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Chisholm A, Tucker KL, Crawford C, Green M, Greenfield S, Hodgkinson J, Lavallee L, Leeson P, Mackillop L, McCourt C, Sandall J, Wilson H, Chappell LC, McManus RJ, Hinton L. Self-monitoring blood pressure in Pregnancy: Evaluation of health professional experiences of the BUMP trials. Pregnancy Hypertens 2024; 35:88-95. [PMID: 38301352 DOI: 10.1016/j.preghy.2024.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether they improved detection or control of hypertension for women at risk of hypertension or with hypertension during pregnancy. This process evaluation aimed to understand healthcare professionals' perspectives and experiences of the BUMP trials of self-monitoring of blood pressure during pregnancy. METHODS Twenty-two in-depth qualitative interviews and an online survey with 328 healthcare professionals providing care for pregnant people in the BUMP trials were carried out across five maternity units in England. RESULTS Analysis used Normalisation Process Theory to identify factors required for successful implementation and integration into routine practice. Healthcare professionals felt self-monitoring of blood pressure did not over-medicalise pregnancy for women with, or at risk of, hypertension. Most said self-monitored readings positively affected their clinical encounters and professional roles, provided additive information on which to base decisions and enriched their relationships with pregnant people. Self-monitoring of blood pressure shifts responsibilities. Some healthcare professionals felt women having responsibility to decide on timing of monitoring and whether to act on self-monitored readings was unduly burdensome, and resulted in healthcare professionals taking additional responsibility for supporting them. CONCLUSIONS Despite healthcare professionals' early concerns that self-monitoring of blood pressure might over-medicalise pregnancy, our analysis shows the opposite was the case when used in the care of pregnant people with, or at higher risk of, hypertension. While professionals retained ultimate clinical responsibility, they viewed self-monitoring of blood pressure as a means of sharing responsibility and empowering women to understand their bodies, to make judgements and decisions, and to contribute to their care.
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Affiliation(s)
- Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, 80 B High Street, Evesham, Worcestershire, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TT, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TT, UK
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Level 1 Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Lucy Mackillop
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christine McCourt
- Centre for Maternal & Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Hannah Wilson
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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