Hans van den Heuvel

METHODS This qualitative study using online focus groups was designed as part of a pilot study for telemonitoring in high risk pregnancy. Aimof the feasibility pilot was to examine the accuracy of the tracings, the system’s usability and participants’ experiences and acceptance. In this paper we report women’s experiences of telemonitoring during the pilot. Context of the feasibility pilot Wireless devices for blood pressure (MicrolifeWatchBP) and cardiotocography (Sense4Baby, BMA- Telenatal, The Netherlands) were used for daily follow up of patients with either PPROM, FGR or preeclampsia. 17 18 Following a hospital admission for initial observation and treatment (e.g. antenatal corticosteroids), admitted patients were reviewed by the supervising obstetrician for eligibility for telemonitoring until start of labor. Selection criteria were 1) singleton pregnancy (for technical reasons), 2) travel time from home to the hospital within 30 minutes, 3) the ability to understand the devices and perform measurements as prescribed and 4) no complications requiring i.v. medication or obstetric intervention within 48h (e.g. severe hypertension, signs of infection or antepartum hemorrhage). After instructions by a member of our centre’s Obstetric Telemonitoring Team (consisting of a clinical midwife, the resident on ward supervised by an obstetrician), participants performed their daily CTG and blood pressure before 9.30 AM. Each morning, a member of the Obstetric Telemonitoring Team reviewed the measurements and contacted her at home to ask for symptoms, discuss the results and future management. At least once a week participants visited the outpatient clinic for clinical review. In case of abnormal results (e.g. non reassuring CTG, increase in blood pressure or symptoms of hypertensive disease or infection) patients were admitted to the ward for further evaluation. Design We set up online focus group (FG) discussions in secured Facebook groups within two different groups: one group of women who were admitted to the hospital during pregnancy and one group of women who were monitored at home (using home-based telemonitoring, TM). Conducting online FG is practical to women with young children, because of the possibility to react at any time of the day while there is no time needed to travel. 19 Also, the perceived anonymity of online communication lowers social inhibitions that might hold back participants in a real-time FG. Facebook in particular is a convenient platform for an online FG, because participants are familiar with its interface, the Group function facilitates notifications, tags and commenting on comments. The Secret Group function enables privacy as participating is only possible for invitees. 20 Our FGs were conducted following a semi-structured interview protocol including open ended questions on topics that were defined after literature review and expert opinion. These included: experiences of received health care, personal feelings and family life. The groups were open to the participants and one moderator only [both research physicians, JH (male) or CT (female), trained by experienced researchers using Facebook focus groups]. The moderators did not establish a relationship with the participants before study start, CHAPTER 8 128