Hans van den Heuvel

symptom reporting, experience the use of such technology. Second, the study aimed to formulate recommendations based on these user experiences. Based on the insights originating from the users’ experiences, we identified several recommendations to design and implement similar interventions and to enhance future use of digital technology in clinical care. METHODS Amixed-methods study, alongside a prospective blended care study (SAFE@home study). 16,17 was performed to explore the understanding of patients’ experiences with mHealth. 18,19 Data were collected bymeans of validated questionnaires and semistructured in-depth interviews with patients that had experience with mHealth for remote monitoring of HDP, to explore their experiences and motivations. The research ethics committee of the University Medical Center Utrecht determined that this study was exempt from the Medical Research Involving Humans Act (reference number 18-898-C). Context of the Blended Care Approach in Prenatal Care The overarching prospective study, named Safe@Home, evaluates the use of mHealth technology to remotely monitor blood pressure and preeclampsia symptoms. The data collected within this study were sent by the patient to the digital monitoring team, who reviewed the data each day except for the weekend days. The mHealth technology consisted of an automated blood pressure monitor with Bluetooth connection to a smartphone app for iOS users and a web-based portal for Android users. 16,17 Digital monitoring started from 16 weeks gestational age and was continued until delivery, with interruption in case of hospital admission. Participation in the blended care approach was offered to pregnant women whom, at intake, presented with one of the following risk factors for hypertensive complications: chronic hypertension, history of prior preeclampsia, or maternal cardiac or renal disease requiring prenatal care in our clinic in the University Medical Centre Utrecht (university hospital) or Diakonessenhuis Utrecht (general teaching hospital). Access to a smartphone or tablet with internet connection and good understanding of either the Dutch or English language were required. More information about the overarching study can be found in previous publications. 16,17 A prenatal visit schedule was predefined for this group of patients, with a reduced number of visits while continuing remote monitoring. Participants were asked to measure their blood pressure every weekday before 10 AM and at least 1 hour after waking up. A 9-question symptom score list could be answered in case of hypertension. Predetermined thresholds (systolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg) or self-reported symptoms of preeclampsia in the questionnaire resulted in automatically generated alarm signals on a monitoring dashboard in the hospital. For health care providers, a web portal providedonline access topatient-reportedquestionnaires andbloodpressure data. Members CHAPTER 7 104