Title: End user experience of Hayat app and dashboard: qualitative assessment of usability, community engagement and validity of data for antenatal care provision and routine immunization in rural Pakistan and Afghanistan (Preprint)

Abstract

BACKGROUND An mHealth app was developed for front line health workers, to strengthen maternal, neonatal and child health services through increased transparency, accountability, and improved governance by collecting and disseminating real-time data. Key features included tracking frontline health workers through Global Positioning System during outreach visits, registration of clients; and recording data. OBJECTIVE In this paper we report the end user experiences of the captured during the qualitative end line study of the Hayat app. This includes perceptions and experience of the using the digital app with a focus on usability, validity of data, and community response. This paper aims to identify barriers and enablers to integration of mhealth and inform how digital technology can be utilized for strengthening the district health systems in LMICs. METHODS Qualitative assessment was carried out in select rural districts of Khyber Pakhtunkhwa and Gilgit-Baltistan in Pakistan and select catchments of Bamyan and in Badakshan Province in Afghanistan. Methods used for assessment included 17 focus group discussions with LHWs and 28 key informant interviews with health workers and key stakeholders. Thematic content analysis was undertaken based on an adapted framework derived from the World Health Organization guide for “Monitoring and Evaluating Digital Health Interventions” and technology acceptance model. RESULTS The study revealed high usability of the app both by the stakeholders. Overall, the app improved quality and timeliness of data, improved immunization coverage and maternal care through supportive supervision and monitoring of frontline health workers. Data validity improved and health managers were confident of the reliability of data collected through the app. However, connectivity issues, difficulty in access to remote sites, security issues, lack of incentives and increased workload were some of the perceived barriers identified by the end users. CONCLUSIONS The use of smart phone-based application has high acceptability among the HCPs, and has benefitted the existing health system functioning but providing reliable data, and better monitoring. However, successful integration of app in the health system will require inter sectorial collaboration to address the challenges identified in implementation. CLINICALTRIAL N/A