A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study

Development and early implementation of telemonitoring of complicated pregnancies - A qualitative study with the perspectives of health professionals

BACKGROUND

Telemonitoring may offer promising opportunities in health care. In obstetric health care, there is a need to expand and improve digitalization. Nevertheless, there is limited knowledge based on healthcare professionals' perspectives regarding the use of telemedicine and remote cardiotocography during pregnancy, as well as its implementation.

AIM

To explore the perspectives of health-care professionals who manage telemonitoring of complicated pregnancies.

DESIGN AND SETTING

A qualitative interview study undertaken in a hospital with a tertiary obstetric unit in Northen Denmark.

METHODS

Based on a purposive sample strategy, 11 semi-structured interviews of health-care professionals involved in the management of telemonitoring in women with complicated pregnancies were conducted and analyzed using a reflexive thematic analytical approach.

FINDINGS

The findings are assembled into two main themes. The experience of relevance to own practice: included the embedded potentials in telemonitoring providing women-centred care, but also challenges related to the implementation of a new technology. Experience of challenges and potential in day-to-day operation: included frustrations regarding the technological devices and software, working experiences increasing confidence in telemonitoring, and perspectives on the required interdependence across departments.

CONCLUSION

This study adds important knowledge to support awareness and reflection on how challenges impact the successful implementation of telemonitoring in obstetric and midwifery care. This includes knowledge of important processes and resources to ensure ongoing implementation and evaluation. Implementation strategies and collaborations to support a multiple-level system change, such as an interdisciplinary team, seem crucial to minimize challenges, build shared visions, and engage staff.

Person-Generated Health Data in Women's Health: Scoping Review

BACKGROUND

The increased pervasiveness of digital health technology is producing large amounts of person-generated health data (PGHD). These data can empower people to monitor their health to promote prevention and management of disease. Women make up one of the largest groups of consumers of digital self-tracking technology.

OBJECTIVE

In this scoping review, we aimed to (1) identify the different areas of women's health monitored using PGHD from connected health devices, (2) explore personal metrics collected through these technologies, and (3) synthesize facilitators of and barriers to women's adoption and use of connected health devices.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, we searched 5 databases for articles published between January 1, 2015, and February 29, 2020. Papers were included if they targeted women or female individuals and incorporated digital health tools that collected PGHD outside a clinical setting.

RESULTS

We included a total of 406 papers in this review. Articles on the use of PGHD for women steadily increased from 2015 to 2020. The health areas that the articles focused on spanned several topics, with pregnancy and the postpartum period being the most prevalent followed by cancer. Types of digital health used to collect PGHD included mobile apps, wearables, websites, the Internet of Things or smart devices, 2-way messaging, interactive voice response, and implantable devices. A thematic analysis of 41.4% (168/406) of the papers revealed 6 themes regarding facilitators of and barriers to women's use of digital health technology for collecting PGHD: (1) accessibility and connectivity, (2) design and functionality, (3) accuracy and credibility, (4) audience and adoption, (5) impact on community and health service, and (6) impact on health and behavior.

CONCLUSIONS

Leading up to the COVID-19 pandemic, the adoption of digital health tools to address women's health concerns was on a steady rise. The prominence of tools related to pregnancy and the postpartum period reflects the strong focus on reproductive health in women's health research and highlights opportunities for digital technology development in other women's health topics. Digital health technology was most acceptable when it was relevant to the target audience, was seen as user-friendly, and considered women's personalization preferences while also ensuring accuracy of measurements and credibility of information. The integration of digital technologies into clinical care will continue to evolve, and factors such as liability and health care provider workload need to be considered. While acknowledging the diversity of individual needs, the use of PGHD can positively impact the self-care management of numerous women's health journeys. The COVID-19 pandemic has ushered in increased adoption and acceptance of digital health technology. This study could serve as a baseline comparison for how this field has evolved as a result.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/26110.

Midwives' experience of telehealth and remote care: a systematic mixed methods review

INTRODUCTION

Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth.

METHODS

Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to 'midwives', 'telehealth' and 'experience'. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes.

RESULTS

After applying the inclusion/exclusion criteria, 10 articles on midwives' experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience.

CONCLUSIONS

Most current studies suggest that midwives' experience of telehealth is deeply intertwined with midwives' experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.

Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students' Perceived Knowledge, Skills, Attitudes, and Experience

BACKGROUND

The COVID-19 pandemic has highlighted the growing relevance of telehealth in health care. Assessing health care and nursing students' telehealth competencies is crucial for its successful integration into education and practice.

OBJECTIVE

We aimed to assess students' perceived telehealth knowledge, skills, attitudes, and experiences. In addition, we aimed to examine students' preferences for telehealth content and teaching methods within their curricula.

METHODS

We conducted a cross-sectional web-based study in May 2022. A project-specific questionnaire, developed and refined through iterative feedback and face-validity testing, addressed topics such as demographics, personal perceptions, and professional experience with telehealth and solicited input on potential telehealth course content. Statistical analyses were conducted on surveys with at least a 50% completion rate, including descriptive statistics of categorical variables, graphical representation of results, and Kruskal Wallis tests for central tendencies in subgroup analyses.

RESULTS

A total of 261 students from 7 bachelor's and 4 master's health care and nursing programs participated in the study. Most students expressed interest in telehealth (180/261, 69% very or rather interested) and recognized its importance in their education (215/261, 82.4% very or rather important). However, most participants reported limited knowledge of telehealth applications concerning their profession (only 7/261, 2.7% stated profound knowledge) and limited active telehealth experience with various telehealth applications (between 18/261, 6.9% and 63/261, 24.1%). Statistically significant differences were found between study programs regarding telehealth interest (P=.005), knowledge (P<.001), perceived importance in education (P<.001), and perceived relevance after the pandemic (P=.004). Practical training with devices, software, and apps and telehealth case examples with various patient groups were perceived as most important for integration in future curricula. Most students preferred both interdisciplinary and program-specific courses.

CONCLUSIONS

This study emphasizes the need to integrate telehealth into health care education curricula, as students state positive telehealth attitudes but seem to be not adequately prepared for its implementation. To optimally prepare future health professionals for the increasing role of telehealth in practice, the results of this study can be considered when designing telehealth curricula.

The role of mobile health in prevention, diagnosis, treatment and self-care of COVID-19 from the healthcare professionals' perspectives

Background

To facilitate disease management, understanding the attitude of healthcare professionals regarding the use of this tool can help mobile health (mHealth) program developers develop appropriate interventions.

Aims

To assess the perspective of healthcare professionals regarding the contribution of mobile-based interventions in the prevention, diagnosis, self-care, and treatment (PDST) of COVID-19.

Methods

This is a survey study conducted in 2020 in Iran with 81 questions. In this study mHealth functionalities were categorized into four dimensions including innovative, monitoring and screening, remote services, and education and decision-making. The data were analyzed using descriptive statistics, ANOVA, and the Kruskal-Wallis test to compare the attitudes of the different job groups.

Results

In total, 123 providers participated, and 87.4% of them reported that mHealth technology is moderate to most helpful for the management of COVID-19. Healthcare professionals believed that mHealth technology could be most helpful in self-care and least helpful in the diagnosis of COVID-19. Regarding the functionalities of the mobile application, the results showed that the use of patient decision aids can be most helpful in self-care and the use of computer games can be least helpful in treatment. The participants believed that mHealth is more effective in monitoring and screening dimensions and less effective in providing remote services.

Conclusions

This study showed that healthcare professionals believed that mHealth technology could have a better contribution to self-care for patients with COVID-19. Therefore, it is better to plan and invest more in the field of self-care to help patients to combat COVID-19. The results of this study revealed which mhealth functionalities work better in four domains of prevention, treatment, self-care, and diagnosis of COVID-19. This can help healthcare authorities to implement appropriate IT-based interventions to combat COVID-19.

A Chilean survey of perinatal women and health care professionals' views towards perinatal apps

BACKGROUND

Women around the globe are increasingly engaging with pregnancy and parenting apps, almost becoming a routine part of the maternity experience. However, little is known about what perinatal women and health care professionals feel about those apps in Latin American countries, where the digital transformation has been slower but where digital technologies could also bridge gaps in access to quality health care.

METHODS

This study aimed to assess views towards pregnancy and parenting apps in perinatal women and perinatal health care professionals in Chile through an online survey. In perinatal women, we explored app use, what they value in the apps they use, and what an "ideal app" would be for them. In health professionals, we explored opinions about women using perinatal apps and what they think a perfect app for their clients would be.

RESULTS

The survey was completed by 451 perinatal women and 54 perinatal health care professionals. Results show that perinatal women in Chile frequently use perinatal apps, and they and health care professionals show a positive attitude towards them. The most valued attributes are information and monitoring of body changes during pregnancy, information and monitoring of the baby's development (in the uterus and after birth), information and tips on how to stay healthy, and having the possibility to interact with other women.

CONCLUSIONS

Perinatal apps are accepted by perinatal women and health care professionals in Chile. Some needs for an "ideal app" emerged. Participants mentioned the need to address mental health, including the mental health of their partner, and the need for support during the transition to parenthood.

Implementing a Perinatal Depression Screening in Clinical Routine: Exploring the Patient's Perspective

Introduction Perinatal depression (PND) is a frequently observed mental disorder, showing a prevalence of up to 20% and resulting in unfavorable maternal and neonatal outcomes. Targeted screening for PND offers the potential to identify and treat undiagnosed cases and help prevent its deleterious consequences. The aim of the present study was to evaluate participants' personal attitudes and acceptance of a routine screening program for PND in pregnancy care, identify any potential underlying factors, and appraise the general perspective on perinatal mental health problems. Methods In total, 732 women in their second trimester of pregnancy took part in a PND screening program that was incorporated in routine prenatal care using the Edinburgh Postnatal Depression Scale (EPDS) and completed a web-based survey on screening acceptance. Results Participants viewed PND screening as useful (78.7%, n = 555/705), especially in terms of devoting attention to perinatal mental health problems (90.1%, n = 630/699), easy to complete (85.4%, n = 606/710), and without feelings of discomfort (88.3%, n = 628/711). Furthermore, women with previous or current mental health issues rated the usefulness of screening significantly higher, as did women with obstetric risks (p < 0.01 - p = 0.04). The final regression model explained 48.4% of the variance for screening acceptance. Conclusion Patient acceptance for PND screening was high in our study cohort, supporting the implementation of screening programs in routine pregnancy care with the potential to identify, sensitize, and treat undiagnosed patients to reduce stigmatization and offer access to tailored dedicated PND care programs.

Attitudes and Expectations of Clinical Research Participants Toward Digital Health and Mobile Dietary Assessment Tools: Cross-Sectional Survey Study

Background

The adoption of health technologies is key to empower research participants and collect quality data. However, the acceptance of health technologies is usually evaluated in patients or healthcare practitioners, but not in clinical research participants.

Methods

A 27-item online questionnaire was provided to the 11,695 members of a nutrition clinical research participant database from the Nantes area (France), to assess (1) participants' social and demography parameters, (2) equipment and usage of health apps and devices, (3) expectations in research setting and (4) opinion about the future of clinical research. Each item was described using frequency and percentage overall and by age classes. A global proportion comparison was performed using chi-square or Fisher-exact tests.

Results

A total of 1529 respondents (81.0% women, 19.0% men) completed the survey. Main uses of health apps included physical activity tracking (54.7%, age-related group difference, p < 0.001) and food quality assessment (45.7%, unrelated to age groups). Overall, 20.4% of respondents declared owning a connected wristband or watch. Most participants (93.8%) expected the use of connected devices in research. However, protection of personal data (37.5%), reliability (35.5%) and skilled use of devices (28.5%) were perceived as the main barriers. Most participants (93.3%) would agree to track their food intake using a mobile app, and 80.5% would complete it for at least a week while taking part in a clinical study. Only 13.2% would devote more than 10 min per meal to such record. A majority (60.4%) of respondents would accept to share their social media posts in an anonymous way and most (82.2%) of them would accept to interact with a chatbot for research purposes.

Conclusions

Our cross-sectional study suggests that clinical study participants are enthusiastic about all forms of digital health technologies and participant-centered studies but remain concerned about the use of personal data. Repeated assessments are suggested to evaluate the research participant's interest in technologies following the increase in use and demand for innovative health services during the pandemic of COVID-19.

Conceptualizing the digitalization of healthcare work: A metaphor-based Critical Interpretive Synthesis

The digitalization of healthcare work has gained center stage in academic debates spanning disciplines as diverse as medicine, sociology and STS. The different analytical interests and methodological traditions of these three strains of scholarship have, however, resulted in quite diverging approaches to this issue. Points of interest have ranged from the (disattended) promise of increased efficiency of healthcare work, to dynamics of task delegation, (re-)professionalization and (re-)distribution of invisible work, to the disruption of informal organization. Instead of studying these dynamics in practice, in this paper we foreground the potentiality for theory-making inherent in the systematic cross-contamination of different theoretical and disciplinary perspectives. We perform a Critical Interpretive Synthesis (CIS) centering the ways the digitalization of healthcare work has been investigated in recent STS, sociological and medical literature. To open up assumptions and insights intrinsic to each body of literature for scholars and practitioners in other fields, we propose here a metaphor-based variation on CIS approaches. We probe, in turn, what slime molds can teach us about STS's focus on interconnections and materiality, how we can better understand sociological analyses of invisible work exploring them through theatrical performances, and which lessons river engineering offers concerning medical scholarship's discussion of efficiency and proper healthcare work. Thinking through these metaphors, we conceptualize the digitalization of healthcare work as a phenomenon spanning, at once, the directionality of technological innovation trajectories and the open-endedness of situated changes in work practices. Based on our analysis, we propose focusing on technological scripts, and various forms of invisible work and informal organization as entry points into the study of the tension between directionality and open-endedness in the context of the digitalization of healthcare work.

Midwives' perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland

OBJECTIVE

To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland.

DESIGN

Cross-sectional study based on an online survey using quantitative methods.

SETTING

Midwives working in Switzerland.

PARTICIPANTS

Self-selected convenience sample of 630 members of the Swiss Federation of Midwives.

MEASUREMENT

Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied.

FINDINGS

A good half of the respondents associated telemedicine with either an advantage beyond the pandemic ("Reduced workload", "Improved health care provision", "Greater self-care of clients"), while the others saw a pandemic-related advantage ("Protection from COVID-19", "Maintaining care/counseling in an exceptional situation"), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive "Reduced workload" was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and "Protection from COVID-19" was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated "Maintaining care" and "Improved health care provision" as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative.

KEY CONCLUSION

Midwives' perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved.

IMPLICATION FOR PRACTICE

Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care.

[Smart sensors in pregnancy: Narrative review on the use of smart home technology in routine prenatal care]

INTRODUCTION

Today's routine prenatal care in Germany includes regular in-person appointments of pregnant women with doctors or midwives. Considering an increasing digitalization of the health care sector and in view of the global COVID-19 pandemic, the frequency of in-person visits could be reduced by remote monitoring using smart sensor technology. We aim to give an overview of the current international research on the use of smart sensors in prenatal care and its benefits, costs and resource consumption.

METHODS

For this narrative review, PubMed and Science Direct were searched for clinical trials using smart sensors in prenatal care published in English or German language from 1/2016 to 12/2020. We included studies which addressed the benefits, costs and resource consumption of this innovative technology.

RESULTS

We identified 13 projects using smart sensors in the fields of basic prenatal care, prenatal care for patients with hypertensive disease in pregnancy and prenatal care for women with gestational diabetes. The projects detected positive effects of smart sensors on health care costs and resource consumption and at least equal benefits for the pregnant women.

DISCUSSION AND CONCLUSIONS

The current COVID-19 pandemic underlines the need for the introduction of smart sensor technology into German prenatal care routine. Remote monitoring could easily reduce the frequency of in-person visits by half. Smart sensor concepts could be approved as digital health applications in Germany. In order to increase user acceptance, there should not be any additional costs for pregnant women and health care professionals using modern health care apps. However, health insurance providers need to invest in smart sensor technology in order to eventually benefit from it.

Willingness to Use Digital Health Tools in Patient Care Among Health Care Professionals and Students at a University Hospital in Saudi Arabia: Quantitative Cross-sectional Survey

BACKGROUND

The adoption rate of digital health in the health care sector is low in many countries. A facilitating factor for successful implementation and adoption of digital health is acceptance by current and future health care professionals.

OBJECTIVE

This study was conducted to identify factors associated with willingness to use digital health tools in patient care among health care professionals and students.

METHODS

This was a quantitative cross-sectional survey study conducted among health care professionals and students at a university hospital in Riyadh, Saudi Arabia. A nonprobability convenience sampling procedure was used to recruit participants. Data were collected using a self-completed e-questionnaire that was distributed by email. Chi-square tests, t tests, and logistic regression were used to analyze the data.

RESULTS

We found that 181 out of 218 health care professionals (83.0%; 75.6% [59/78] physicians; 87.1% [122/140] nurses) and 115 out of 154 students (74.7%; 80.0% [76/95] medical students and 66.1% [39/59] nursing students) were willing to use digital tools in patient care. Willingness to use digital tools was significantly associated with attitude (Adjusted Odds Ratios [AOR] 1.96; 95% CI 1.14-3.36) and self-efficacy (AOR 1.64; 95% CI 1.17-2.30) among health care professionals, and with current year of study (AOR 2.08; 95% CI 1.18-3.68) and self-efficacy (AOR 1.77; 95% CI 1.17-2.69) among students. No significant difference in willingness to use digital tools was found between physicians and nurses (P=.113), and between medical and nursing students (P=.079).

CONCLUSIONS

The findings of this study should encourage policy makers and hospital managers to implement relevant eHealth interventions within routine health care systems in Saudi Arabia. For successful implementation, digital health education programs should be implemented simultaneously, so that current and future health care professionals are able to develop required positive attitudes as well as practical skills and competencies.

Midwives' views towards women using mHealth and eHealth to self-monitor their pregnancy: A systematic review of the literature

INTRODUCTION

There are many mobile telephone apps to help women self-monitor aspects of pregnancy and maternal health. This literature review aims to understand midwives’ perspectives on women self-monitoring their pregnancy using eHealth and mHealth, and establish gaps in research.

METHODS

MEDLINE, PubMed, Scopus, CINAHL and PsycINFO were systematically searched on midwifery, eHealth/mHealth and perspectives. Qualitative, quantitative and mixed-methods studies published in English were considered for inclusion in the review, without geographical limitations. Relevant articles were critically appraised and narrative synthesis was conducted.

RESULTS

Twelve relevant papers covering midwives’ perspectives of the use of eHealth and mHealth by pregnant women were obtained for inclusion in this review. Seven of these publications focused on midwives’ views of eHealth, and five on their perspectives of mHealth interventions. The studies included demonstrate that midwives generally hold ambivalent views towards the use of eHealth and mHealth technologies in antenatal care. Often, midwives acknowledged the potential benefits of such technologies, such as their ability to modernise antenatal care and to help women make more informed decisions about their pregnancy. However, midwives were quick to point out the risks and limitations of these, such as the accuracy of conveyed information, and negative impacts on the patient-professional relationship.

CONCLUSIONS

Post-COVID-19, where technology is continuously developing, there is a compelling need for studies that investigate the role of eHealth and mHealth in self-monitoring pregnancy, and the consequences this has for pregnant women, health professionals and organisations, as well as midwifery curricula.

Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study

BACKGROUND

Approximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel's attitudes to perceived usefulness of internet-based interventions.

OBJECTIVE

The purpose of this study was to examine health professionals' perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful.

METHODS

Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: "How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?" The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often).

RESULTS

The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006).

CONCLUSIONS

Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.

Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands

Background

Daily monitoring of fetal and maternal conditions in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home-based monitoring with home visits by professionals or telemonitoring with self-measurements performed by pregnant women and uploaded for in-clinic assessment. For both alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to what extent, for which reasons, and for which pregnancy complications these strategies are used.

Objective

This study aims to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring in the Netherlands.

Methods

This nationwide cross-sectional study involved sending a web-based survey to the obstetrics departments of all 73 hospitals in the Netherlands to be answered by 1 representative dedicated to pregnancy monitoring per hospital. The primary outcome was the provision of home-based monitoring or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home-based monitoring and telemonitoring, including (contra)indications, advantages, and disadvantages for pregnant women and clinicians.

Results

The response rate for the provision of either home-based monitoring or telemonitoring was 100%. In 2018, 38% (28/73) of centers in the Netherlands offered either home-based monitoring or telemonitoring or both to pregnant women with complications. Home-based monitoring was offered in 26% (19/73) of the centers; telemonitoring, in 23% (17/73); and both in 11% (8/73). Telemonitoring was first offered in 2009, increasing from 4% (3/73) of hospitals in 2014 to 23% (17/73) in 2018. Responses were received from 78% (57/73) of the invited hospitals and analyzed. Of all 17 centers using telemonitoring, 59% (10/17) did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation. Other (6/17, 35%) telemonitoring centers are participating in an ongoing multicenter randomized clinical trial comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission. Home-based monitoring and telemonitoring are provided for a wide range of complications, such as fetal growth restriction, pre-eclampsia, and preterm rupture of membranes. The respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. The stated barriers included lack of insurance reimbursement and possible technical issues.

Conclusions

Home-based monitoring is provided in 26% (19/73) and telemonitoring, in 23% (17/73) of hospitals in the Netherlands to women with pregnancy complications. Altogether, 38% (28/73) of hospitals offer either home-based monitoring or telemonitoring or both as an alternative to hospital admission. Future research is warranted to assess safety and reimbursement issues before more widespread implementation of this practice.

Emergency consultations in obstetrics: identification of decisive, contributing and associated factors

PURPOSE

Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies.

METHODS

This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12).

RESULTS

This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p < 0.0001), less educated (p = 0.0002), and more likely to be unemployed and single. Different prevalences for anxiety and depression were detected correlating with the number of ED visits although each showing only low effect sizes (0.024 resp. 0.015).

CONCLUSIONS

Pregnant women attending the ED more often might benefit from health education, psychosomatic interventions, and social support to overcome their depression and anxiety to avoid non-urgent ED consultations. Further prospective studies are needed to support these findings.

Being 'A Google Mom' or securely monitored at home: Perceptions of remote monitoring in maternity care

AIMS

To understand the perspectives of both healthcare professionals in maternity care and pregnant women with higher risk pregnancies about remote monitoring in maternity care.

DESIGN

Qualitative descriptive design.

METHODS

Individual and focus group interviews were conducted in public maternity care and in a level III hospital in Finland during April-May 2018. The sample consisted of healthcare professionals working in the primary care and at the hospital and hospitalized pregnant women. Altogether, 17 healthcare professionals and 4 pregnant women participated in the study. The data were analysed using inductive thematic network analysis.

RESULTS

Many possibilities - and an equal number of concerns - were identified regarding remote monitoring in pregnancy, depending on the respondent's viewpoint from holistic to symptom-centred care. Healthcare staff had reservations about technology due to previous negative experiences and difficulties trusting technology. The pregnant women thought that monitoring would ease the staff's workload if the latter had enough technological skills. Remote monitoring could increase security in pregnancy care but create a feeling of false security if the women ignored their subjective symptoms. Face-to-face visits and the uniqueness of human contact were strongly favoured. Pregnant women wished to use monitoring as a confirmation of their subjective feelings.

CONCLUSION

Remote monitoring could be used as a supplementary system in pregnancy care, although it could replace only some healthcare visits. Pregnant women identified more possibilities for remote monitoring compared with the staff members both in primary care and the hospital.

IMPACT

A comprehensive understanding of pregnant women's and healthcare professionals' perceptions of remote monitoring in pregnancy was built to be able to develop new technologies in maternity care. In certain cases, remote monitoring would supplement traditional pregnancy follow-ups. Staff in primary and specialized care, and healthcare managers, should support teamwork to be able to understand different approaches to pregnancy care.

Women's Attitudes Toward Self-Monitoring of Their Pregnancy Using Noninvasive Electronic Devices: Cross-Sectional Multicenter Study

Background

Pregnancy can be distressing, particularly if expectant mothers are worried about the well-being of their fetus. Consequently, the desire for reassurance and frequent fetal monitoring is often pronounced. Smart wearable devices and telemedicine are promising tools that could assist women in self-monitoring their pregnancy at home, hence disburdening emergency departments (EDs). They present the possibility to clarify the need for urgent care remotely and offer tighter pregnancy monitoring. However, patients’ acceptance of such new technologies for fetal monitoring has not yet been explored extensively.

Objective

This survey aimed to elucidate the attitudes of women toward self-monitoring of their pregnancy using noninvasive electronic devices. The technical details of the proposed devices were not specified.

Methods

A cross-sectional multicenter study was conducted at the departments of obstetrics of the University Hospitals of Heidelberg and Leipzig, Germany. All patients seen in the obstetrics clinic who were above 18 years were offered participation. We designed a survey questionnaire including validated instruments covering population characteristics, issues in current and past pregnancies, as well as attitudes toward self-monitoring of pregnancy with smart devices.

Results

A total of 509 pregnant women with no previous experience in telemedicine participated. Only a small minority of 5.9% (29/493) regarded self-monitoring with wearable devices as an alternative to consulting their physicians. Along these lines, only 7.7% (38/496) strongly believed they would visit the ED less often if such devices were readily available. However, if the procedure were combined with a Web-based telemetric physician consult, 13.5% (66/487) would be highly motivated to use the devices. Furthermore, significantly more women regarded it as an alternative prior to seeing a doctor when they perceived a decline in fetal movements (P<.001). Interestingly, women with university degrees had a higher propensity to engage in pregnancy self-monitoring compared with women without one (37% vs 23%; P=.001). Of the participants, 77.9% (381/489) would like smart wearable devices to measure fetal heart sounds, and 62.6% (306/489) wished to use the devices on their own. Feedback from a doctor or midwife was also very important in their choice of such devices (61.8%, 301/487 wished feedback). The intended frequency of use differed vastly among women, ranging from 13.8% (65/471) who would like to use such a device several times per day to 31.6% (149/471) who favored once per week at most.

Conclusions

Our results point to a skeptical attitude toward pregnancy self-monitoring among pregnant women. Nevertheless, many women are open to using devices for pregnancy monitoring in parallel to consulting their physician. The intention to use such devices several times daily or weekly, expressed by more than half of the participants, highlights the potential of such technologies.