Acceptability and feasibility of the 4P care tele-nursing approach: perceptions of risk and needs of urban pregnancies at risk of preeclampsia

Problem: Hypertensive disorders of pregnancy, particularly preeclampsia, remain a leading cause of maternal mortality. Gaps persist in early detection and continuity of care, especially in urban settings. Background: Digital health innovations, including nurse-led tele-nursing, offer opportunities to strengthen surveillance and continuity of care. Yet, evidence on their acceptability and feasibility in Thailand is limited among women at risk of preeclampsia. Aim: To explore the acceptability and feasibility of the 4P Care Tele-Nursing Approach among urban pregnant women at risk of preeclampsia and their caregivers, focusing on perceptions of risk, care needs, and expectations of digital nursing support. Methods: A formative qualitative design was employed. Semi-structured interviews were conducted with 20 pregnant women at moderate to high risk of preeclampsia and 10 caregivers at two tertiary hospitals in Thailand. Data were transcribed verbatim and thematically analyzed using a reflexive approach, with rigor ensured through member checking, peer debriefing, and SRQR adherence. Findings: Six themes emerged: (1) perceiving risk and emotional vulnerability, (2) navigating health information in uncertainty, (3) trust and continuity with nurses, (4) perceptions of self-monitoring and data recording, (5) facilitators of digital engagement, and (6) barriers to sustained use. Women valued reassurance and continuity, while caregivers highlighted shared responsibility. Feasibility depended on system simplicity and responsiveness. Discussion: Anticipatory perceptions indicate that while digital self-monitoring is received, sustainability requires timely feedback and integration into care pathways. Conclusion: The 4P Care Tele-Nursing Approach was perceived as acceptable and feasible if systems are user-friendly, responsive, and embedded in continuity with nurses.