# Adapting and evaluating smartphone app-enhanced home blood pressure monitoring among pregnant women in Ghana

> **NIH NIH R21** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $192,507

## Abstract

Project Summary / Abstract
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality, particularly in
LMICs. Home BP monitoring is an emerging strategy to promote frequent monitoring of BPs, however unique
challenges exist in LMICs. Given widespread smartphone use in urban Ghana, we will leverage accessible
technology, adapted to the Ghanaian setting, to overcome barriers to home BP monitoring.
Aim 1 (R21) will adapt a home BP monitoring smartphone app to the Ghanaian context, using the ADAPT-ITT
framework. Stakeholder focus groups and cognitive interviews will be held with Ghanaian pregnant women,
midwives, and Obstetrician/Gynecologists to iteratively adapt the smartphone app, with a focus on cultural
relevance, locally appropriate language and phrasing, and useability in low literacy and numeracy populations.
Aim 2 (R21) will assess the feasibility, acceptability, and fidelity of a smartphone app-enhanced home BP
monitoring intervention among pregnant patients in Ghana. We will engage 100 pregnant participants over 4
weeks of home BP monitoring using the refined smartphone app, and complete pre-and-post validated scales
of acceptability, appropriateness, and feasibility. Fidelity will be evaluated by examining stored values in the BP
monitor and smartphone app to determine if concerning combinations of elevated BPs and preeclampsia
symptoms correctly trigger clinical alerts. Aim 3 (R33) will measure the adherence to BP monitoring with a
smartphone app-enhanced home BP monitoring intervention among pregnant patients in Ghana. We will
engage a prospective cohort of 200 pregnant participants in home BP monitoring from enrollment through
delivery. Adherence to BP monitoring will be measured both as frequency and time to drop-off of monitoring
over the course of pregnancy. Aim 4 (R33) will evaluate the clinical response to elevated BPs with a
smartphone app-enhanced home BP monitoring intervention among pregnant patients in Ghana. Automatic
alerts, triggered by BPs and symptoms, will be sent to study nurses trained on clinical response protocols.
Timely clinical response (routine alert: <4 hours; urgent alert: <1 hour) will be evaluated by comparing times of
a recorded elevated BP to the outgoing phone call by the nurse and successful contact with the participant.
Appropriateness of clinical response will be assessed using an expert consensus approach. Outcome of
clinical response will be evaluated by the proportion of participants who adhere with clinical advice provided by
the study nurse.
Smartphone app-enabled home BP monitoring is a novel strategy to address challenges in managing HDP.
Implementing home BP monitoring in LMICs will provide a critical step toward frequent assessment of BPs,
earlier diagnosis of HDP, and prevention of serious maternal morbidity and mortality.

## Key facts

- **NIH application ID:** 11058774
- **Project number:** 1R21TW012939-01
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Emma Rachel Lawrence
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $192,507
- **Award type:** 1
- **Project period:** 2024-09-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11058774

## Citation

> US National Institutes of Health, RePORTER application 11058774, Adapting and evaluating smartphone app-enhanced home blood pressure monitoring among pregnant women in Ghana (1R21TW012939-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/11058774. Licensed CC0.

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