Hans van den Heuvel

11 User experiences of digital health in obstetric care Themost important objectives in digital health evaluation are: What are our users’ needs that we can possibly address with digital health? What is the target population I aim to influence with my innovation? How will the participants adopt the tool and how do they interact with technology? To collect information on patient views of digital health in pregnancy, and to use their views in research and prenatal care, we used 3 different methods: a review of existing literature, a feasibility study, and a mixed-methods approach to describe experiences of women who used our digital health platform (chapters 2, 7 and 8). Presently, pregnant women are ‘digital natives’. Therefore, they are equipped with the hardware to send measurements and the mind-set to communicate digitally with their health care provider. Results of previous literature reflect this general view: women report that platforms for home measurements are easy to use and the time involved fits into their daily routine. These applications and platforms enable transmission of data in the electronic patient file in het hospital to monitor abnormal values from a distance. 6,21,22 In this way, home data can facilitate shared decision making between patient and care provider. Pregnant women consider the medical professional’s expertise indispensable to oversee the needed actions in management and feel relieved that the monitoring is not solely the patient’s responsibility. Based on our participants’ insights, we made a set of recommendations for future development and implementation of digital health care, which are represented in Chapter 7. In summary, digital health innovations are regarded as useful for participants if they provide insights in data in forms of graphic representations with personalized surveys and thresholds. When integrated in usual care, participants feel the health care provider is responsible for detection of abnormalities and making clinical decisions. Insights in the experiences of pregnant women are important to ensure future care will be based on the individual patient’s perspective, preferences and needs. Findings fromprevious studies and our Facebook focus group study (Chapter 8) reveal that telemedicine may provide important psychological benefits during pregnancy. 23 When women’s perception of high risk pregnancy and quality of care experience improve with telemonitoring, this may contribute to better quality of life and reduction of antenatal anxiety and its consequences for mother and child. On the shift from hospital admission to home-based telemonitoring, the experiences of participants provide some recommendations for implementation from the patient perspective (Chapter 8): these include the demand for patient education and a clear antenatal management plan, adequate participant selection for telemonitoring, daily contact (by telephone or teleconferencing) by a select group of staff for a continuum of care (as our Obstetric Telemonitoring Team) and weekly hospital visits. As long as conclusive data on the clinical safety of telemonitoring in high risk or complicated pregnancy are lacking, we recommend to use strict protocols for care providers and patients, and to allow only limited SUMMARY AND GENERAL DISCUSSION 185