Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy

Abstract

Background: Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence.

Methods: Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials.

Results: The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring.

Conclusions: With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable.

Keywords: Digital intervention; Hypertension; Intervention planning; Person-based approach; Pre-eclampsia; Pregnancy.

Fig. 1

The intervention planning activities undertaken in the development of BUMP behavioural content

Fig. 2

Illustration of the BUMP telemonitoring system software and network architecture. The SMS and the BUMP apps (a) can be used. The latter has an informative blood pressure (BP) chart that can be used during a clinical visit. The web application (b) receives the BP readings, and a rule-based algorithm assigns the BP level and suggests the next action to the user. The clinical and audit-trail data (c) are stored in a database server within the NHS intranet. Specialised vendor services, such as the Esendex SMS service and the Google Analytics (d), are used to enable the SMS service and anonymised website usage data collection, respectively. A weekly email report of abnormal readings or missing data issues (e), which can also be visualised as Flags on the website, is sent to authorised midwives

Fig. 3

llustration of the iterative refinement of the BP feedback information given to intervention participants (note: Version 1 is the leftmost version presented below and final version is rightmost in figure)

Fig. 4

The BUMP logic model