Challenges Associated with the use of Smartwatches for out of Clinic Blood Pressure Monitoring Among Expectant Mothers in a Developing Country: A Case study of Nakuru County Kenya

Abstract

Pre-eclampsia is a leading cause of maternal mortality globally and more so in developing countries. The condition, if detected early, can be prevented to avert death and suffering. This early detection has become easier with the development of devices such as smartwatches with BP sensors which have enhanced the practice of Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM). However, most of these devices and monitoring practices have not been widely adopted in developing countries due to the high cost of devices and the lack of institutionalization of the ABPM and HBPM in healthcare systems. This study sought to examine the use of low-cost smartwatches, a mobile application, and a support system for the implementation of ABPM and HBPM among expectant mothers in Nakuru county, Kenya. A total of 34 expectant mothers were involved in the study over 8 months. A total of 967 readings were collected with only 3 out of the 34 mothers managing to take at least 71 readings during the period of the study. The study established that the use of low-specification phones that were incompatible with the mobile application, failure of the smartwatches to work appropriately, difficulties in getting mothers who met the inclusion criteria under 20 weeks gestation, poor adherence to the data collection, and loss of the devices negatively impacted the quality and consistency of BP monitoring among the expectant mothers. The study therefore recommends the use of more robust devices such as cuff BP readers and the inclusion of community health volunteers in the early identification of pregnant mothers from the community and subsequent follow-up for ABPM and HBPM.