Introduction
Materials and methods
Setting
Participants
Recruitment
Characteristic
| Survey participants (n = 75) Frequency (proportion) | Interview participants (n = 22) Frequency (proportion) |
---|---|---|
Clinical role | ||
House Officer | 23 (30.7%) | 4 (18.2%) |
Junior Resident in | 17 (22.7%) | 6 (27.3%) |
Obstetrics/Gynaecology | 25 (33.3%) | 8 (36.4%) |
Senior Resident in | 10 (13.3%) | 4 (18.2%) |
Obstetrics/Gynaecology | ||
Consultant (“attending”) in Obstetrics/Gynaecology | ||
Gender | ||
Male | 54 (73.0%) | 18 (81.8%) |
Female | 20 (27.0%) | 4 (18.2%) |
Other/ Prefer Not To Respond | 0 (0%) | 0 (0%) |
Years in practice as a doctor | ||
< 1 | 21 (28.0%) | 4 (18.2%) |
1—5 | 5 (6.7%) | 2 (9.1%) |
6—10 | 19 (25.3%) | 8 (36.4%) |
11—20 | 25 (33.3%) | 7 (31.8%) |
> 20 | 5 (6.7%) | 1 (4.5%) |
Average patients with preeclampsia managed weekly | ||
0—5 | 20 (27.0%) | 5 (22.7.0%) |
6—10 | 40 (54.1%) | 8 (36.4%) |
11—15 | 8 (10.8%) | 4 (18.2%) |
16—20 | 3 (4.1%) | 5 (22.7%) |
> 20 | 3 (4.1%) | 0 (0.0%) |
Average patients with eclampsia managed monthly | ||
0 | 7 (9.3%) | 3 (13.6%) |
1 | 28 (37.3%) | 7 (31.8%) |
2 | 12 (16.0%) | 7 (31.8%) |
3 | 11 (14.7%) | 5 (22.7%) |
4 | 4 (5.3%) | 0 (0.0%) |
5 or higher | 13 (17.3%) | 0 (0.0%) |
Design
Procedures
Analysis
Results
Current state of BP monitoring among pregnant women in Ghana is inadequate
“So it means that when you come [for antenatal care], the next time you’re coming is a month later. So, within that time, what are you doing? Who is monitoring your BP and all that? So if anything happens within that period, you don’t know. Or no one will know.” ID 13, Male Junior Resident
“Most people don’t have BP machines at home. And they just live life on a day-to-day basis. Unless you have symptoms, you don’t really go to the hospital. You don’t see the need to check your blood pressure.” ID 16, Female House Officer
“So they may have to walk to a pharmacy shop and get their blood pressures checked. But then, if they have to do this several times a day, it becomes a bit of an inconvenience. And of course, it has financial implications because they have to pay for their blood pressures to be monitored. So it’s easier if they have the education and they have the means to get a blood pressure monitor. Then they can do it themselves.” ID 1, Male Senior Resident
Doctors perceived significant benefits to home BP monitoring
Benefit categories | Benefits | Representative quotation |
---|---|---|
Patient Benefits
|
Empowerment
| “So she owns her health. She understands, she asks questions. It's more of a joint care, multidisciplinary approach. We have the patient as one of the clinicians.” ID 17, Female Senior Resident |
Trust of diagnosis
| “When [patients] start home BP monitoring early, they realize that it's not the doctor saying it…you know this is something I didn't have and I can see myself that [BP] is going up…As against me springing a diagnosis on you.” ID 4, Female Consultant | |
Clinical Benefits
|
More quantity and quality of data
| “I think [home monitoring] would create a better overall picture of the patient's response rather than that snapshot that you get when they come to you once every 4 weeks.” ID 22, Male Consultant |
Earlier detection and improved management
| “If the high risk people are monitoring at home,…we are going to pick most of the diagnoses early, it will help us put in interventions early, and we are definitely going to achieve better outcomes.” ID 12, Male Junior Resident | |
Systemic Benefits
|
Reduced healthcare expenditure
| "So [home monitoring] will probably help reduce the costs for the facility and for the patient. It will help us catch late cases earlier. It will reduce the time and then probably the manpower you put into managing those adverse cases.” ID 13, Male Junior Resident |
Public health promotion
| “Other members of the family are going to go ahead and check their blood pressures. And they could have essential hypertension that could be picked up and they could seek care. So giving it to one person will save the whole family.” ID 10, Male House Officer |
Doctors acknowledged key barriers to home BP monitoring
Barrier categories | Barriers | Representative qualitative quotation |
---|---|---|
Patient Barriers
|
Health literacy
| “I think the number one barrier is when they've not been properly educated. If they don't understand. Once they have the understanding, I believe they will use it. So the next thing will be working on their understanding. So lots of counseling.” ID 21, Male Consultant |
Agency to make and act upon healthcare decisions
| “Here is a case that a lady comes, she's told about everything. But the husband doesn't come. The husband doesn't see the need to come and listen to what we say. Meanwhile, he is the provider. Yes, so if you say, okay, let's get a [BP monitor],….[he] tells you that I don't have the money to buy the [BP monitor] or I won't do it. He's taking the major decision here.” ID 9, Male Senior Resident | |
Willingness to perform regular BP monitoring
| “Every woman wants to have a safe delivery and to have their babies. So, if they understand the complications of the disease, they will be motivated.” ID 11, Male Senior Resident | |
Ability to use BP monitor
| “If they have been taught well…I think our patients are smart enough to do it and it should be accurate.” ID 6, Male Senior Resident | |
Clinical Barriers
|
Provider comfort with home management
| “If something goes wrong, we will be held responsible. Because you allowed her to go home and now she has had a stroke. So I think from healthcare workers, that may be the resistance to allowing more women to monitor their blood pressures at home. If something goes wrong, who is going to be held responsible?” ID 4, Female Consultant |
Provider trust in home BP values
| “Most patients who understand what is wrong with them, will not lie…I think that is the bottomline. By and large I think most people will not give false readings.” ID 14, Male Junior Resident | |
Systemic Barriers
|
Cost of BP monitors
| “When it comes to our care, cost is literally a big barrier. You know most patients cannot afford [a BP monitor].” ID 19, Male Senior Resident |
Quality of BP monitors
| “You have to check to see the cuff size, whether it tallies. Whether the machine is working well or not. Use it on another person to be really sure that hey this machine is good. It's not just that the values are high, the machine is actually appropriate for the person.” ID 5, Male Junior Resident | |
Provider-patient communication of abnormal BP values
| “I think [there should be] systems in place so that when BPs are elevated…that the [patient] can call and complain to somebody that this is the BP I checked and these are the symptoms I am feeling and all of that. And if they need for the person to [come to the hospital], then the person reports.” ID 8, Male Junior Resident |
“It’s the whole cost and benefit analysis. If you can provide pregnant women with a device that could prevent her from coming to the hospital and be admitted, and then the cost of reporting to the hospital, the admission, daily bed charges...in the long run you realize it’s actually cheaper to actually provide a device.” ID 17, Female Senior Resident
Doctors believed home BP monitoring would be feasible and impactful
“So I think this should be the way to go…Helping [patients] get a monitor, teaching them how to check it properly, and then telling them or educating them on what to do when they get abnormal figures. This will help.” ID 12, Male Junior Resident
“If the BP is high, it is high. So if they come [in] or they call that they are checking their BPs and it is high, then you have to act on it… It will affect the clinical management” ID 13, Male Junior Resident