Table 3. Key Themes and Quotes From 28 Participants Who Completed Interviews by Using Elements of the Health Belief Model and Perinatal Status, Atlanta, Georgia, 2021.

Prenatal		Postpartum
Subthemes	Postpartum quote	Subthemes	Postpartum quote
Susceptibility
Few or no perceptible symptoms (for all hypertensive disorders and gestational diabetes)	Attending participanta with gestational hypertension and preeclampsia All my vitals were always so stable. They just sent me the cuff in the mail just, just because, um, they wanted me to watch myself. But, no, it was not, . . . There wasn’t really any discussion. Um, all of the . . . going through prenatal, nothing was out the normal for my pregnancy. I didn’t have anything abnormal.	• Belief that pregnancy-related conditions would just go away and were not of concern following pregnancy • Perception that chronic hypertension (as diagnosed in the medical record) was only of concern during pregnancy (when it was detected with each pregnancy), likely because of limited engagement with care outside of pregnancy	Nonattending participantb with gestational hypertension I wasn't really concerned about my blood pressure as much as probably other people may have been. I know it's something that runs in my family, but it has never been a problem that I had. There's more of something that seems to be just gestational.
Severity
• Primary concerns: impact of high-risk condition on the developing fetus (stillbirth, miscarriage, preterm birth, macrosomia, low birth weight) • Limited concerns: stroke or maternal death (during delivery) because of hypertension	Attending participanta with gestational hypertension Interviewer: And with, with having preeclampsia, any time during your pregnancy, were you ever worried about your health or your baby's health? Response: Yes, I did...Like would he have it? Would he be . . . Would he have high blood pressure? Like, would I have my baby too, too, too early? Because my mom, see, my mom had . . . [pre-eclampsia], my momma had me early. She had me about when she was about [6 months or 7] months.	• Potential stroke or death because of hypertension (the silent killer) and heart disease • Experiences with family, history of hypertension, and heart disease	Attending participanta with preeclampsia When I went to my visits they was like, “Oh, your blood pressure’s up. You don't feel sick?” And it really put my perspective in like I say of how serious it was because I . . . know how serious it was, but to actually go through it with yourself and knowing these are dangers when someone's actually telling you, this is how serious it is in your pregnancy. You could be walking around fine . . . what they say, they call blood pressure, the silent killer, and your blood pressure be sky high and you could just pass away.”
Benefits
• Primary: preventing potential adverse consequences for baby • Limited: maintaining one’s own health	Participant with chronic hypertension and superimposed preeclampsiac Interviewer: Do you feel like being pregnant made it easier to stop smoking or harder? Why? Response: Yeah, it was easier. Because I know why I had to. I had a, why . . . that [stopping smoking] was a challenge at first, but I was told that before I even got pregnant, so I wasn't surprised by that.	• Primary: seeing one’s kids grow up or staying healthy to care for family • Limited: heart disease prevention (1 participant only)	Participant with gestational hypertension Now I still take my iron pills and like every now and then I take an aspirin just like, you know, to be on the safe side 'cause I'm like, now I have 4 kids I have to watch over and I have to take care of myself.
Barriers
• Medication side effects • Challenges remembering to take medication • Cost of blood pressure monitor • Time, particularly if working or caring for older children	Attending participanta with chronic hypertension and superimposed preeclampsiac Yeah. I understand where they were trying to go. I got it because I was high risk, so I definitely needed to rest. [inaudible] but I have 2 other kids. I couldn't rest as much. Blood pressure medicine, no. I was taking . . . my last time taking blood pressure . . . they keep trying to prescribe it to me, but it makes me sick. I just can't, it makes me so sick.	• Time and energy to focus on own health while caring for infant and older children • Cost or availability of blood pressure monitor • Finding a primary care physician who will take uninsured or Medicaid-insured patients • Food as a source of comfort	Nonattending participantb with preeclampsia I’m just now really getting to myself to be honest with you. . . It happened subtly and just unconsciously. I was just so focused on my kids, and the newborn requires so much intricate care. And I was just so . . . I threw myself into accomplishing that I think that it, like slowly things would slip. Like, oh, I didn't shower today. You know? And I don’t realize that till 8 o’clock at night, [laughs] at night. You know? Attending participanta with preeclampsia The last time I called, which was about a month and a half ago, they didn't have nothing available. I'm trying to be a new patient. I'm really trying to get in, but it's hard.
Cues to Action
• Structured diabetes care curriculum • Worksheets for glucose monitoring and structured counseling • Telephone calls for blood pressure checks • Alarms, pill organizers	Attending participanta with chronic hypertension, superimposed preeclampsiac, and gestational diabetes Mainly what I did for myself was to try to set an alarm so that we know it's time to check your blood pressure, in the mornings make sure . . . And I had went and bought a pill organizer so I can keep my medicine by my bed and wake up and have the medicines right there. So, I wouldn’t have to look for them. . . I liked the educational process, to know what to eat and not to eat because, like I said, that was the first time anybody told me when I got pregnant what I should not eat and what I needed to slow down eating because I didn't know.	• Home blood pressure check • Postpartum visit (limited) • Family advice and support (eg, through babysitting) • Insurance brochures	Attending participanta with chronic hypertension with superimposed preeclampsiac They suggested that I see a primary doctor about my blood pressure. Oh, not my blood pressure, but since I had gestational hypertension. . . [W]e go to the YMCA, and the Y, it accepts the Medicaid that we have so it be somebody there watching the children while we go exercising, . . . so like WellCare and another Medicaid, it pay for it for us. They pay for our exercising; they pay for people to watch the children while we go exercising. [Wellcare] be handing out brochures, but I never tried it out until like we went the other day. Participant with chronic hypertension Instead of just saying, Okay, I'm going to take a smoke. Go and take a walk instead. So, I've been hearing her in the back of my mind, “Come on, Ms. [last name]. You can do it. It's been working out really well though.”
Self-Efficacy
• Home blood pressure and glucose monitoring • Higher among participants with known chronic conditions • Existing relationships with primary care	Attending participanta with chronic hypertension My numbers were always great. They were never high. The only one time it did get high, I was actually in labor and didn't know. And that's the day that I went to the hospital. But, other than that, my numbers always stayed low.	• Understanding warning signs Home blood pressure monitoring, including at retail outlets with blood pressure cuffs	Attending participanta with gestational diabetes and gestational hypertension My sugar may be regular. Sometimes it'd be either, or every now and then, it'd be both. Since I'm not consistent, and I'm not on no high blood pressure medication, I just take it and watch myself and try to record, so when I go back to the doctor, I'll let him see it. Interviewer: Taking it [medication] at home, how did that make you feel? Participant: Like I was trying to help take care of myself. I knew how disastrous high blood pressure could be if it went too high, what could happen to me.

^a Attending participant: attended a postpartum visit within the Grady Health System after her recent pregnancy.

^b Nonattending participant: did not attend a postpartum visit within the Grady Health System after her recent pregnancy.

^c Superimposed preeclampsia: Preeclampsia that develops in a patient with existing hypertension.