Strategies for improving home blood pressure monitoring among pregnant women with low adherence in Ghana.

Introduction: Hypertensive disorders of pregnancy (HDP) remain a leading cause of maternal morbidity and mortality globally, with a disproportionate burden in low- and middle-income countries (LMICs) such as Ghana. In high-income settings, home blood pressure (BP) monitoring has emerged as an effective tool for early detection of HDP; however, limited data exist regarding its feasibility and acceptability in LMICs. This qualitative study sought to explore the experiences of women in Ghana who demonstrated low adherence to a home BP monitoring intervention during pregnancy. Methods: This study was conducted at Korle Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana. Participants were 16 postpartum women, purposively sampled from an overarching cohort study of home BP monitoring based on low adherence, defined as recording BP values ≤ 4 days per week on average. Semi-structured interviews were conducted in English or Twi. Interview guide questions focused on participants' experiences recording their BPs, specifically eliciting challenges and perceived benefits. Interviews were audio-recorded, translated, transcribed, coded in Dedoose using an iteratively developed codebook, and thematically analyzed. Results: Participants had a mean age 30.4 years, 87% were married, and 69% had previously given birth. There were 29 codes grouped into four comprehensive themes: (1) disconnect between understanding and action, (2) barriers to adherence, (3) facilitators, and (4) suggestions for improvement. While many women understood the importance of BP monitoring in pregnancy and acknowledged its benefits, for some, there was dissonance between their understanding and behavior. Barriers included competing health priorities and familial responsibilities. Women emphasized familial support as a key facilitator to monitoring their BPs and suggested inclusion of their spouses and family members in further training. Finally, several women noted that frequent reminders, along with a machine with automatic data capturing, would facilitate adherence to at-home monitoring. Conclusion: Though participants recognized that home blood pressure monitoring was important, several barriers, including familial responsibilities and physical health, prevented them from adhering to daily checks. Incorporating culturally relevant digital reminders, simplified logging methods, and support from family may strengthen adherence. Future work will adapt and evaluate a smartphone-based reminder and data-capture platform informed by stakeholder input.