"I’ll be alarmed and I’ll want to take action": experiences responding to high blood pressures among pregnant women engaged in home blood pressure monitoring

Le résumé fourni par la source

Home blood pressure (BP) monitoring is an emerging strategy to increase BP monitoring in pregnancy. Effective programs require women to recognize elevated readings, understand when urgent action is needed, and receive clear, consistent advice after contacting healthcare providers. Challenges in low-resource settings include lower health literacy and limited engagement in health monitoring and antenatal care. This qualitative study explored how women measured and responded to elevated BP readings during a home monitoring intervention at a tertiary hospital in Ghana. We purposively sampled 20 postpartum women who had recorded at least five elevated home BP readings during pregnancy. Semi-structured interviews were conducted from November to December 2024 and examined participants’ understanding of high BP, confidence in interpreting readings, responses to elevated values, and experiences communicating with the midwife phoneline. Interviews were coded and analyzed thematically. The Health Belief Model was applied after inductive analysis to organize and interpret the themes. Participants’ mean age was 32.6 years. Thirteen were married and four had chronic hypertension. Interviews revealed three thematic steps in the pathway from measuring high BP at home to seeking medical advice: understanding when BP is high, recognizing it as abnormal and urgent, and engaging with the health system. Most participants could distinguish normal from high readings and understood the risks of hypertension in pregnancy. However, this knowledge did not consistently prompt urgent action. Some attributed high readings to stress, poor sleep, or recent activity, and chose to rest and recheck. Others repeated previous telephone advice to self-manage before calling again. Decisions to contact the phoneline were shaped by prior advice, expected responses, and interpersonal experiences. Barriers included shyness, concern about disturbing midwives, and uncertainty about whether one high reading required action. Women were more willing to call when interactions made them feel reassured, valued, and cared for. Women generally recognized high BP as abnormal and potentially harmful, but patient interpretation, interpersonal communication, and inconsistent health service advice sometimes delayed contact with providers. Home BP monitoring programs in low-resource settings should strengthen patient training and ensure that telephone response staff provide supportive, standardized, and guideline-consistent advice.

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