Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study

Abstract

Background To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)–based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs.

Exploring usability problems of mHealth applications developed for cervical cancer: An empirical study

“…A comparative discussion with the related prior works are presented here. First, in some research, authors developed and proposed a mobile application focusing on specific themes such as screening, awareness, 13 , 15 while we have not designed or developed any app but evaluated four existing apps focusing on two different themes. In our research, we have carried out usability evaluation and highlighted the issues to improve system design.…”

“…Similarly, to increase the practices of cervical cancer screening among the vulnerable community, Lee et al 14 developed an application to encourage Korean ethnic females to get a Pap test (in the United States) and found that the persuasiveness of mobile apps enriching learning about cervical cancer and influencing screening. Likewise, Stocks et al 15 developed an mHealth application to assist HPV-based screening in western Kenya, while Stocks et al 15 showed that the mHealth app was useful for community health volunteers to conduct HPV-dependent screening of cervical cancer and facilitated for answering frequently asked questions and providing counseling. Again, the fast-growing mobile technologies create awareness for HPV infection, vaccination, and screening programs among women, especially younger ones in an efficient manner.…”

Utilization of digital tools to enhance COVID-19 and tuberculosis testing and linkage to care: A cross-sectional evaluation study among Bodaboda motorbike riders in the Nairobi Metropolis, Kenya

“…The digital tool provided clinical decision support to guide standardized processes for selecting individuals to receive COVID-19 antigen testing, TB diagnosis and/or confirmatory COVID-19 PCR testing. With expansion of testing outside of health facilities, it can be challenging to implement traditional approaches to supervision in order to ensure adherence to clinical guidelines-research in Kenya has shown suboptimal adherence to guidelines among trained community health workers [30]. Having step-by-step clinical processes embedded in the workflow of the digital tool provides real-time guidance for health workers to encourage adherence to guidelines.…”

Rapid Design of a Student-Centred App for Musculoskeletal Clinical Skills: An Example of a Theoretically Informed Approach to Developing Apps for Learning

“…While education-related mobile apps proliferate, to date the processes used to design a quality mobile app for medical education are infrequently reported [ 1 ]. The studies that describe app development generally focus on practicalities of design and evaluation of the completed app, rarely describing the design process [ 2 ]. This lack of a clear design process for health professions education apps may explain the lack of quality mobile apps available to support medical student learning [ 3 ].…”