The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

Tucker, Katherine L.; Bowen, Liza; Crawford, Carole; Mallon, Philippa; Hinton, Lisa; Lee, Mei‐Man; Oke, Jason; Taylor, Kathryn; Heneghan, Carl; Bankhead, Clare; Mackillop, Lucy; James, Tim; Oakeshott, Pippa; Chappell, Lucy C; McManus, Richard J

doi:10.1016/j.preghy.2017.11.009

Cited by 16 publications

(20 citation statements)

References 15 publications

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“…Self-testing was not common though most respondents thought that women would find self-testing acceptable, which fits with other research in the area. [23] While self-testing was valued, nearly all of those supporting home-testing would repeat the measurement in clinic, typically in order to perform an up-to-date reading. Practice and views became more positive with the implementation of remote monitoring due to the pandemic, though with much lower levels of acceptability than BP self-monitoring.…”

Section: Discussionmentioning

confidence: 99%

Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic

Fletcher¹,

Chappell²,

Lavallee³

et al. 2021

Pregnancy Hypertension

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Objective This study aimed to understand the views and practice of obstetricians regarding self-monitoring for hypertensive disorders of pregnancy (blood pressure (BP) and proteinuria), the potential for self-management (including actions taken on self-monitored parameters) and to understand the impact of the COVID-19 pandemic on such views. Design Cross-sectional online survey pre- and post- the first wave of the COVID-19 pandemic. Setting and Sample UK obstetricians recruited via an online portal. Methods A survey undertaken in two rounds: December 2019-January 2020 (pre-pandemic), and September-November 2020 (during pandemic) Results 251 responses were received across rounds one (1 5 0) and two (1 0 1). Most obstetricians considered that self-monitoring of BP and home urinalysis had a role in guiding clinical decisions and this increased significantly following the first wave of the COVID-19 pandemic (88%, (132/150) 95%CI: 83–93% first round vs 96% (95%CI: 92–94%), (97/101), second round; p = 0.039). Following the pandemic, nearly half were agreeable to women self-managing their hypertension by using their own readings to make a pre-agreed medication change themselves (47%, 47/101 (95%CI: 37–57%)). Conclusions A substantial majority of UK obstetricians considered that self-monitoring had a role in the management of pregnancy hypertension and this increased following the pandemic. Around half are now supportive of women having a wider role in self-management of hypertensive treatment. Maximising the potential of such changes in pregnancy hypertension management requires further work to understand how to fully integrate women’s own measurements into clinical care.

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Section: Discussionmentioning

confidence: 99%

Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic

Fletcher¹,

Chappell²,

Lavallee³

et al. 2021

Pregnancy Hypertension

View full text Add to dashboard Cite

show abstract

“…There is a limited body of evidence on the accuracy and usefulness of self-testing for urine protein and urine glucose 27 – 30 . In a sample of pregnant women in the UK self-testing for urine protein gave 81% sensitivity and 93% specificity compared to laboratory reference standards 28 . There was no direct comparison made between self-measurement and measurements by healthcare professionals in this study, but similar estimates for sensitivity and specificity were found when healthcare professionals conducted the urine protein tests and these were compared with the laboratory reference standard potentially suggesting better agreement in this study compared to our findings.…”

Section: Discussionmentioning

confidence: 99%

Reliability, usability and identified need for home-based cardiometabolic health self-assessment during the COVID-19 pandemic in Soweto, South Africa

Calvert

Kolkenbeck‐Ruh

Crouch

et al. 2022

Sci Rep

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A major obstacle to tackling the growing burden of chronic disease in South Africa is lack of testing, particularly where individuals face multiple barriers to accessing health services. We conducted a pilot study to evaluate a cardiometabolic self-measurement kit, including assessment of blood pressure, obesity and urine analysis, amongst adults in Soweto, South Africa. Participants (N = 94) were recruited by researchers during community health screening and were provided with a home test kit including a tablet with self-measurement instructions. The participants entered their results on the tablet and, on completion, the researcher immediately repeated the measurements. We interviewed 10% of participants to understand their experience and views of the kits. Concordance correlation coefficients ranged from 0.78 for waist circumference to 0.93 for height, while the overall percentage agreement ranged from 80.5% for both urine protein and urine glucose testing to 91.4% for the identification of central obesity (ratio of waist circumference to height of ≥ 0.5). Participants saw the need for self-testing and found the process for the most part simple, though urine testing and height self-assessment presented some challenges. This pilot study suggests that self-assessment at home has the potential to facilitate the identification of individuals at risk for cardiometabolic disease in low-income settings, adding to a growing body of evidence on the use of self-testing in disease prevention and detection. However, we would not recommend self-testing for urine glucose and protein without further study.

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“…Instructions in response to abnormal signs and symptoms were provided to patients for self-management interventions manually (n=6) [44,[47][48][49][50][51], automatically (n=4) [40,43,45,46], or both (n=4) [36,38,39,56], or they were unspecified (n=2) [42,57]. Manual instructions for patients and HCPs included written or verbal instructions, and automatically provided instructions were given through a digital platform, such as a mobile or web app or a web-based dashboard.…”

Section: Intervention Design and Implementationmentioning

confidence: 99%

Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review

Aquino¹,

Munce²,

Griffith³

et al. 2020

JMIR Mhealth Uhealth

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Background High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. Objective The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? Methods A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention’s design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.

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The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

Cited by 16 publications

References 15 publications

Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic

Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic

Reliability, usability and identified need for home-based cardiometabolic health self-assessment during the COVID-19 pandemic in Soweto, South Africa

Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review

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