Abstract P2141: Developing a Targeted Educational Intervention Addressing Barriers to Home Blood Pressure Monitoring for Pregnant People with Hypertensive Disorders of Pregnancy

Abstract

Introduction: Hypertension (HTN) is a leading cause of maternal morbidity and mortality. Home blood pressure monitoring (HBPM) is essential in pregnancy due to blood pressure variability, limited medication options, and high rates of Whitecoat HTN. However, there is no standard for counseling, and utilization is inconsistent. Hypothesis: To identify patient- and provider-reported barriers to HBPM in pregnancies complicated by hypertensive disorders (HDP) to guide the development of a targeted educational intervention. Methods: From April to August 2023, pregnant participants (n = 21, mean age 31.6 years, SD 5.3) with HDP and perinatal healthcare providers (n = 4) were recruited from an academic tertiary care center. In-person interviews explored experiences with HBPM, identified barriers, and gathered recommendations for change. Qualitative analysis was used to generate and reconcile themes and subthemes. Discrepancies were resolved by consensus. Root cause analysis was conducted using the "5 Why Technique," and a Plan-Do-Study-Act (PDSA) cycle informed the design of our intervention. Results: Of the 21 participants, 71.4% utilized HBPM, but only 13.3% received guidance from providers. The average confidence level in HBPM was 6.67 (SD 3.4) on a 0-10 Likert scale. The major root causes leading to decreased confidence in utilizing HBPM included: 1) no standardized guidance or resources for providers and patients regarding HBPM and alert values during pregnancy; 2) no streamlined process recommended or taught to patients; and 3) no consolidated resources on available validated cuffs for this patient population. To address these issues, we developed a patient-centered educational intervention, including physical pamphlets, a video guide, and online links to a template log and validated cuffs currently accessible for this patient population. Conclusion: In conclusion, we identified critical barriers to HBPM in pregnancies with HDP, including insufficient guidance, inadequate access to resources, and absence of standardized processes. A new targeted educational intervention, including patient-focused materials and provider resources, was developed to address these barriers. Ongoing post-intervention data collection aims to refine and optimize the intervention for broader reach and improved confidence in HBPM practices. Targeted solutions like this may ultimately improve maternal outcomes and reduce risks associated with hypertensive disorders in pregnancy.