{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:32:17Z","timestamp":1787315537438,"version":"build-2736575974"},"reference-count":62,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Pakistan, a smartphone-based telemonitoring (TM) program (Raabta) has been designed to support pregnant women with high risk for preeclampsia (HRPE) in Pakistan. However, implementing TM interventions is often challenging, particularly in low-resource settings, given the complexity of healthcare environments and variations in public and private health sectors. This study explores the potential barriers and facilitators for a sustained implementation of the Raabta program in public and private sector hospitals in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a qualitative description design, 57 semi-structured interviews with a diverse group of participants including patients from the public ( n\u2009=\u200915) and private sector hospitals ( n\u2009=\u200917), obstetricians from the public ( n\u2009=\u20095) and private sector hospitals ( n\u2009=\u20097), decision-makers ( n\u2009=\u20097) and telehealth experts ( n\u2009=\u20096). Participants were recruited using purposive and snowball sampling techniques. Interview transcripts were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on the CFIR domains, the findings included: (1) Raabta being perceived as user-friendly even for patients with low digital and language literacy; (2) Outer settings: Limited health and digital literacy, poor language proficiency, and cultural norms can influence the willingness and ability of public sector patients to use the Raabta; (3) Inner settings: The private health sector is well-equipped for the Raabta implementation, while the public health sector faces challenges related to physical space, limited human and financial resources, and physician resistance; (4) Individual characteristics: Majority participants demonstrated positive attitudes toward the Raabta program and expressed confidence in using it (5) Process: Recommendations included adopting a nurse-led model for the private sector, leveraging paramedics for monitoring the Raabta dashboard, integrating Raabta with existing digital platforms, and establishing an advisory committee for program sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Raabta implementation may be more feasible in the private sector due to patient demographics, health and digital literacy, cultural norms, financial resources, physician readiness, and hospital infrastructure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076241292682","type":"journal-article","created":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T05:07:19Z","timestamp":1733807239000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Perceived barriers and facilitators of implementing a sustained smartphone-based telemonitoring program for pregnant women  at high-risk for pre-eclampsia in the public and private sectors in Pakistan"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-0213","authenticated-orcid":false,"given":"Anam","family":"Shahil-Feroz","sequence":"first","affiliation":[{"name":"Community Health Sciences Department, Aga Khan University, Karachi, Pakistan"},{"name":"Dalla Lana School of Public Health, The University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andaz","family":"Riaz","sequence":"additional","affiliation":[{"name":"Community Health Sciences Department, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haleema","family":"Yasmin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Center, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Community Health Sciences Department, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqar","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health, SickKids, Toronto, ON, Canada"},{"name":"Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan"},{"name":"Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Seto","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, The University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada"},{"name":"Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,12,10]]},"reference":[{"key":"bibr1-20552076241292682","first-page":"163","volume":"32","author":"Shah N","year":"2007","journal-title":"Rawal Med J"},{"key":"bibr2-20552076241292682","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-016-0136-x"},{"key":"bibr3-20552076241292682","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0266-5"},{"key":"bibr4-20552076241292682","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-016-0133-0"},{"key":"bibr5-20552076241292682","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-021-01151-6"},{"key":"bibr6-20552076241292682","unstructured":"National Institute of Population Studies (NIPS) [Pakistan] and ICF\n                      . 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