Improving Perinatal Care among Women of African Descent through Home Blood Pressure Self-monitoring in Seattle

Abstract

Perinatal racial and ethnic health disparity in Seattle reflects trends in Washington and nationwide, with a disproportionately high risk of adverse outcomes among women of African descent. Eclampsia is among the major leading causes of these adverse outcomes and has a high prevalence among women of African descent. The Heart, Soul, and Joy (HSJ) project implemented an intervention distributing a home blood pressure cuff (BPC) and self-monitoring tool to perinatal patients in two community health clinic systems to prevent perinatal health disparity among BIPOC communities in federally health-underserved areas in greater Seattle. (The HSJ project was funded by the UW Population Health Initiative). According to the HSJ project model, access to BPC leads to potential for increased home self-monitoring of BP. Home self-monitoring of BP leads to increased somatic information, which can improve patient understanding of and attention to health conditions. This increased understanding enhances self-efficacy, which in turn empowers individuals to seek care more proactively. As a result of this proactive care-seeking, there is increased patient-provider contact, which facilitates timely care provision. This timely intervention has the potential to better address and/or avert health crises. This qualitative study used pre/post, mixed response format survey methods to identify the benefits and barriers to perinatal home blood pressure self-screening among African-descent women attending these community health clinics. For this thesis, qualitative analysis was conducted using narrative survey data from intake, midway, and exit surveys of pregnant women recruited to the study at any stage of gestation and up to one week post-partum. An inductive thematic analysis approach was utilized to identify the benefits and challenges of perinatal home BP self-screening among women of African descent. Findings revealed significant benefits of home BP self-screening, including increasing both patient care-seeking behaviors and patient-provider points of contact. These two shifts due to increased BP self-screening led to timely provider interventions and enabled provider follow-up and patient follow-through. The study identified promising potential for home BP self-screening interventions to improve perinatal care, resulting in reduced racial/ethnic disparities. This thesis reviews these new steps in care flow and highlights the transformative potential of home blood pressure self-monitoring interventions among African-descent women in Seattle. Conclusions reinforce the HSJ model and suggest that it be expanded to include provider follow-up and patient follow-through as important elements in the efficacy of home BP self-screening. Larger-scale research initiatives are warranted to assess this expanded model and to further explore the efficacy of these interventions to improve perinatal outcomes and contribute to eradicating racial/ethnic health disparities.