Examining referral communication in maternal healthcare: Perceptions, gaps, and opportunities for improvement

Background: Effective communication is crucial for high-quality and continuous maternal care. However, a lack of communication between providers often cited in the literature. Exploring maternal Primary Care Providers' (PCPs) perspectives on referral communication in Indonesian setting can uncover barriers, facilitators, and potential solutions for the problem. This study aimed to explore the frequency and content of referral and reply letters as perceived by maternal PCPs and to examine PCPs' perspectives and experiences with referral communication, focusing on reply letters and feedback. Methods: A convergent parallel mixed-methods approach was used, including a survey assessing the frequency and content of referral and reply letters, and semi-structured interviews. Participants were GPs and midwives from ten purposively selected CHCs in West Lombok. Results: Among 117 respondents, 76.1% consistently sent referral letters containing patient history, examinations, diagnoses, and treatment details. However, 41.9% reported infrequent receipt of reply letters. Interviews with 20 PCPs identified various communication channels and the role of local government in facilitating the communication. Nonetheless, there was a lack of timely and adequate feedback. PCPs perceived an imbalance of responsibility in referral communication with specialists, with more responsibility placed on communication prior to referral than on the feedback. Conclusion: This study highlights a gap in referral feedback, emphasizing the need to establish specific mechanism for feedback delivery and to address the perceived responsibility imbalance.