Hans van den Heuvel

7 INTRODUCTION Mobile health (mHealth) refers to the use of mobile devices, mobile phones, and wireless technologies to support the achievement of health objectives. 1 mHealth is expected to improve access to care, enhance patient satisfaction, and reduce clinic visits and admissions without compromising safety of care and is argued to improve interaction with and participation of better-informed and more active patients. 2-4 To date, mHealth has mostly focused on patients with chronic conditions or healthy individuals to improve healthy lifestyle habits. 5-7 As in other domains of health care, including pregnancy care, a shift is currently occurring from hospital-based to home-based services. 8 In search of improved care for pregnant women, tailored care with the integration of mHealth has been suggested as an addition to or partial replacement of frequent prenatal visits. 9 This approach is called blended care, where digital technologies are combined and integrated with face-to-face care. While many of these technologies are being developed and implemented, little is still known about clinical outcomes including safety, effectiveness, patient satisfaction, and ethical considerations. Hypertensive disorders of pregnancy (HDP) are a primary cause of adverse maternal and neonatal outcomes worldwide and occur in 10% of pregnancies. 10 Risk groups for hypertensive complications include women with chronic hypertension, diabetes, obesity, renal disease, cardiac disease, and preeclampsia in a prior pregnancy. The proportion of women with these risk factors has been steadily rising over recent years. 10 For women considered to be at risk, guidelines recommend frequent observation of the fetal condition and the pregnant woman’s blood pressure and signs of preeclampsia. 11 Planned and unplanned visits can range from every 2 weeks to 4 times a week or even daily. The burden of these recurrent visits is significant, for both patients and their spouses and family, as well as for health care services. However, the incidence of preeclampsia with severe features is approximately 3% 12 , meaning that a substantial number of monitored women, while at risk, do not develop this condition. Given the wide ubiquity of smartphones and tablets in most countries, mHealth is a promising alternative for monitoring hypertension during pregnancy. The latest research has shown that pregnant women are willing to undertake repeated self-measurements and a majority of women would like to be involved in their blood pressure management 14,13 and regard remote monitoring important for their pregnancy follow-up. 15 Little is known about the experiences of women using such platforms and how these digital tools can be aligned with their needs and preferences. This study aimed, firstly, to explore how pregnant women, who have used mHealth as part of a blended care approach for repeated blood pressure measurements and preeclampsia USER EXPERIENCES OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 103