A Usability Study of a Mobile Health Application for Rural Ghanaian Midwives

Vélez, Olivia; Okyere, Portia Boakye; Kanter, Andrew S.; Bakken, Suzanne

doi:10.1111/jmwh.12071

Cited by 89 publications

(71 citation statements)

References 24 publications

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“…Usability also interplays significantly with technological factors, such as mobile broadband signal – such factors enhance or detract from a system’s overall usability (even the most user-friendly app will not work if there is no signal). Features of usability can be as simple as screens that require less scrolling [30], or difficulty with usernames and passwords [21]. Such issues may seem small and easy to overcome during piloting, but when a project is brought to scale these seeming inconveniences can limit the workflow of thousands of health care workers and negatively affect clinical care.…”

Section: User Considerationsmentioning

confidence: 99%

“…For instance, midwives in Ghana were dismissive about any device with free text fields that were meant to include subjective information, as they only cared about a small amount of data, which they needed to include in their daily reports [30]. Many studies have shown that sending medical information through short messages becomes difficult with a 160-character limit, or when people speaking multiple languages are involved [14].…”

Section: User Considerationsmentioning

confidence: 99%

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Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Wallis

Blessing

Dalwai

et al. 2017

Global Health Action

124

121

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While the field represents a wide spectrum of products and services, many aspects of mHealth have great promise within resource-poor settings: there is an extensive range of cheap, widely available tools which can be used at the point of care delivery. However, there are a number of conditions which need to be met if such solutions are to be adequately integrated into existing health systems; we consider these from regulatory, technological and user perspectives. We explore the need for an appropriate legislative and regulatory framework, to avoid ‘work around’ solutions, which threaten patient confidentiality (such as the extensive use of instant messaging services to deliver sensitive clinical information and seek diagnostic and management advice). In addition, we will look at other confidentiality issues such as the need for applications to remove identifiable information (such as photos) from users’ devices. Integration is dependent upon multiple technological factors, and we illustrate these using examples such as products made available specifically for adoption in low- and middle-income countries. Issues such as usability of the application, signal loss, data volume utilization, need to enter passwords, and the availability of automated or in-app context-relevant clinical advice will be discussed. From a user perspective, there are three groups to consider: experts, front-line clinicians, and patients. Each will accept, to different degrees, the use of technology in care – often with cultural or regional variation – and this is central to integration and uptake. For clinicians, ease of integration into daily work flow is critical, as are familiarity and acceptability of other technology in the workplace. Front-line staff tend to work in areas with more challenges around cell phone signal coverage and data availability than ‘back-end’ experts, and the effect of this is discussed.

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Section: User Considerationsmentioning

confidence: 99%

Section: User Considerationsmentioning

confidence: 99%

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Wallis

Blessing

Dalwai

et al. 2017

Global Health Action

124

121

View full text Add to dashboard Cite

show abstract

“…[25] Similarly, a usability study of a mobile health application for Ghanaian midwives found difficulty operating a small onscreen keyboard, selecting buttons on a smartphone screen, a safety risk in lack of application password, and difficulty adding new patients to the system. [37] Another study of an mHealth application for tuberculosis treatment in rural South Africa found poor uptake among healthcare workers despite high reported acceptability, largely due to difficulty uploading patient information. [38]…”

Section: Discussionmentioning

confidence: 99%

Usability and feasibility of a tablet-based Decision-Support and Integrated Record-keeping (DESIRE) tool in the nurse management of hypertension in rural western Kenya

Vedanthan

Blank

Tuikong

et al. 2015

International Journal of Medical Informatics

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Background Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. Objective To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. Methods Usability testing consisted of “think aloud” exercises and “mock patient encounters” with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. Results Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. Conclusions This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions.

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“…In general, studies show that aligning software design with the requirements of these health workers is extremely challenging due to unpredictable work environments, privacy and security issues involved in storing and sharing data, and technical know-how of the target users [28]. The limitation of current research is that most of it has been done in the developing world.…”

Section: Introductionmentioning

confidence: 94%

Development and Evaluation of a Perinatal Service Delivery Web Platform for Prenatal Care Coordinators (Preprint)

Chaudhry¹

2018

Preprint

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Background: Digital technology is increasingly being used to enhance various aspects of health care. In the area of community-based, it is important to understand the circumstances and challenges of deploying this technology to solve health care issues. Objective: To develop a tool to support communication and care coordination efforts of community-based prenatal care coordinators who serve low-income pregnant women, and to uncover barriers and facilitators to the tool's use before a wide-scale pilot study. Methods: We devised a four-step development and evaluation process: (1) state-wide stakeholder collaboration to conceptualize the system; (2) expert panel to identify key functionalities to support care coordination and communication between communitybased health workers and pregnant women; (3) iterative and incremental development using agile design and software development; and (4) two evaluations to test usability and user acceptance of the system using real-life scenarios. Results Participants found the web app easy to use and envisioned many benefits of using it in their practices. From the qualitative data, we uncovered many barriers around implementation of the technology, including care coordinator's lack of motivation to participate in the study and provide feedback on the system design. Conclusions: This research provides a methodology for development and deployment of a web-delivered technology in community-based setting. In addition, the research provides insights on real-life challenges of deploying a technology-based solution in communitybased settings.

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A Usability Study of a Mobile Health Application for Rural Ghanaian Midwives

Cited by 89 publications

References 24 publications

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Usability and feasibility of a tablet-based Decision-Support and Integrated Record-keeping (DESIRE) tool in the nurse management of hypertension in rural western Kenya

Development and Evaluation of a Perinatal Service Delivery Web Platform for Prenatal Care Coordinators (Preprint)

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