JMIR Publications

ABSTRACT

Background:

Liberia struggles with maternal mortality due to a lack of standardized obstetric triage and prehospital communication systems. We implemented a Mobile Obstetric Referral Emergency System (MORES) intervention consisting of a triage training and a two-way, templated WhatsApp communication system to reduce care delays among patients transferred from rural health facilities (RHF) to district hospitals.

Objective:

This qualitative study evaluated health workers’ satisfaction and usability of MORES in rural Bong County, Liberia.

Methods:

A structured interview script was developed by Liberian and US experts in obstetric triage. Health workers from RHFs and district hospitals in Bong County participated, following one year of using MORES. Individual interviews were conducted using a structured interview guide, covering MORES usability and impact on patient care, referrals, and the wider health system. Responses were transcribed and analyzed in NVivo12 using a team-based coding methodology. Analysis used a content analysis approach to categorize domains, themes, and subthemes.

Results:

Participants included 62 health workers from 19 RHFs and two hospitals. Respondents were mainly midwives and nurses, with varying ages and years of work experience. Three domains emerged, including usability and effectiveness, health system strengthening, and sustainability and scalability. For effectiveness, all participants perceived MORES to be a useful communication tool and beneficial for patient triage and outcomes (n=62, 100%), with themes of improved prehospital communication (92%), provider attentiveness (63%), and patient care (55%). For health systems strengthening, participants reported improved coordination and accountability (89%), feedback mechanisms (77%), interprofessional teamwork (34%), longitudinal follow-up care (32%), exposing hidden care delays (27%), and establishment of preliminary electronic health record (21%). All participants desired program sustainability and scaling and suggested improving MORES through more frequent trainings and increased cellular data support.

Conclusions:

MORES was perceived as highly usable and beneficial to patient outcomes by reducing care delays for obstetric patients. MORES also demonstrated components of health systems strengthening by improving care pathways in rural Liberia. Future studies should quantitatively evaluate care delay reductions, impact on maternal morbidity, and strategies for scaling MORES.