Perceptions of data processes in mobile-based versus paper-based health information systems for maternal, newborn and child health: a qualitative study in Andhra Pradesh, India

Abstract

BackgroundMany maternal, newborn and child health (MNCH) programmes have paired community health workers with mobile technologies to strengthen the ability of health information systems (HIS) to track women and children across time and beyond the clinical setting. However, little is known regarding the comparative effectiveness of using mobile technologies to enhance HIS data in resource-poor settings.MethodsFocus group discussions were conducted with community health workers called Health Activists (HAs; n=30), Community Organisation Leaders (n=28), HA Trainers (n=21), district and tribal area officials (n=3) and State Officials (n=4). We analysed user perceptions along seven key HIS processes: data collection, transmission, processing, analysis, display, quality checking and feedback.ResultsThe mobile-based health information system (mHIS) was found to be supportive of the MNCH continuum of care by improving the regularity and timeliness of access to robust data. Respondents noted that data errors were reduced in real time through automated error checking and data processing, which also reduced users’ workloads. The mHIS additionally enabled users to analyse both individual and aggregate data, allowing them to identify specific individuals in need of services or training as well as to identify general trends in service delivery. The system's data display and feedback mechanisms were viewed as improving data use for decision-making. The remaining challenges of the mHIS versus the paper-based HIS included resource, infrastructural and technological barriers that hindered efficient use over time.ConclusionsAs compared to paper-based HIS systems, mobile technologies can improve health information processes in resource-poor settings. More efforts are needed to ensure sufficient financial investment, training and use of mHIS data at all levels of the HIS.

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

“…Health workers agreed that the Client Data App simplified individual client data collection, was easily integrated into their workflow, and enhanced their capacity to deliver follow-up services across the care continuum. These findings align with other studies that have demonstrated the benefits of equipping health workers with data management technologies to improve the continuity of care in rural populations [27, 61]. At the same time, our results highlight several challenges that would need to be addressed to optimize the utility of a client data management system using mobile devices in resource-poor settings.…”

“…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.…”

“…Our results revealed that the lack of network reliability compromised the efficiency and usability of the Client Data App, notwithstanding the technological systems put in place to address these complications. Other studies have shown that poor network coverage and signal strength are often a major limitation to implementation of mobile technologies [23, 27, 31, 65, 66]. While the MOTECH team took careful measures to mitigate connectivity challenges, such as instituting a customer support call center and using high-storage devices with offline and multinetwork functionality, users still grew frustrated with the efforts required to upload data.…”

“…In particular, mobile apps, or software applications developed specifically for use on small, wireless computing devices such as smartphones or tablets, have been shown to improve the quality of care provided to pregnant and recently delivered women through electronic decision support [17, 18, 22], health worker planning [23, 24], and data collection and reporting [19, 25–27]. The reported ease of use and adaptability of mobile apps (or applications) for diverse populations also makes them an attractive, low-cost platform for developing health education and clinical care strategies [28–30].…”

Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs?

“…However, broader details on the platform were not well detailed [ 22 ]. Beyond summative evaluations, qualitative studies have sought to explore user perceptions of mobile tools and/or health information messaging programs in the US [ 23 , 24 ], New Zealand [ 25 ], and India [ 26 – 29 ]. However, none of these present quantitiative data on the technological performance of the program; instead focusing on reported perceptions of the technology, including feasibility, usability and/or acceptability.…”