Understanding mobile application development and implementation for monitoring Posyandu data in Indonesia: a 3-year hybrid action study to build “a bridge” from the community to the national scale

Abstract

Background Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. Methods A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. Results (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs’ knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. Conclusions The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs’ book. Hence, its implementation is promising for use at the national level.

Posyandu Application for Monitoring Children Under-Five: A 3-Year Data Quality Map in Indonesia

“…In the context of this research, we define accuracy as the proportion of plausible values in the data (i.e., not outliers, as defined by WHO). Consistency corroborates internal consistency between related data items at different times [3].…”

“…The younger the age, the higher the digital literacy and the other way around. Nevertheless, regardless of age, training and motivation can increase the service and data entry [3,40,41]. The support factor from the midwife also plays an essential role in monitoring, supervising, and verifying the inputted data by the cadre using mHealth.…”

“…For example, community health workers (CHWs) use mobile apps rather than laptops because they are easier to use. However, using it is another training issue because technology literacy about documentation and reporting needs much effort [3]. Moreover, access to adequate training in technology literacy during the pandemic is problematic [2,4].…”

“…In Indonesia, a mother-child health (MCH) community healthcare setting has been established since the 1980s, named Posyandu, abbreviated from Pos Pelayanan Terpadu or Integrated service post [3,11,12]. Posyandu is located in every village, run by CHWs, and supervised by a village midwife in coordination with Pusat Kesehatan Masyarakat (Puskesmas) or the Public Health Center [3,13]. Regarding mHealth, midwives and CHWs have access to MCH's data.…”

“…Efforts to build capacity for CHWs and mothers of children under five using the app have been conducted since 2018. CHWs need more time to adapt to the app, from registering their identity (id) to the data collection [3] and being supervised by village midwives to obtain good data quality. Thus, the data can be used to improve the analysis results.…”