[The meanings that postpartum women assign to gestational hypertension and premature birth]

Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy

BACKGROUND

Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence.

METHODS

Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials.

RESULTS

The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring.

CONCLUSIONS

With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable.

An Integrative Review of Mothers' Experiences of Preeclampsia

OBJECTIVE

To describe and synthesize the extant research on women's experiences with preeclampsia into the postpartum period, when birth is necessary to save the mother's or infant's life.

DATA SOURCES

The PubMed, PsycINFO, CINAHL, and ISI Web of Science databases were searched for relevant articles published between 2004 and 2014.

STUDY SELECTION

Although a comprehensive search was performed, only eight studies were found that answered the research question and were included in the review.

DATA EXTRACTION

Data were extracted and analyzed from each article that addressed women's experiences of pre-eclampsia: authors, year, country, study purpose, design, sample size, setting, main focus, data collection method, study findings, and limitations.

DATA SYNTHESIS

The following themes emerged from the synthesis of how women experience severe preeclampsia: (a) From Feeling Fear and Closeness to Death to Feeling Hope, (b) Relationship With the Infant, (c) Separation From Loved Ones, and (d) Communication With Health Professionals.

CONCLUSION

Fear and feeling close to death characterized the experience of childbirth for many of these women, and the premature birth was a shock for many. Having a newborn in the NICU was experienced as a transition from fear to hope as the newborn's life was sustained outside the womb. Separation of the mother from the newborn when one or both need special care remains a problem. Health care professionals must ensure that women in this situation receive the information and support they need and that the information is understood. This review revealed that more research is necessary regarding this specific mother-infant dyad and their families in the context of Western countries and developing countries.