Hans van den Heuvel

7 were reported. 15 Our study confirmed that pregnant women at risk of HDP are willing to participate in self-monitoring services and are capable of bearing the responsibilities of measuring their ownbloodpressure. 15,21,22 Our study confirmed thatwomenwho experienced HDP in a prior pregnancy, in particular, were strongly in favor of blended care approaches in prenatal care. 22 A comparable intervention for pregnant women with hypertension that included remote monitoring of blood pressure and monitoring by health care professionals reported that 83% of the participants experienced a feeling of safety and that 68% preferred to be contacted within 12 hours after the measurement in case of abnormal measurements, preferably by their midwife or obstetrician. 15 Our study found comparable feelings of appreciation and safety among the users, partly because of the follow-up by health care professionals by phone or via clinical visits. Self-measuringwas found to be reassuring; when abnormal values were detected as women took and interpreted their own measurement, it was clear for the participants when to contact the clinic. 21 Other studies have also found that women prefer that blood pressure monitoring should not stop at the delivery date, but should be available postnatally, which was also expressed by our interview participants. 21,22 Opportunities for and Challenges With Blended Care Approaches in Clinical Care With the rapid development and implementation of digital technologies in health care settings, theneed for ethical guidanceandpractical recommendations for the implementation of such technologies, including mHealth, is widely acknowledged by patients, health care professionals, and influential advisory councils. 23-25 With the implementation of these technologies, it becomes possible to move beyond mere speculative debates about the opportunities and challenges of mHealth and to investigate how the practice is developing. Our study explored both user experiences and the expectations of users prior to using mHealth tools for digital monitoring. User experiences depend not only on the quality of the technology but also on the expectations one has before using it. Investigating both expectations and experiences is helpful, not only to understand what may motivate pregnant women to use such technologies but also to assess whether these tools live up to users’ expectations. Our study provides several insights in that respect: less frequent hospital visits and better-informed patients were often mentioned as factors contributing to the satisfaction with this technology. This shows that some of the widely discussed promises of mHealth were met in our study. Other claims about mHealth, such as increased accessibility, cost-effectiveness, and more empowered patients 1,2 , were not (fully) substantiated by our study. Furthermore, our study indicates that ethical guidance for the use of digital technologies in health care settings differs in significant ways from concerns about digital health consumers. Using digital technologies, including mHealth, in health care settings raises a wider range of ethical challenges than have been described in the consumer context. 26,27 Aside from concerns about effectiveness, privacy, and safety, the health care context requires us to carefully assess the delegation of responsibilities to patients, influence on patient autonomy, USER EXPERIENCES OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 115