“This is really going to help our wonderful mothers”: A qualitative analysis of midwife perspectives on implementing a triage phone line to support home blood pressure monitoring in Ghana

Problem Preeclampsia and eclampsia are a significant cause of maternal morbidity and mortality in low-resource settings. Background Diagnosis of preeclampsia is based on the new development of elevated blood pressures after 20 weeks of gestation, with or without proteinuria, or with signs or symptoms of end-organ involvement (ACOG Practice Bulletin 222, 2020/2023). Home BP monitoring is an important strategy to detect elevated BPs for early intervention and management. Aim To explore midwives’ perspectives on implementation of a midwife-led triage phone line to support home BP monitoring in Ghana. Methods Participants were 21 midwives trained to staff an on-call phone line and provide clinical advice to pregnant women calling from home with high BPs. Semi-structured face-to-face interviews about perceived benefits, challenges, and experiences were conducted, audio-recorded, transcribed, coded, and thematically analysed. Findings Thematic analysis demonstrated high overall acceptability and feasibility of the phone line. Participants reported confidence and comfort collecting BP information and giving advice over the phone. Midwife-perceived benefits included patients’ ability to communicate with midwives between antenatal visits and report elevated BPs early, and that patients were willing to follow clinical advice given over the phone. Challenges included patient-level and systems-level logistical issues, including bad phone connections, divided opinions on integrating the phone line into normal duties, and desire for extra compensation. Discussion Despite challenges, midwives had an overarching positive perception of the phone line and recommended expanding this model across Ghana. Conclusion Additional education is needed to recognise and integrate this initiative into standard midwifery care. Expanding midwife-led triage phone lines has great potential to enhance home BP monitoring in Ghana and other low-resource settings.