Defining self-monitoring in postpandemic maternity care: Perspectives from women, partners, healthcare professionals, and policymakers.

Introduction: We aimed to explore the conceptualization and perception of self-monitoring amongst women, partners, healthcare professionals (HCPs), and policymakers, with particular interest in those living with social/medical complexity.

Material and methods: Across the United Kingdom, 96 semi-structured in-depth qualitative interviews were conducted with 40 women, 15 partners, 21 HCPs, and 20 policymakers to discuss their lived experience of utilizing, delivering, or developing policy for self-monitoring during the COVID-19 pandemic. A thematic framework analysis was undertaken to develop themes, considered by participant type, ethnicity, geographical region, personal experience of self-monitoring, and social complexity, and a content analysis was used to explore how self-monitoring was conceptualized.

Results: Two themes (and ten sub-themes) were derived from the Thematic Framework Analysis: "Organizational logistics" (reported by up to 10% participants; sub-themes: useful resources and infrastructure, lack of instructions and information provided, communication between HCPs and service users, logistical issues, legitimate concerns about clinical practice, and personalization of care) and "Agency and responsibility over care" (reported by up to 6% participants; sub-themes: anxiety and overwhelm, control over care, avoiding hospitals, and disengaged users). A post hoc Qualitative Content Analysis was conducted in a deviation from the protocol which showed women and partners conceptualized self-monitoring as a general awareness of one's body and monitoring for specific clinical signs, whereas HCPs and policymakers understood self-monitoring as the use of a device for self-measurement.

Conclusions: Marked differences exist in how self-monitoring is conceptualized by service users and service providers, which could influence how service users engage with the practice. Outstanding concerns about implementation include instructions for service users, communication between service users and service providers, HCP workload, safety and quality of care, and the management of disengaged users when self-monitoring is used to replace care delivered face to face.