Patient and Provider Perspectives on Cardiovascular Health Education and Engagement Following Hypertensive Disorders of Pregnancy: A Qualitative Study.

Abstract

Hypertensive disorders of pregnancy are associated with a significantly increased risk for later cardiovascular disease. This risk is mediated by the interval development of hypertension and insulin resistance. These are preventable and/or modifiable risk factors for cardiovascular disease if affected people engage in preventive efforts. This study explores knowledge, perceptions, barriers and motivators regarding cardiovascular preventive health engagement among people with hypertensive disorders of pregnancy and clinicians who care for them. Qualitative study using an editing approach. A tertiary referral centre in Salt Lake City, Utah. Postpartum people who had a hypertensive disorder of pregnancy with their recent pregnancy (~1 month ago) and clinicians who practise obstetrics and/or primary care. Semi-structured interviews of patients conducted approximately 1 month postpartum explored: (1) knowledge and understanding regarding long-term health risks after hypertensive disorders of pregnancy, (2) actual and preferred sources and settings for learning about their health and (3) barriers and motivators to engaging in lifestyle modification. Semi-structured interviews of clinicians explored: (1) knowledge and understanding regarding long-term health risks after hypertensive disorders of pregnancy, (2) actual and preferred settings for providing preventive health education and resources and (3) barriers and motivators to engaging with patients regarding preventive health after a hypertensive disorder of pregnancy. Recruitment continued until thematic saturation was reached for each group. A thematic analysis was performed using an editing approach. N/A for this qualitative study. Sixteen patients and fourteen clinicians were recruited and interviewed. Patients were unaware of long-term health risks related to their hypertensive disorder of pregnancy and were interested in learning about it from their healthcare provider. Although they were interested in learning about how to reduce their health risks, patients cited several barriers to engagement in lifestyle change and health screenings, including lack of time and other necessary resources. Clinicians expressed a preference for providing preventive health education in the outpatient postpartum setting, although they listed loss to follow-up after delivery as a major barrier. Clinicians only discussed long-term health risks for those patients who remained hypertensive at their postpartum follow-up visit. In general, women's health providers (OB/GYN physicians and midwives) considered cardiovascular prevention to be beyond their scope of practice, even those who provide well-woman care outside of pregnancy. Postpartum patients with hypertensive disorders of pregnancy are unaware of their long-term health risks and want to learn about them. They prefer to learn about these risks by discussing them with their healthcare provider. Regardless of speciality, clinicians who discuss long-term health after hypertensive disorders of pregnancy generally do so only for those patients who remain hypertensive at their postpartum follow-up visit, but loss to follow-up is considered a major barrier. Engaging with patients and clinicians as stakeholders will be essential to develop effective, patient-centred interventions promoting cardiovascular health after hypertensive disorders of pregnancy that can capitalise on motivators and overcome barriers.