Hans van den Heuvel

7 Also, when their measurement indicated normal blood pressure, the digital monitoring was considered useful and reassuring, because it would indicate that the symptoms were not caused by hypertension. Comparable to the results of the questionnaire, all interviewed women would recommend the system to other pregnant women. Some reflections of the interview participants indicated that their expectations did not always match their experiences. A few women were surprised by health care professionals calling when they did not expect it, while at other times, they were not called by the health care professional when they expected it based on their uploaded blood pressure data (2/11; both with a history of hypertension). Participants who needed reassurance that their blood pressure or symptoms were nothing to worry about sometimes called the hospital themselves. Furthermore, one interview participant needed several extra hospital visits because of hard-to-control hypertension, eventually leading to hospital admission. As a result, she was somewhat disappointed that the digital monitoring platform did not live up to her expectations (P5, Table 2). Theme 2: Usability of the mHealth Tool Quantitative Analysis Analysis of the questionnaires showed that nearly all participants considered the user instructions of the blood pressure monitor (49/51, 96%) and smartphone app or website (48/51, 94%) to be clear and understandable. Similarly, almost everyone (49/51, 96%) found it easy to learn how to use the mHealth technology. Furthermore, the vast majority of participants (47/51, 92%) was satisfied with the usability of the mHealth technology; 81% (41/51) of the participants said the daily measurements took ≤5 minutes a day (average 4.57 minutes, range 3-15 minutes), and women could easily continue their daily routine while using the technology (50/51, 98%). Some found it difficult to combine digital monitoring with their daily routine (5/51, 10%). On a scale from 1 to 10, the blood pressure monitor was rated at 8.5 (range 6-10), usage of the smartphone app at 7.6 (range 1-10), and content of the smartphone app at 7.8 (range 1-10). Qualitative Analysis Similar to the questionnaire, interview participants (6/11) considered the app to be “modern” and easy to use; all users of the web portal (4/11) suggested that an Android app would be more user-friendly. Moreover, the iOS app was regarded to be comprehensive; the symptom survey was considered short but clear and easy to complete — it did not take them much effort and time (4/11; 2 with a history of HPD and 2 without). Other technical aspects that contributed to the ease of use were the reminder function, automatic Bluetooth synchronization, and perceived high accuracy of the measurement. A couple of participants (2/11) noted that technical understanding of the functioning of the app was irrelevant for their user experience. USER EXPERIENCES OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 109