocols, referral mechanisms, reassurance on the accuracy and trust in the self-monitored measurements and demonstration of timeliness in the provision of follow-up care for pregnant women

Accountability · Family medicine · Focus group · Health care · Political science · Public health · Qualitative research · Sociology · Blood Pressure and Hypertension Studies · Maternal and fetal healthcare · Medicine · Nursing · Pregnancy and preeclampsia studies