Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia

Christopher W. Reynolds; Madison Horton; HaEun Lee; Wahdae-Mai Harmon; Joseph Sieka; Nancy Lockhart; Jody R. Lori

doi:10.5334/aogh.4030

Figures & Tables

Table 1a

Cell phone access and usages among community health assistants (n = 112) in Bong County, Liberia.

	N	FREQUENCY
Uses phone to communicate with other health care providers	83	74.1%
Uses phone daily	78	69.6%
Personal phone that can send text messages	72	64.2%
Personal phone is a smartphone	37	33%
Uses WhatsApp	11	9.8%

[i] Focus group discussions conducted with community health assistants in Bong County Liberia. Among 20 focus group discussions, 112 CHAs participated in groups of 3-14 participants each.

Table 1b

Cell phone access and usages among Midwives (n = 18) in Bong County, Liberia.

	N	FREQUENCY
Uses phone to communicate with other health care providers	18	100%
Uses phone daily	18	100%
Personal phone that can send text messages	18	100%
Personal phone is a smartphone	13	72.2%
Uses WhatsApp	9	50%

[i] Individual interviews conducted with 18 midwives in Bong County, Liberia.

Table 2

Facilitators and Barriers to WAT-RT System in rural Liberia.

FACILITATORS	BARRIERS
– Utilizes pre-existing infrastructure with referral pathways that are proven to be successful	– Financial support for consistent mobile data
– RHFs staff medical professionals accustomed to communicating with facility-level providers	– Inconsistent access to power sources for phone charging
– Desires from rural facility providers to have obstetric triage training	– Lack of standard triage protocols
– Strong interest and desire for the program among midwives and CHAs	– Lack of referral decision standards
– Involves facility providers earlier, which may reassure family who otherwise refuse transport	– Unwillingness from “stubborn” patients to have their health information shared
– Central hub to store patient information which could be widely accessible indefinitely	– No standard for what patient information is transferred or how it is collected
– Cost effective: presents no cost to patients and low-cost to health care providers	– Must be integrated to the inconsistently used rural health center referral form
– High access to smartphones among midwives	– Low access to smartphones among CHAs
– Bidirectional communication allows family to purchase supplies before arrival to the facility	– Low familiarity with WhatsApp among CHAs
– Desire from RHF to receive patient outcomes and follow-up outpatient appointments	– Inconsistent network connectivity

Table 3

Factors Affecting Timely Care for Obstetric Patients in Rural Liberia.

STAGE OF CARE SEEKING	FACTOR	ADDRESSABLE BY WAT-RT SYSTEM?
Pre-hospital	Transport barriers, lack of private transportation or reliable ambulance	Yes
	Financial barriers	No
	Geographic distances to facilities	No
	Patient unwillingness	No
	Family dynamics	No
Facility delays	Lack of standard triage protocols	Yes
	Lack of standard for when to refer to higher level care	Yes
	Insufficient data collection infrastructure	Yes
	Inaccurate communication of patient information	Yes
	Reliance on family to communicate health information	Yes
	Resource insufficiencies	No
	Policy of payment before treatment	No
	Desire to be cared for by female providers	No
Post-delivery care	Rural health facilities do not receive confirmation of arrival or health status of mom or baby	Yes
	No opportunities for RHF to improve care based on outcomes	Yes
	RHFs unsure when they should see mother and baby for follow-up appointment	Yes