mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings

Abstract

Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings—using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider’s ability to manually count respiratory rate—has proven inadequate. Furthermore, hypoxemia—a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death—is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop “mPneumonia,” an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality from pneumonia and other childhood illnesses in low-resource settings.

Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana

“…However, several health center-based CHNs were less motivated to enter data when the reports were not generated. These findings align with other research studies that have found technical issues such as screen freezes and delayed uploads impede efficient use and limit user uptake of mobile health applications [27, 55, 67]. A lower threshold of data completeness and accuracy for receiving automated reports may have improved usability.…”

mPneumonia, an Innovation for Diagnosing and Treating Childhood Pneumonia in Low-Resource Settings: A Feasibility, Usability and Acceptability Study in Ghana

“…Updates to the mPneumonia application from the initial prototype reduced the time it took HCPs to complete the application the first time, cutting it by over 40% from a mean of 43.4 minutes (previously reported) to a median of 25 minutes (reported here). [23] Additional improvements to the application were also made based on the pilot test results.…”

“…The five questions used were identical to those from the prior field testing stage of the mPneumonia prototype. [23]…”

“…Additional details about the development, field testing, and features of mPneumonia are described elsewhere. [23] In Ghana, where HCPs are currently trained to use the paper-based IMCI guidelines for diagnosing childhood illnesses, we conducted a design-stage qualitative pilot study to understand the feasibility, usability and acceptability of the mPneumonia application in frontline health facilities.…”

Evaluating clinicians’ user experience and acceptability of LearnTB, a smartphone application for tuberculosis in India

“…Studies have concentrated their efforts in improving their interventions prior to evaluating the acceptability (23,24) and others investigated the acceptability of mHealth interventions demonstrating positive results (25)(26)(27)(28). Each of these studies evaluated interventions other than smartphone applications, such as short messaging service (SMS), telecommunication interfaces as well as ehealth interventions emphasizing protocol compliance and treatment adherence respectively.…”