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Implementing self-management: a mixed-methods study of women’s experiences of a postpartum hypertension intervention (SNAP-HT)
Alexandra Elspeth Cairns
University of Oxford
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6989-0887
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This work is licensed under a CC BY 4.0 License. Read Full License
Background Self-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management, in women with medicated hypertensive disorders of pregnancy. Methods A mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews, at four weeks and six months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of Normalisation Process Theory. Participants provided a score (Likert scale 1-5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach. Results Sixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both four weeks and six months: adjusted differences 0.6 (95% confidence interval (CI) 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively. Conclusions Interviews and quantitative data showed that self-management enhanced women’s sense of control, and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible, reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum, and reinforce the effectiveness of the intervention used in this study. Trial registration Prospectively registered with ClinicalTrials.gov on 07/01/2015 (NCT02333240) https://clinicaltrials.gov/ct2/show/NCT02333240.
Keywords
Hypertension; pregnancy; qualitative methods; self-management; self-monitoring.
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CURRENT STATUS: Under Review
Version 2
Posted 09 Jan, 2020
No community comments so far
Review #1 received
Received 19 Jan, 2020
Reviewers invited
Invitations sent on 13 Jan, 2020
Reviewer #1 agreed
On 13 Jan, 2020
Editor assigned
On 08 Jan, 2020
Submission checks complete
On 07 Jan, 2020
No comments provided
Reviewer #3 agreed
On 09 Dec, 2019
Review #3 received
Received 09 Dec, 2019
Editorial decision: Minor revision
On 09 Dec, 2019
Review #1 received
Received 03 Nov, 2019
Review #2 received
Received 18 Oct, 2019
Reviewer #2 agreed
On 14 Oct, 2019
Reviewer #1 agreed
On 11 Oct, 2019
Reviewers invited
Invitations sent on 23 Sep, 2019
Editor assigned
On 10 Sep, 2019
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On 08 Aug, 2019
First submitted
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This preprint is under consideration at Trials. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Implementing self-management: a mixed-methods study of women’s experiences of a postpartum hypertension intervention (SNAP-HT)
Alexandra Elspeth Cairns
University of Oxford
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6989-0887
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 09 Jan, 2020
No community comments so far
Review #1 received
Received 19 Jan, 2020
Reviewers invited
Invitations sent on 13 Jan, 2020
Reviewer #1 agreed
On 13 Jan, 2020
Editor assigned
On 08 Jan, 2020
Submission checks complete
On 07 Jan, 2020
No comments provided
Reviewer #3 agreed
On 09 Dec, 2019
Review #3 received
Received 09 Dec, 2019
Editorial decision: Minor revision
On 09 Dec, 2019
Review #1 received
Received 03 Nov, 2019
Review #2 received
Received 18 Oct, 2019
Reviewer #2 agreed
On 14 Oct, 2019
Reviewer #1 agreed
On 11 Oct, 2019
Reviewers invited
Invitations sent on 23 Sep, 2019
Editor assigned
On 10 Sep, 2019
Submission checks complete
On 08 Aug, 2019
First submitted
On 07 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Self-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management, in women with medicated hypertensive disorders of pregnancy. Methods A mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews, at four weeks and six months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of Normalisation Process Theory. Participants provided a score (Likert scale 1-5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach. Results Sixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both four weeks and six months: adjusted differences 0.6 (95% confidence interval (CI) 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively. Conclusions Interviews and quantitative data showed that self-management enhanced women’s sense of control, and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible, reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum, and reinforce the effectiveness of the intervention used in this study. Trial registration Prospectively registered with ClinicalTrials.gov on 07/01/2015 (NCT02333240) https://clinicaltrials.gov/ct2/show/NCT02333240.
Figure 1