Abstract
Introduction
Hypertensive disorders of pregnancy (HDPs) affect approximately one in seven US deliveries and are associated with significant adverse maternal health outcomes. Standard postpartum care, typically a single 6-week visit, is insufficient for ongoing HDP management, education, and support. Combining home blood pressure monitoring with health coaching may enhance self-management, lifestyle change, and engagement with care, yet patient perspectives remain underexplored. This qualitative study examined 1-year postpartum experiences among birthing people with HDPs and explored perceptions of a postpartum health coaching intervention.
Methods
This qualitative study was embedded within the STAC-MyHEARTp randomized trial (NCT05685251), which compared home blood pressure monitoring plus health coaching to usual care. Using an explanatory sequential design, semi-structured interviews were conducted posttrial and analyzed thematically. Self-Determination Theory and Self-Regulation Theory guided coding and interpretation, with comparison across intervention and control arms.
Results
Thirty-two participants (16 per arm) completed interviews. Four themes were identified: (1) postpartum experiences were emotionally and medically challenging, characterized by fear, anxiety, and hypervigilance; (2) participants strongly desired education and support, with coaching filling gaps unmet by standard care; (3) coaching provided behavioral, emotional, and healthcare benefits, including enhanced motivation, confidence, self-monitoring, lifestyle change, and self-advocacy; (4) persistent gaps, particularly in mental health support and continuity of care, remained across groups. Control participants recognized the potential value of structured support.
Conclusions
Health coaching offers meaningful, multidimensional support for individuals with HDP, promoting self-efficacy, engagement, and lifestyle change. Integrating structured coaching into comprehensive postpartum care can address persistent gaps, improve patient experience, and potentially enhance long-term cardiovascular and psychosocial outcomes, underscoring the need for sustained, person-centered postpartum care.