Exploring Caregivers’ Perspectives and Perceived Acceptability of a Mobile-Based Telemonitoring Program to Support Pregnant Women at High-Risk for Preeclampsia in Karachi, Pakistan: A Qualitative Descriptive Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Design and Setting Overview
2.2. Proposed Mobile-Based Telemonitoring Program
2.3. Participant Recruitment and Eligibility Criteria
2.4. Data Collection Methods
2.5. Data Analysis
3. Results
3.1. Caring for Pregnant Women at High-Risk for Preeclampsia
3.1.1. Caregivers’ Roles in Supporting High-Risk Pregnant Women
I know how to care for her, and I try not to give her any stress. I take good care of her and provide her with everything she wants so she doesn’t get stressed. I also support her in taking care of our children so that she can stay stress-free. (Husband 14)
We live in a joint family, so I have support from my three brothers and their wives. Everyone takes good care of her and asks her about her health and wellbeing. (Husband 14)
3.1.2. Challenges in Caring for Pregnant Women at High-Risk for Preeclampsia
The difficulty is to close the shop, rush home, take her to the hospital in time, purchase prescribed medicines, drop her home, and again go back to the work. Sometimes I feel helpless as I am alone and need to take care of her as well as run my shop to earn our living. (Husband 15)
Traveling is a big issue especially when she is experiencing bleeding… in those circumstances, her husband rents a car and drives very slowly. Again, waiting at the hospital for seeing a doctor in a clinic is also a big challenge. (Brother’s Wife 27)
The difficulty is that… I am alone and do not have any support. When I leave for work, my wife is alone at home with my 4 years old son. God forbid if she becomes unconscious so there is no one to take care of her… my 4 years son would not be able to do anything for her. (Husband 17)
I am unable to take her for blood pressure monitoring in the nearby clinic for the last 3 to 4 days… since I get late from work. I leave at 0700am in the morning and return at 1100pm in the night and by that time all clinics are closed. (Husband 08)
3.2. Supporting Caregivers through the Use of the Telemonitoring Program
3.2.1. Reducing Caregiver Distress and Anxiety
I will not be stressed while I am at work as my wife will be monitored by the doctor for her health condition… I will not be worried even if she (his wife) is alone at home. (Husband 06)
3.2.2. Reducing Caregiver Workload
It will be extremely helpful for me as my wife would be able to take care of herself and would be able to monitor her blood pressure and report it to the doctor through the app. This will save me a lot of time and effort as I will not need to take her to the clinic regularly for blood pressure monitoring… she will not need me during the daytime and would be able to reach out to the doctor by herself. (Sister 19)
3.2.3. Convenient and Cost-Effective
We will not have to travel so far for seeing a doctor... the women will be monitored at home through the provided home blood pressure machine… we will be able to save a lot of time… we will not have to stand in long queues we will use the time to complete our household chores. (Mother-in-law 20)
This machine will have many benefits. We will have a blood pressure monitoring facility at home… we will not have to pay 100Rs daily to the clinic for one-time blood pressure measurements. We will also save our transportation costs… and we will be able to use the savings for buying prescribed medicines and supplements. (Sister-in-law 24)
3.3. Caregivers’ Expectations of the Telemonitoring Program
3.3.1. Ease-of-Use of Telemonitoring Program
The machine should be very simple so that technologically illiterate people can use it… I know my wife would be able to use it, but it might be difficult for others who do not have the technology and are not literate (Husband 18).
3.3.2. Continuous Monitoring of Pregnant Women and Baby
The machine should include the contact number of the doctor so that the women can call the number and seek advice from the doctor on the medicines and home remedies for reducing blood pressure… the doctor should also be able to guide us about nearby hospitals for emergency visits. (Husband 17)
3.4. Considerations for Implementing the Telemonitoring Program
3.4.1. Caregivers and Community Acceptance of the Telemonitoring Program
I think we will have to seek permission from elders in our home like my mother, my father, and my grandmother… I believe they will be supportive of the use of this machine… since this machine is trying to help high-risk pregnant women. (Husband 06)
I will give permission to my daughter-in-law for the use of this machine but there might be some families that will not allow you to monitor pregnant women from home and you would need to give awareness to such families on the usefulness of this machine… and then they might be able to accept it. (Mother-in-law 20)
3.4.2. Training of Pregnant Women and Caregivers on Telemonitoring Program Use
Some women are literate, and some are illiterate, so there would be some problems and you will have to guide them and show them how the machine can be used… I know the use of smartphones so I will be able to help my wife. (Husband 07)
3.4.3. Cost of Telemonitoring Program
My brother-in-law would not be able to afford this machine due to financial constraints. I do not think he would be able to contribute to the purchase of this machine. Only yesterday, he was talking about financial difficulties and their impact on daily living. (Sister 12)
4. Discussion
4.1. Principal Findings
4.2. Comparison with Prior Research
4.3. Recommendations
- A mobile phone-based telemonitoring program should be developed to support informal caregivers of high-risk pregnant women with the aim of reducing caregiver stress and workload, which is associated with the frequent traveling to healthcare appointments and visits to a clinic to take blood pressure readings.
- A context-specific TM program should be designed using a user-centric approach to include local language, visuals, and voice message alerts to allow less educated and non-tech savvy pregnant women and their caregivers to use the TM program.
- The caregivers should be trained on the use of TM programs to address issues associated with technological illiteracy.
- The caregivers should be sensitized to the benefits of the TM program to increase the acceptance and uptake of the TM program.
- The TM program should be low-cost to enable a large number of high-risk pregnant women and their caregivers to access the program because of the financial constraints that are common in LMICs.
4.4. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Definition of Pregnant Women at High-Risk for PE as Per NICE Guidelines
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Inclusion Criteria | Exclusion Criteria |
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|
|
Characteristics of Caregivers | Category | N (%) or Mean ± SD |
---|---|---|
Gender | Female | 13 (46.42%) |
Male | 15 (53.57%) | |
Age | 34.82 ±11.48 | |
Educational Level | No education | 9 (32.14%) |
Less than high school | 9 (32.14%) | |
High school | 8 (28.57%) | |
College or university | 2 (7.14%) | |
Occupation | Homemaker | 12 (42.85%) |
Professional | 16 (57.14%) | |
Relationship with pregnant women at high-risk for PE | Husband | 15 (53.57%) |
Mother | 2 (7.14%) | |
Mother-in-law | 2 (7.14%) | |
Sister | 6 (21.42) | |
Sister-in-law | 1 (3.57%) | |
Wife of Husband’s brother | 2 (7.14%) | |
Caregiving experience (years) | 2.42 ± 1.19 | |
Access to a mobile phone | Yes | 25 (89.28%) |
No | 3 (10.71%) | |
Type of Phone | Basic mobile phone | 12 (42.85%) |
Smartphone | 13 (46.42%) | |
Access to the internet | Yes | 10 (35.71%) |
No | 18 (64.28%) | |
Availability of blood pressure monitor at home | Yes | 19 (67.85%) |
No | 9 (32.14%) |
Themes | Sub-Themes |
---|---|
Caring for pregnant women at high-risk for PE | Caregivers’ roles in supporting high-risk pregnant women |
Challenges in caring for pregnant women at high-risk for PE | |
Supporting caregivers through the use of the TM program | Reducing caregiver distress and anxiety |
Reducing caregiver workload | |
Convenient and cost-effective | |
Caregivers’ expectation of the TM program | Ease-of-use of TM program |
Continuous monitoring of pregnant women | |
Considerations for implementing the TM program | Caregivers and community acceptance of TM program |
Training of pregnant women and caregivers on TM program use | |
Cost of TM Program |
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Feroz, A.S.; Meghani, S.N.; Yasmin, H.; Saleem, S.; Bhutta, Z.; Arshad, H.; Seto, E. Exploring Caregivers’ Perspectives and Perceived Acceptability of a Mobile-Based Telemonitoring Program to Support Pregnant Women at High-Risk for Preeclampsia in Karachi, Pakistan: A Qualitative Descriptive Study. Healthcare 2023, 11, 392. https://doi.org/10.3390/healthcare11030392
Feroz AS, Meghani SN, Yasmin H, Saleem S, Bhutta Z, Arshad H, Seto E. Exploring Caregivers’ Perspectives and Perceived Acceptability of a Mobile-Based Telemonitoring Program to Support Pregnant Women at High-Risk for Preeclampsia in Karachi, Pakistan: A Qualitative Descriptive Study. Healthcare. 2023; 11(3):392. https://doi.org/10.3390/healthcare11030392
Chicago/Turabian StyleFeroz, Anam Shahil, Salima Nazim Meghani, Haleema Yasmin, Sarah Saleem, Zulfiqar Bhutta, Hajraa Arshad, and Emily Seto. 2023. "Exploring Caregivers’ Perspectives and Perceived Acceptability of a Mobile-Based Telemonitoring Program to Support Pregnant Women at High-Risk for Preeclampsia in Karachi, Pakistan: A Qualitative Descriptive Study" Healthcare 11, no. 3: 392. https://doi.org/10.3390/healthcare11030392