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Principal Investigator: Emma Rachel Lawrence
Organization: UNIVERSITY OF MICHIGAN AT ANN ARBOR
Fiscal Year: 2024
Award: $192,507
Funding agency: John E. Fogarty International Center for Advanced Study in the Health Sciences
Project Summary / Abstract
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality, particularly in
LMICs. Home BP monitoring is an emerging strategy to promote frequent monitoring of BPs, however unique
challenges exist in LMICs. Given widespread smartphone use in urban Ghana, we will leverage accessible
technology, adapted to the Ghanaian setting, to overcome barriers to home BP monitoring.
Aim 1 (R21) will adapt a home BP monitoring smartphone app to the Ghanaian context, using the ADAPT-ITT
framework. Stakeholder focus groups and cognitive interviews will be held with Ghanaian pregnant women,
midwives, and Obstetrician/Gynecologists to iteratively adapt the smartphone app, with a focus on cultural
relevance, locally appropriate language and phrasing, and useability in low literacy and numeracy populations.
Aim 2 (R21) will assess the feasibility, acceptability, and fidelity of a smartphone app-enhanced home BP
monitoring intervention among pregnant patients in Ghana. We will engage 100 pregnant participants over 4
weeks of home BP monitoring using the refined smartphone app, and complete pre-and-post validated scales
of acceptability, appropriateness, and feasibility. Fidelity will be evaluated by examining stored values in the BP
monitor and smartphone app to determine if concerning combinations of elevated BPs and preeclampsia
symptoms correctly trigger clinical alerts. Aim 3 (R33) will measure the adherence to BP monitoring with a
smartphone app-enhanced home BP monitoring intervention among pregnant patients in Ghana. We will
engage a prospective cohort of 200 pregnant participants in home BP monitoring from enrollment through
delivery. Adherence to BP monitoring will be measured both as frequency and time to drop-off of monitoring
over the course of pregnancy. Aim 4 (R33) will evaluate the clinical response to elevated BPs with a
smartphone app-enhanced home BP monitoring intervention among pregnant patients in Ghana. Automatic
alerts, triggered by BPs and symptoms, will be sent to study nurses trained on clinical response protocols.
Timely clinical response (routine alert: <4 hours; urgent alert: <1 hour) will be evaluated by comparing times of
a recorded elevated BP to the outgoing phone call by the nurse and successful contact with the participant.
Appropriateness of clinical response will be assessed using an expert consensus approach. Outcome of
clinical response will be evaluated by the proportion of participants who adhere with clinical advice provided by
the study nurse.
Smartphone app-enabled home BP monitoring is a novel strategy to address challenges in managing HDP.
Implementing home BP monitoring in LMICs will provide a critical step toward frequent assessment of BPs,
earlier diagnosis of HDP, and prevention of serious maternal morbidity and mortality.
Terms: <Address><Adherence><Age><Android App><Android Application><Apoplexy><Blood Pressure><Blood Pressure Monitors><Bluetooth><Brain Vascular Accident><Caring><Cell Phone><Cell Phone Application><Cell phone App><Cellular Phone><Cellular Phone App><Cellular Phone Application><Cellular Telephone><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Chronologic Fetal Maturity><Client satisfaction><Clinical><Consensus><Continuous Sphygmomanometers><Country><Data><Discipline of obstetrics><Drops><EPH Gestosis><Early Diagnosis><Eclampsia><Economic Income><Economical Income><Enrollment><Fetal Age><Focus Groups><Frequencies><Gestation><Gestational Age><Gestational Hypertension><Ghana><Gold Coast><Group Interviews><Gynecologist><Health Care Systems><Healthcare Systems><Home><Home Blood Pressure Monitoring><Hospitals><Hour><Hypertension><Hypertension induced by pregnancy><Hypertension-Associated Pregnancy Disorder><Income><Intervention><Intervention Strategies><LMIC><Language><Maternal Mortality><Measures><Midwife><Mobile Phones><Monitor><Morbidity><Morbidity - disease rate><Netherlands><Notification><Nurses><Obstetrics><Outcome><Participant><Patient Satisfaction><Patients><Phase><Phone><Population><Pre-Eclampsia><Preeclampsia><Pregnancy><Pregnancy Associated Hypertension><Pregnancy Toxemias><Pregnant Women><Prenatal care><Prevention><Production><Prospective cohort><Proteinuria-Edema-Hypertension Gestosis><Protocol><Protocols documentation><Provider><Recommendation><Safety><Seizures><Self Blood Pressure Monitoring><Site><Smart Phone App><Smart Phone Application><Smartphone App><Stroke><Symptoms><System><Technology><Telephone><Testing><Time><Training><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Woman><Work><acceptability and feasibility><ages><blood pressure elevation><brain attack><cell phone based app><cerebral vascular accident><cerebrovascular accident><clinical risk><cognitive interview><early detection><elevated blood pressure><enroll><expectant mother><expecting mother><forgetting><high blood pressure><homes><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disease of pregnancy><hypertensive disorder><hypertensive factor><iOS app><iOS application><iPhone><iPhone App><iPhone Application><inadequate health literacy><incomes><increase in blood pressure><increased blood pressure><interventional strategy><literacy><low and middle-income countries><low health literacy><mHealth therapeutic><mHealth therapy><mHealth treatment><maternal death><maternal morbidity><math ability><math achievement><math competence><math competency><math proficiency><mathematic ability><mathematic achievement><mathematic compentence><mathematic compentency><mathematic proficiency><mathematical ability><mathematical achievement><mathematical compentence><mathematical compentency><mathematical proficiency><mhealth interventions><mobile health intervention><mobile health therapeutic><mobile health therapy><mobile health treatment><mobile phone app><mortality><new approaches><novel><novel approaches><novel strategies><novel strategy><number sense><numeracy><nurse><phrases><poor health literacy><pre-eclamptic><pregnancy associated death><pregnancy associated mortality><pregnancy care><pregnancy disorder><pregnancy hypertension><pregnancy related death><pregnancy toxemia/hypertension><pregnant><pregnant mothers><prenatal appointment><prenatal checkup><prenatal visit><prevent><preventable death><preventable mortality><preventing><proficient in math><programs><quantitative literacy><recruit><reduced health literacy><response><smart phone><smartphone><smartphone application><smartphone based app><smartphone based application><stroked><strokes>