Using eHealth to Increase Autonomy Supportive Care: A Multicenter Intervention Study in Antenatal Care

Pregnant women's attitudes to and experiences with a smartphone-based self-test for prediction of pre-eclampsia: a qualitative descriptive study

OBJECTIVES

To explore attitudes to and experiences using a smartphone-based self-test for prediction of pre-eclampsia among pregnant women.

DESIGN

A qualitative, descriptive study.

SETTING

An obstetrical care unit at a university hospital in Denmark.

PARTICIPANTS

Twenty women who had participated in the Salurate trial, a clinical trial testing the efficacy of a smartphone-based self-test for prediction of pre-eclampsia, were purposefully chosen for the study, using maximum variation sampling.

DATA COLLECTION AND ANALYSIS

Data were collected by semistructured, individual, face-to-face interviews conducted from 4 October 2018 to 8 November 2018. Data were transcribed verbatim and analysed by means of thematic analysis.

RESULTS

Qualitative thematic analysis resulted in the identification of three main themes: Raising awareness, self-testing has the potential to be an integrated part of pregnancy and trusting in technology. Two subthemes were identified under each main theme.

CONCLUSIONS

The smartphone-based self-test for prediction of pre-eclampsia has potential to be integrated into antenatal care, and women found it feasible to use. However, testing affected the participating women psychologically, leading to feelings of worry as well as safety. Therefore, if self-testing is implemented, it is important to take actions to handle adverse psychological side effects, including increasing knowledge on pre-eclampsia and having healthcare professionals ongoingly address the psychological state of women throughout pregnancy. In addition, it is essential to emphasise the importance of subjective bodily sensations during pregnancy, including fetal movements. Further studies on the experience of being labelled low risk versus high risk for pre-eclampsia are warranted since this was not investigated in this trial.

Maternal knowledge-seeking behavior among pregnant women in Tanzania

BACKGROUND

Maternal mortality continues to be a global challenge with about 830 women dying of childbirth and pregnancy complications every day. Tanzania has a maternal mortality rate of 524 deaths per 100,000 live births.

OBJECTIVE

Knowing symptoms associated with antenatal risks among pregnant women may result in seeking care earlier or self-advocating for more immediate treatment in health facilities. This article sought to identify knowledge-seeking behaviors of pregnant women in Northern Tanzania, to determine the challenges met and how these should be addressed to enhance knowledge on pregnancy risks and when to seek care.

METHODS

Interview questions and questionnaires were the main data collection tools. Six gynecologists and four midwives were interviewed, while 168 pregnant women and 14 recent mothers participated in the questionnaires.

RESULTS

With the rise in mobile technology and Internet penetration in Tanzania, more women are seeking information through online sources. However, for women to trust these sources, medical experts have to be involved in developing the systems.

CONCLUSION

Through expert systems diagnosis of pregnancy complications and recommendations from experts can be made available to pregnant women in Tanzania. In addition, self-care education during pregnancy will save women money and reduce hospital loads in Tanzania.

A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Health Care in Pregnancy Panel

OBJECTIVE

To perform a literature review of key aspects of prenatal care delivery to inform new guidelines.

DATA SOURCES

A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov.

METHODS OF STUDY SELECTION

We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction.

TABULATION, INTEGRATION, AND RESULTS

Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth.

CONCLUSION

Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.

Effects of smartphone application education combined with hands-on practice in breast self-examination on junior nursing students in South Korea

BACKGROUND

Breast self-examination is a convenient and effective way to detect breast abnormalities. Based on Dale's Cone of Experience theory, we hypothesized that the combination of a smartphone application with hands-on practice would have a greater impact than using a smartphone application alone. The purpose of this study was to compare the effects of different educational methods on (a) knowledge, (b) attitudes, (c) skills, and (d) students' satisfaction with the learning methods.

METHODS

We conducted a pre- and post-test quasi-experimental design and developed a smartphone application using a video clip. One experimental group received smartphone-based education, another group received smartphone-based education combined with hands-on practice, and the control group received a one-time classroom lecture. We administered a pre-test, provided intervention, and conducted a post-test.

RESULTS

Among the three groups, the knowledge and attitude of the experimental groups were significantly higher than that of the control group. In addition, the group using the combination of the smartphone application and hands-on practice showed the highest score changes in skills and satisfaction with the learning methods.

CONCLUSIONS

Smartphone application use combined with hands-on practice could be an effective education method for breast self-examination.

Telemedicine in Low-Risk Obstetrics

Telemedicine has been used to expand access to routine prenatal care for patients in rural areas and areas without enough obstetrician/gynecologists. Telemedicine can be used to reduce face-to-face visits, to increase patient autonomy and satisfaction, for behavioral modification, and to aid in smoking cessation. Patients and providers alike find telemedicine a useful adjunct to routine care.

Mobile Health Applications for Prenatal Assessment and Monitoring

BACKGROUND

A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care.

METHODS

In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care.

RESULTS

Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable.

CONCLUSIONS

Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.