Improving care for women with High blood pressure In pregnancy to reDuce risk of heart Disease dEvelopiNg in later life (HIDDEN)

Background Hypertensive disorders of pregnancy (HDP) affect 1 in 7 pregnant women. Postnatally, HDP is associated with a doubling in the risk of cardiovascular disease and hypertension in later life.

Women of Black African and Caribbean heritage have the highest prevalence of HDP and cardiovascular complications during pregnancy.

Furthermore, hypertension is more prevalent and results in more severe disease in women of Black African and Caribbean heritage.

As cardiovascular disease is the leading cause of death in women, the National Institute for Health and Care Excellence (NICE) Hypertension in Pregnancy Guideline states “advise women who have had HDP to discuss how to reduce their risk of cardiovascular disease, including hypertensive disorders, with their general practitioner or specialist” (page 40).

However, most pregnant women, and healthcare professionals caring for them, are not aware of the risk of cardiovascular disease or the NICE recommendation for risk reduction in HDP.

Aim and Objectives We aim to raise awareness in women and healthcare professionals to support self-care to reduce the risk of cardiovascular disease and hypertension in women with HDP.

Our objectives are to: (a) understand the lived experiences of women with HDP and the challenges faced by healthcare professionals providing care for them, (b) develop a Community of Practice, where people with a joint interest in HDP collaborate regularly (e.g. women of Black African and Caribbean heritage, healthcare professionals) to consider potential implementation strategies to improve NICE recommendation uptake, and (c) co-design a resource for self-care of cardiovascular health for all women with HDP.

Methods This 18-month study consists of 2 work packages: (1) We will conduct semi-structured interviews with approximately 20 women with HDP to understand their experiences and their understanding of cardiovascular risk.

We will also interview approximately 20 healthcare professionals (e.g. midwives, health visitors, general practitioners, practice nurses, physician associates, obstetricians, cardiologists) to explore their perspectives on the acceptability and feasibility of the NICE recommendation. (2) We will develop a Community of Practice which will meet 4 times at collaborative design workshops, to discuss key barriers, facilitators, and strategies for adopting and implementing the NICE recommendation, based on knowledge from the previous work package.

At these workshops, the Community of Practice will also co-design a self-care resource (e.g. patient information leaflet, infographic, or videos) for knowledge mobilisation to accelerate the implementation of the NICE recommendation.

The co-designed implementation strategies and the resource will be evaluated by obtaining feedback at our dissemination event. Future work includes testing in a pilot study, followed by a large-scale study.

Dissemination We will co-produce a dissemination plan with patient and public participants to share our innovations with pregnant women, the public, healthcare professionals, and other researchers.

Examples of potential dissemination pathways include social media, animations, healthcare professional updates, journal publications, and conferences.

Impact Through our dissemination and knowledge mobilisation activities, we will improve the quality of postnatal care and self-care to prevent cardiovascular disease. Women will be empowered and supported to lead healthier lives. We will therefore improve the health of women and their families.