Digital Transformation in Non-Communicable Disease Management in Pregnant Women: The Effectiveness of Telemedicine on Patient Therapy Compliance
Abstract
Non-Communicable Diseases (NCDs) in pregnant women, such as gestational diabetes and hypertension, increase the risk of maternal and perinatal complications. Low adherence to therapy is the main challenge in managing NCDs. Telemedicine has the potential to improve compliance through service access and remote monitoring. This study aims to analyze the factors that affect therapy adherence in pregnant women with NCDs, especially the frequency of telemedicine use, perception of convenience, and trust in services. This study uses a cross-sectional design with a quantitative approach. A total of 185 pregnant women with NCDs in Malang were selected as respondents through purposive sampling. Data were collected using an online questionnaire and analyzed using logistic regression to determine factors influencing therapy adherence. The results of the multivariate analysis showed that the frequency of telemedicine use, the perception of ease of use, and the level of trust in services were factors that significantly affected therapy adherence in pregnant women with non-communicable diseases. Respondents who used telemedicine ≥2 times per month had a higher chance of therapy adherence (AOR = 3.21; 95% CI: 1.33–7.76; p = 0.009). Perceived ease of use also increases the likelihood of compliance (AOR = 2.97; 95% CI: 1.28–6.90; p = 0.011). In addition, high levels of trust in telemedicine services were associated with increased therapeutic adherence (AOR = 2.56; 95% CI: 1.15–5.71; p = 0.022). Telemedicine plays an important role in improving pregnant women's therapeutic adherence to NCDs through increased access, ease of use, and trust in services.
References
Aljerian, N. A., Almasud, A. M., AlQahtani, A., Alyanbaawi, K. K., Almutairi, S. F., Alharbi, K. A., Alshahrani, A. A., Albadrani, M. S., & Alabdulaali, M. K. (2025). Exploring a Systems-Based Model of Care for Effective Healthcare Transformation: A Narrative Review in Implementation Science of Saudi Arabia’s Vision 2030 Experience. Healthcare (Basel, Switzerland), 13(19), 1–24. https://doi.org/10.3390/healthcare13192453
Al-Mamun, M., Kalam, A., & Uzzal, N. I. (2025). Factors affecting maternal health and antenatal care services of working mothers in Southwestern Coastal Bangladesh: a cross-sectional study. Annals of Medicine and Surgery (2012), 87(2), 487–496. https://doi.org/10.1097/MS9.0000000000002895
Amoakoh-Coleman, M., Agyepong, I. A., Zuithoff, N. P., Kayode, G. A., Grobbee, D. E., Klipstein-Grobusch, K., & Ansah, E. K. (2016). Client factors affect provider adherence to clinical guidelines during first antenatal care. PLoS One, 11(6), e0157542. https://doi.org/10.1371/journal.pone.0157542
Andrejek, N., Lea, Z., Cussons, A., Sandeep, S., Dennis, C.-L., La Porte, L. M., Vigod, S. N., Silver, R. K., Meltzer-Brody, S., & Singla, D. R. (2025). Advancing telemedicine and task-sharing to improve access to psychotherapy for perinatal populations. Communications Medicine, 5(1), 406. https://doi.org/10.1038/s43856-025-01099-9
Arifin, H., Chou, K. R., Ibrahim, K., Fitri, S. U. R., Pradipta, R. O., Rias, Y. A., Sitorus, N., Wiratama, B. S., Setiawan, A., Setyowati, S., Kuswanto, H., Mediarti, D., Rosnani, R., Sulistini, R., & Pahria, T. (2022). Analysis of Modifiable, Non-Modifiable, and Physiological Risk Factors of Non-Communicable Diseases in Indonesia: Evidence from the 2018 Indonesian Basic Health Research. Journal of Multidisciplinary Healthcare, 15(September), 2203–2221. https://doi.org/10.2147/JMDH.S382191
Asadollahi, F., Zagami, S. E., Eslami, S., & Roudsari, R. L. (2025). Barriers and facilitators for mHealth utilization in pregnancy care: a qualitative analysis of pregnant women and stakeholder’s perspectives. BMC Pregnancy and Childbirth, 25(1), 1–13. https://doi.org/10.1186/s12884-025-07244-5
Borges do Nascimento, I. J., Abdulazeem, H., Vasanthan, L. T., Martinez, E. Z., Zucoloto, M. L., Østengaard, L., Azzopardi-Muscat, N., Zapata, T., & Novillo-Ortiz, D. (2023). Barriers and facilitators to utilizing digital health technologies by healthcare professionals. Npj Digital Medicine, 6(1), 1–28. https://doi.org/10.1038/s41746-023-00899-4
Cravo, A., Attar, D., Freeman, D., Holmes, S., Ip, L., & Singh, S. J. (2022). The Importance of Self-Management in the Context of Personalized Care in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 17(1), 231–243. https://doi.org/10.2147/COPD.S343108
Davies, A., Mullin, S., Chapman, S., Barnard, K., Bakhbakhi, D., Ion, R., Neuberger, F., Standing, J., Merriel, A., Fraser, A., & Burden, C. (2023). Interventions to enhance medication adherence in pregnancy- a systematic review. BMC Pregnancy and Childbirth, 23(1), 135. https://doi.org/10.1186/s12884-022-05218-5
Dhagarra, D., Goswami, M., & Kumar, G. (2020). Impact of Trust and Privacy Concerns on Technology Acceptance in Healthcare: An Indian Perspective. International Journal of Medical Informatics, 141(1), 104164. https://doi.org/10.1016/j.ijmedinf.2020.104164
Esopo, K., Derby, L., & Haushofer, J. (2020). Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa: a systematic review. BMC pregnancy and childbirth, 20(1), 316. https://doi.org/10.1186/s12884-020-02992-y
Firoz, T., Pineles, B., Navrange, N., Grimshaw, A., Oladapo, O., & Chou, D. (2022). Non-communicable diseases and maternal health: a scoping review. BMC Pregnancy and Childbirth, 22(1), 787. https://doi.org/10.1186/s12884-022-05047-6
Fitzpatrick, P. J. (2023). Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners. Frontiers in Digital Health, 5(November), 1–13. https://doi.org/10.3389/fdgth.2023.1264780
Hawkins, S. S. (2023). Telehealth in the Prenatal and Postpartum Periods. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN, 52(4), 264–275. https://doi.org/10.1016/j.jogn.2023.05.113
Jaeger, K. M., Nissen, M., Leutheuser, H., Danzberger, N., Titzmann, A., Pontones, C. A., Goossens, C., Ziegler, P., Uhrig, S., Haeberle, L., Bleher, H., Kast, K., Kornhuber, J., Schoeffski, O., Braun, M., Fasching, P. A., Beckmann, M. W., Eskofier, B. M., & Huebner, H. (2025). Adherence to digital pregnancy care - lessons learned from the SMART start feasibility study. NPJ Digital Medicine, 8(1), 561. https://doi.org/10.1038/s41746-025-01966-8
Ladak, Z., Grewal, N., Kim, M. O., Small, S., Leber, A., Hemani, M., Sun, Q., Hamza, D. M., Laur, C., Ivers, N. M., Falenchuk, O., & Volpe, R. (2024). Equity in prenatal healthcare services globally: an umbrella review. BMC Pregnancy and Childbirth, 24(1), 191. https://doi.org/10.1186/s12884-024-06388-0
Li, J., Silvera-Tawil, D., Varnfield, M., Hussain, M. S., & Math, V. (2021). Users’ Perceptions Toward mHealth Technologies for Health and Well-being Monitoring in Pregnancy Care: Qualitative Interview Study. JMIR Formative Research, 5(12), e28628. https://doi.org/10.2196/28628
Lourenço, J., & Guedes-Martins, L. (2025). Pathophysiology of Maternal Obesity and Hypertension in Pregnancy. Journal of Cardiovascular Development and Disease, 12(3). https://doi.org/10.3390/jcdd12030091
Maher, D., Harries, A. D., Zachariah, R., & Enarson, D. (2009). A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem. BMC public health, 9(1), 355. https://doi.org/10.1186/1471-2458-9-355
McCarthy, M., Houghton, C., & Matvienko-Sikar, K. (2021). Women’s experiences and perceptions of anxiety and stress during the perinatal period: a systematic review and qualitative evidence synthesis. BMC Pregnancy and Childbirth, 21(1), 1–12. https://doi.org/10.1186/s12884-021-04271-w
Mohamed, H., Ismail, A., Sutan, R., Rahman, R. A., & Juval, K. (2025). A scoping review of digital technologies in antenatal care: recent progress and applications of digital technologies. BMC Pregnancy and Childbirth, 25(1), 1–29. https://doi.org/10.1186/s12884-025-07209-8
Mueller, H. J., Pennington, E. L., Carr, A. S., & Barner, J. C. (2025). Effectiveness of Telehealth for Disease Management During the Perinatal Period: A Scoping Review. Telemedicine Journal and E-Health : The Official Journal of the American Telemedicine Association, 31(8), 938–957. https://doi.org/10.1089/tmj.2024.0501
Mumtaz, H., Riaz, M. H., Wajid, H., Saqib, M., Zeeshan, M. H., Khan, S. E., Chauhan, Y. R., Sohail, H., & Vohra, L. I. (2023). Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review. Frontiers in Digital Health, 5(September), 1–8. https://doi.org/10.3389/fdgth.2023.1203945
Neto, O. L., & Wyl, V. Von. (2024). Digital Transformation of Public Health for Noncommunicable Diseases: Narrative Viewpoint of Challenges and Opportunities. JMIR Public Health and Surveillance, 10(1), 1–11. https://doi.org/10.2196/49575
Omboni, S., McManus, R. J., Bosworth, H. B., Chappell, L. C., Green, B. B., Kario, K., Logan, A. G., Magid, D. J., McKinstry, B., Margolis, K. L., Parati, G., & Wakefield, B. J. (2020). Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension, 76(5), 1368–1383. https://doi.org/10.1161/HYPERTENSIONAHA.120.15873
Religioni, U., Barrios-Rodríguez, R., Requena, P., Borowska, M., & Ostrowski, J. (2025). Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life. Medicina (Kaunas, Lithuania), 61(1), 1–16. https://doi.org/10.3390/medicina61010153
Sheiner, E. (2020). Gestational Diabetes Mellitus: Long-Term Consequences for the Mother and Child Grand Challenge: How to Move on Towards Secondary Prevention? In Frontiers in clinical diabetes and healthcare (Vol. 1, p. 546256). https://doi.org/10.3389/fcdhc.2020.546256
Smedslund, G., Østerås, N., & Hestevik, C. H. (2025). Effects of remote patient monitoring on health care utilization in patients with noncommunicable diseases: Systematic review and meta-analysis. JMIR mHealth and uHealth, 13, e68464. https://doi.org/10.2196/68464
Solikha, D. A., Butler, D. C., Setiawan, E., Korda, R. J., & Kelly, M. (2025). Primary health care performance measurement at the service delivery level in Indonesia: a scoping review. BMC Health Services Research, 25(1), 898. https://doi.org/10.1186/s12913-025-12955-8
Sontakke, S., Takalikar, V., Deshmukh, J., Motghare, V. M., Kalikar, M., & Turankar, A. (2021). Assessment of adherence to medication during chronic illnesses in pregnancy. Perspectives in Clinical Research, 12(3), 153–158. https://doi.org/10.4103/picr.PICR_111_19
Stephansson, O., & Sandström, A. (2024). Can short- and long-term maternal and infant risks linked to hypertension and diabetes during pregnancy be reduced by therapy? Journal of Internal Medicine, 296(3), 216–233. https://doi.org/10.1111/joim.13823
Syairaji, M., Nurdiati, D. S., Wiratama, B. S., Prüst, Z. D., Bloemenkamp, K. W. M., & Verschueren, K. J. C. (2024). Trends and causes of maternal mortality in Indonesia: a systematic review. BMC Pregnancy and Childbirth, 24(1), 1–14. https://doi.org/10.1186/s12884-024-06687-6
Vudathaneni, V. K. P., Lanke, R. B., Mudaliyar, M. C., Movva, K. V., Mounika Kalluri, L., & Boyapati, R. (2024). The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation. Cureus, 16(3), 1–9. https://doi.org/10.7759/cureus.55534
Wang, N., Zhou, S., Liu, Z., & Han, Y. (2024). Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study. Journal of Medical Internet Research, 26(1), e48654. https://doi.org/10.2196/48654
Xiao, Z., & Han, X. (2023). Evaluation of the Effectiveness of Telehealth Chronic Disease Management System: Systematic Review and Meta-analysis. Journal of Medical Internet Research, 25(1), e44256. https://doi.org/10.2196/44256
Xie, W., Dai, P., Qin, Y., Wu, M., Yang, B., & Yu, X. (2020). Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis. BMC Pregnancy and Childbirth, 20(1), 198. https://doi.org/10.1186/s12884-020-02892-1
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