Uncontrolled hypertensive disorders of pregnancy (HDP) are a major source of maternal
mortality. National guidelines recommend blood pressure (BP) measurement 3-10 days after
discharge and ≥1 preventive care visit within one year of delivery. Yet, barriers such as
childcare or transportation issues reduce adherence to in-person BP checks, particularly
among racial or ethnic minority patients. Programs in which patients self-measure BP
(SMBP) at home show promising results regardless of patient race. However, a recent
meta-analysis concluded current SMBP programs do not reduce maternal mortality or racial
disparities in clinical outcomes, potentially due to their specific limitations: they end
within six weeks of birth (though HDP can persist for months) and have decreased
engagement with non-White people or those living in disadvantaged areas, though these
populations are at the highest risk of persistent HTN and its adverse long-term effects.
Thus, there is an urgent need to optimize SMBP programs to target short- and long-term
HDP-related morbidity and to broadly implement these programs to eliminate disparities in
HDP-related outcomes. One such program is Rhode Island (RI)-Statewide Postpartum
HypErtension REmote Surveillance (RI-SPHERES), a technology-based SMBP program that aims
to reduce short- and long-term HDP-associated morbidity in RI using the collaborative
care model, a health services intervention that improves health outcomes and reduces
racial disparities on a population level for people with chronic conditions. The proposed
research aims to determine the effectiveness of RI-SPHERES in reducing short- and
long-term morbidity associated with HDP throughout RI. This builds upon our pilot RCT
(NCT05595629), in which a standard SMBP program was compared to a SMBP program that used
a Bluetooth-enabled BP cuff that syncs to a smartphone application (app) to send
automated reminders and provide adaptive messaging tailored to distinct BP values and
symptoms. RI-SPHERES will expand this SMBP program to provide app-based patient-informed
educational content on HDP-specific preventive care and bidirectional communication with
RI-SPHERES staff for one year postpartum. Incorporating adaptive and automatic messaging
increases RI-SPHERES' scalability by reducing clinical staff burden. However, formal
analysis of factors that may hinder widespread implementation of RI-SPHERES is needed.
Thus, we will conduct a Hybrid Type I Non-Inferiority Implementation-Effectiveness Trial
among 1536 patients with HDP that compares a standard SMBP program to RI-SPHERES in terms
of persistent HTN at six weeks postpartum and receipt of preventive care within one year
of delivery (Specific Aim 1). We will examine the effect of both programs on increasing
equity in terms of race, ethnicity, language, and geography for postpartum patients with
HDP in Rhode Island (Specific Aim 2). We will also develop an implementation toolkit to
facilitate the dissemination of RI-SPHERES (Specific Aim 3). The proposed project is
expected to deliver a mechanism that will fill multiple research gaps for HDP identified
by the US Preventive Services Task Force: 1) addressing health inequities through
multilevel interventions, 2) evaluating SMBP programs; and 3) mitigating HDP's short- and
long-term health consequences of HDP.