Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia
Background: Maternal mortality continues to disproportionately affect low- and middle-income countries, including Liberia. Though the relationship between obstetric triage systems and improved maternal outcomes is well documented, standardized triage protocols are lacking in rural Liberia. Mobile he...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2023-05-01
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| Series: | Annals of Global Health |
| Subjects: | |
| Online Access: | https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4030 |
| _version_ | 1797804379458240512 |
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| author | Christopher W. Reynolds Madison Horton HaEun Lee Wahdae-Mai Harmon Joseph Sieka Nancy Lockhart Jody R. Lori |
| author_facet | Christopher W. Reynolds Madison Horton HaEun Lee Wahdae-Mai Harmon Joseph Sieka Nancy Lockhart Jody R. Lori |
| author_sort | Christopher W. Reynolds |
| collection | DOAJ |
| description | Background: Maternal mortality continues to disproportionately affect low- and middle-income countries, including Liberia. Though the relationship between obstetric triage systems and improved maternal outcomes is well documented, standardized triage protocols are lacking in rural Liberia. Mobile health interventions are a promising method to triage obstetric patients. Objectives: This study explores the acceptability of a WhatsApp Triage, Referral, and Transfer (WAT-RT) system among Liberian midwives and community health assistants. Methods: Individual interviews and focus group discussions were conducted among midwives (n = 18) and community health assistants (n = 112). Interviews were designed to understand the current referral system in rural Liberia, how a WAT-RT System can address referral limitations, and the acceptability of the WAT-RT System. Data were audio recorded, transcribed, and translated into English. Data analysis was conducted via NVivo12 with independent and cooperative techniques among multiple researchers. Findings: The current referral system is not standardized with limitations including a lack of triage protocols, transportation difficulties, and inconsistent communication of patient information, which could be addressed by a WAT-RT System. The acceptability for the WAT-RT System was high. Facilitators to implementation included utilizing a pre-existing communication and referral infrastructure, access and competency surrounding mobile phones, and increased opportunities for training and inter-provider collaboration. Barriers included disproportionate phone access between midwives and community health assistants, network reliability, and a lack of data standards. Recommendations for successful implementation included centralizing phone financing and standardizing triage protocols. Conclusions: The WAT-RT System demonstrated high acceptability among frontline health care providers in rural Liberia. Barriers to program success could be reasonably addressed with simple interventions and planning. Multiple benefits included addressing care delays for obstetric patients, promoting bidirectional provider communication, and increasing the quality of obstetric triage. Future studies should focus on piloting the WAT-RT System among this population and recruiting other key stakeholders to determine intervention feasibility. |
| first_indexed | 2024-03-13T05:36:17Z |
| format | Article |
| id | doaj.art-24ed71497f4c451f9e83ef4c5259f939 |
| institution | Directory Open Access Journal |
| issn | 2214-9996 |
| language | English |
| last_indexed | 2024-03-13T05:36:17Z |
| publishDate | 2023-05-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj.art-24ed71497f4c451f9e83ef4c5259f9392023-06-14T07:20:47ZengUbiquity PressAnnals of Global Health2214-99962023-05-01891343410.5334/aogh.40301529Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural LiberiaChristopher W. Reynolds0https://orcid.org/0000-0001-6634-391XMadison Horton1HaEun Lee2Wahdae-Mai Harmon3Joseph Sieka4Nancy Lockhart5Jody R. Lori6University of Michigan Medical School, Ann Arbor, MIColumbia University School of Nursing, New York City, NYCenter for Global Health Equity, University of Michigan, Ann Arbor, MIUniversity of Liberia, MonroviaUniversity of Liberia, MonroviaUniversity of Michigan School of Nursing, Ann Arbor, MIUniversity of Michigan School of Nursing, Ann Arbor, MIBackground: Maternal mortality continues to disproportionately affect low- and middle-income countries, including Liberia. Though the relationship between obstetric triage systems and improved maternal outcomes is well documented, standardized triage protocols are lacking in rural Liberia. Mobile health interventions are a promising method to triage obstetric patients. Objectives: This study explores the acceptability of a WhatsApp Triage, Referral, and Transfer (WAT-RT) system among Liberian midwives and community health assistants. Methods: Individual interviews and focus group discussions were conducted among midwives (n = 18) and community health assistants (n = 112). Interviews were designed to understand the current referral system in rural Liberia, how a WAT-RT System can address referral limitations, and the acceptability of the WAT-RT System. Data were audio recorded, transcribed, and translated into English. Data analysis was conducted via NVivo12 with independent and cooperative techniques among multiple researchers. Findings: The current referral system is not standardized with limitations including a lack of triage protocols, transportation difficulties, and inconsistent communication of patient information, which could be addressed by a WAT-RT System. The acceptability for the WAT-RT System was high. Facilitators to implementation included utilizing a pre-existing communication and referral infrastructure, access and competency surrounding mobile phones, and increased opportunities for training and inter-provider collaboration. Barriers included disproportionate phone access between midwives and community health assistants, network reliability, and a lack of data standards. Recommendations for successful implementation included centralizing phone financing and standardizing triage protocols. Conclusions: The WAT-RT System demonstrated high acceptability among frontline health care providers in rural Liberia. Barriers to program success could be reasonably addressed with simple interventions and planning. Multiple benefits included addressing care delays for obstetric patients, promoting bidirectional provider communication, and increasing the quality of obstetric triage. Future studies should focus on piloting the WAT-RT System among this population and recruiting other key stakeholders to determine intervention feasibility.https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4030obstetric triageliberiaglobal healthmhealthwhatsapppre-hospital communicationmobile technology |
| spellingShingle | Christopher W. Reynolds Madison Horton HaEun Lee Wahdae-Mai Harmon Joseph Sieka Nancy Lockhart Jody R. Lori Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia Annals of Global Health obstetric triage liberia global health mhealth pre-hospital communication mobile technology |
| title | Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia |
| title_full | Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia |
| title_fullStr | Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia |
| title_full_unstemmed | Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia |
| title_short | Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia |
| title_sort | acceptability of a whatsapp triage referral and transfer system for obstetric patients in rural liberia |
| topic | obstetric triage liberia global health mhealth pre-hospital communication mobile technology |
| url | https://account.annalsofglobalhealth.org/index.php/up-j-agh/article/view/4030 |
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