Exploration of how a mobile health (mHealth) intervention may support midwives in the management and referral of women with pre-eclampsia in rural and remote areas of highland Scotland.

White, Alan

Abstract

Mobile health (mHealth) interventions have elsewhere been shown to support midwives in the early identification of pregnancy complications in rural and remote locations. The purpose of this thesis was to undertake a qualitative and descriptive investigation into whether an mHealth intervention might be acceptable and useful to rural midwives in detecting and managing women who are presenting with possible pre-eclampsia, and in making timely referrals. The study also investigated whether an mHealth intervention might offer any advantage and/or improvement over current practice. Globally, hypertensive disorders account for 12% of all maternal deaths and, in the UK, pre-eclampsia affects up to 6% of pregnant women. Severe cases of eclampsia, progressing from pre-eclampsia, develop in up to 2% of these pregnancies. The early identification of pre-eclampsia and being able to appropriately manage it before the onset of eclampsia is recognised as a way to prevent complications, and to mitigate the worst effects of pre-eclampsia. This study made use of the growing body of evidence on the efficacy of mobile health (mHealth) interventions. It explored whether such interventions could support midwives in the management of women with pre-eclampsia in rural and remote settings in the Scottish highlands. The research involved gathering and analysing data from midwives (n=18) at three focus groups in Highland Scotland during June and July 2017. These midwives were asked to consider whether a new mLearning/ mHealth toolkit might support their practice regarding women presenting with pre-eclampsia. The investigation found that geographic and digital isolation are real challenges, and most of the midwives in the study saw advantages in an intervention that requires no internet connectivity. They welcomed being able to work on their continuous professional development (CPD) whilst on the move, as well as the inclusion of an audio-visual module to help explain pre-eclampsia to women. However, participants were less in agreement on the value to midwives of an intervention that provided advice on how to diagnose pre-eclampsia, although it was suggested that this could be of value to healthcare practitioners with less experience of pre-eclampsia. This thesis contributes to the emergent body of knowledge concerning the need for and efficacy of mHealth interventions in reproductive, maternal and child health, and may help to inform future initiatives in other regions and cultures. The study has also informed the parallel development of a prototype device that is currently being tested with multidisciplinary healthcare teams in highland Scotland. This thesis also suggests that there is the potential to develop a tool that could assist in building psycho-social resilience and support retention among midwives and other healthcare workers, in rural and remote areas of Scotland and other locations. The scope of this study was limited in that participants were recruited from only one health board, and in that it focused only on pre-eclampsia. Further research could expand the scope to widen participation or address other areas.

Citation

WHITE, A. 2018. Exploration of how a mobile health (mHealth) intervention may support midwives in the management and referral of women with pre-eclampsia in rural and remote areas of highland Scotland. Robert Gordon University [online], MRes thesis. Available from: https://openair.rgu.ac.uk

• Thesis Type: Thesis
• Deposit Date: Aug 13, 2019
• Publicly Available Date: Aug 13, 2019
• Keywords: Problems in pregnancy; Pre-eclampsia; Eclampsia; Rural midwivery; Remote healthcare; Mobile health; mHealth
• Public URL: https://rgu-repository.worktribe.com/output/348687
• Award Date: Feb 28, 2018