Utilizing Lean Software Methods To Improve Acceptance of Global eHealth Initiatives: Results From the Implementation of the Basic Emergency Care App

Abstract

Background Health systems in low- and middle-income countries face considerable challenges in providing high-quality accessible care. eHealth has had mounting interest as a possible solution given the unprecedented growth in mobile phone and internet technologies in these locations; however, few apps or software programs have, as of yet, gone beyond the testing phase, most downloads are never opened, and consistent use is extremely rare. This is believed to be due to a failure to engage and meet local stakeholder needs and the high costs of software development. Objective World Health Organization Basic Emergency Care course participants requested a mobile point-of-care adjunct to the primary course material. Our team undertook the task of developing this solution through a community-based participatory model in an effort to meet trainees’ reported needs and avoid some of the abovementioned failings. We aimed to use the well-described Lean software development strategy—given our familiarity with its elements and its ubiquitous use in medicine, global health, and software development—to complete this task efficiently and with maximal stakeholder involvement. Methods From September 2016 through January 2017, the Basic Emergency Care app was designed and developed at the University of California San Francisco. When a prototype was complete, it was piloted in Cape Town, South Africa and Dar es Salaam, Tanzania—World Health Organization Basic Emergency Care partner sites. Feedback from this pilot shaped continuous amendments to the app before subsequent user testing and study of the effect of use of the app on trainee retention of Basic Emergency Care course material. Results Our user-centered mobile app was developed with an iterative participatory approach with its first version available within 6 months and with high acceptance—95% of Basic Emergency Care Course participants felt that it was useful. Our solution had minimal direct costs and resulted in a robust infrastructure for subsequent assessment and maintenance and allows for efficient feedback and expansion. Conclusions We believe that utilizing Lean software development strategies may help global health advocates and researchers build eHealth solutions with a process that is familiar and with buy-in across stakeholders that is responsive, rapid to deploy, and sustainable.

“ChatGPT, can you help me save my child’s life?” - Diagnostic Accuracy and Supportive Capabilities to lay rescuers by ChatGPT in prehospital Basic Life Support and Paediatric Advanced Life Support cases – an in-silico analysis

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Mobile application adjunct to the WHO basic emergency care course: a mixed methods study

“…The second-generation BEC app incorporated extensive feedback from the first-generation application and addressed reported limitations with that version, including the ability to function without internet access and track application use centrally. 17 The second-generation BEC app was designed as an expanding logic framework that could be deployed within a self-contained app on any mobile operating system or accessed through chatbot services across multiple platforms like WhatsApp or Facebook Messenger as well as short message service (SMS) for the greatest possible reach. Additionally, a chat-based approach was believed to allow for broader translation from English to other languages as it does not always require completely rewriting the app software, but rather may allow for common translational services to be employed.…”

The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design (Preprint)

“…The software's incorporation of nudges, sprints, and documentation, contributes to a more systematic and effective approach to behavior modification within an Agile project management context. Other project management strategies, such as Lean and Six Sigma, have previously been developed into software to increase the efficiency of healthcare innovations [23][24][25]. However, these programs do not focus specifically on the creation, implementation, and diffusion of evidence-based nudges, contrary to AgileNudge+ which has been designed based on Agile science.…”