Hans van den Heuvel

7 of the digital monitoring team (midwives or obstetric nurses) reviewed the data every morning from the outpatient department. The combination of blood pressure measurement and the presence of symptoms was reviewed and if needed, the digital monitoring team could consult the obstetrician for advice. Subsequently, participants were contacted to advise about management or follow-up. The platformwas embedded into prenatal care with the use of a reduced predefined prenatal visit schedule, with regular appointments in the outpatient department carried out by hospital midwives and gynecologists (in training). Data Collection Questionnaires At 36 weeks of gestation, two questionnaires were sent by email to all participants of the prospective study. One questionnaire assessed the usability of the mHealth technology (via an app or web portal) and the connected devices, focusing on the ease of use and given instructions. This usability questionnaire consisted of 9 propositions rated on a 5-point Likert scale (strongly agree to strongly disagree) to obtain quantifiable scores (see Textbox 1). Furthermore, the use of the blood pressure monitor, usability of the smartphone app, and content of the app could be rated on a scale from 1 to 10. The usability questionnaire was generated by the study team and not validated before the start of the study. The second questionnaire was the validated Client-Centered Care Questionnaire (CCCQ). The CCCQ was developed as an instrument to measure client-centeredness as experienced by clients of care organizations and to evaluate the effects of interventions aimed at improving the client-centeredness of care services. 20 Themes of the CCCQ include recognition, respect, autonomy, and partnership as perceived by the participants. It consists of 15 questions rated on a 5-point Likert scale, ranging from “totally disagree” to “totally agree” (Multimedia Appendix 1). Results of the CCCQ can be interpreted using a unidimensional application. This is done by aggregating all information in one measure and calculating a total test score. This total score expresses care receivers’ perception of client-centered care, with higher scores representing higher perceived client-centered care. Separate questions are discussed thematically, in line with the qualitative results of this study. Textbox 1. Items on the usability questionnaire. - The system and its use were easy to understand. - I felt at ease using the system during pregnancy. - While using the system, I was able to continue my daily activities. - I am satisfied with the ease of use of this system. - I would recommend this system to other pregnant women. - The instructions for use of the blood pressure monitor were clear. - The instructions for use of the app were clear. - It was clear when to provide my measurements. - It was clear when to contact my health care provider. USER EXPERIENCES OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 105