Background Mobile health (mHealth) has the potential to improve access to healthcare, especially in developing countries. The proliferation of mHealth has not been accompanied by a corresponding growth in design guidelines for mHealth applications. This paper proposes a framework for mHealth application design that combines the Information Systems Research (ISR) framework and design thinking. We demonstrate a use case for the proposed framework in the form of an app to read the result of the tuberculin skin test (TST), which is used to screen for latent tuberculosis infection. The framework was used in the redesign of the TST reading app but could also be used in earlier stages of mHealth app design. Methods The ISR framework and design thinking were merged based on how the modes of design thinking integrate with the cycles of the ISR framework. Using the combined framework, we redesigned an mHealth app for TST reading, intended to be used primarily in a developing context by healthcare workers. Using the proposed framework, the app was iterated upon and developed with the aid of personas, observations, prototyping and questionnaires. Result The combined framework was applied through engagement with end-users, namely ten healthcare workers and ten graduate students. Through review of the literature and iterations of the app prototype, we identified various usability requirements and limitations. These included challenges related to image capture and a misunderstanding of instructions. These insights influenced the development and improvement of the app. Conclusion The combined framework allowed for engagement with end-users and for low-cost, rapid development of the app while addressing contextual challenges and needs. The integration of design thinking modes with the ISR cycles was effective in achieving the objectives of each approach. The combined framework acknowledges the importance of engaging users

On 11 March 2020, the World Health Organisation (WHO) declared a global pandemic as the world experienced the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to 144 countries (World Health Organisation, 2020a). The disease resulting from the virus -coronavirus disease 2019 (COVID-19) -had already overloaded the health systems of many nations. In South Africa, which confirmed its first positive COVID-19 case on 5 March, the pandemic has resulted in extreme measures to prevent its spread, including a national lockdown and various restrictions on movement. It has also resulted in one of the most widespread health communication campaigns since the HIV epidemic during the 2000s.

cultural nuances influenced co-design workshops and artefacts. Adjustments to the rhythms of the workshops and co-design activities enabled "transferability" between rural and urban settings, and across diverse cultures, regardless of whether these settings include members from the same cultures. CCS CONCEPTS• Human-centered computing → Participatory design; Contextual design; Field studies.

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Background Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. Objective This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. Methods We conducted a scoping review using the 6-stage framework by Arksey and O’Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. Results During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. Conclusions Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy.

BACKGROUND Maternal and child health (MCH) is a major global health concern due to the increasing socioeconomic and healthcare inequalities, especially impacting low-and-middle-income countries (LMICs). Digital health technologies are creating opportunities to address the social determinants of maternal and child health by facilitating access to information or providing practical and other forms of support throughout the maternity journey. Previous reviews exist in different disciplines that synthesize digital health intervention outcomes in LMICs. However, contributions in this space are scattered across publications in different disciplines lacking coherence in what digital maternal health means across these fields. Cross-disciplinary reviews are becoming increasingly important to provide a holistic understanding across fields. While there are few attempts that consolidate learning from across different disciplines in the context of digital health technologies, however, they are limited in relation to maternal and child health. OBJECTIVE This cross-disciplinary scoping review aims to synthesize the existing published literature in three major disciplines on the use of digital health interventions for MCH in LMICs, with a particular focus on Sub-Saharan Africa. We also engaged with several cross-disciplinary researchers and grassroots organizations to further validate the papers included in the scoping review and explored the challenges of implementing digital health interventions for MCH in the Global South METHODS We conducted a scoping review using Arksey and O’Malley’s five-stage framework across three disciplines, including public health, social sciences applied to health, and human-computer interaction research in healthcare. The following scholarly databases were searched: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science and PLOS. To complement the review, we further conducted 27 in-depth interviews with cross-disciplinary researchers and grassroots practitioners. We inquired about: additional MCH projects in LMICs, community challenges they faced, and the role of community-based co-design methods while implementing digital health interventions for MCH in LMICs. RESULTS During the search 284, peer-reviewed articles were identified. After removing 41 duplicates, 141 papers met our inclusion criteria: 34 from Social Sciences applied to Health, 58 from Public Health, and 49 from Human-Computer Interaction research in healthcare. These papers were selected for further analysis, then tagged (labeled) by three researchers using a custom data extraction framework obtaining the following findings. First, the scope of digital health technologies was found to target: 1) health education (e.g., breastfeeding, child nutrition), 2) care and follow-up of health service utilization (to support Community Health Workers - CHWs), 3) maternal mental health, and 4) nutritional and health outcomes. The technologies used to deliver these interventions included mobile apps, SMS, Voice Messaging (audio messages, reminders), web-based applications, social media (e.g., Facebook, Twitter, WhatsApp), movies and videos (e.g., digital storytelling and digital media education), and wearable or sensor-based devices. Second, the review identified several key challenges: a) little attention has been given to understanding the lived experiences of the communities these interventions targeted, b) key role players (e.g., fathers, grandparents, and other family members) are often excluded from studies, technologies and many studies are designed considering nuclear families that do not represent the family structures of the local cultures, c) usability and other short-term user studies are often confused with co-design, and d) there is an overemphasis on designing technology to support health services and little to no consideration designing technology to support the wellbeing of caregivers and children. CONCLUSIONS Digital health interventions aimed to support Maternal and Child Health (MCH) have shown steady growth in Africa and other LMIC settings. Unfortunately, the potential role of the community was found to be negligible as these interventions do not often include the communities early and inclusively enough in the design process. These interventions are likely to be ineffective in the long term if delivered without the involvement of the direct beneficiaries We highlight the key opportunities for technology aimed at the MCH arena in LMICs, such as: More affordable mobile data, better access to smartphones and wearable technologies and the rise of custom-developed, culturally appropriate mobile applications, which are more suited to low literacy users. We also focus on threats such as an over-reliance on SMS and text-based communications and the difficulty of MCH research and technological interventions translating into policy.

In March of 2020, South Africa responded to the global COVID-19 pandemic by instituting a full lockdown. This meant that only essential services were allowed to operate, causing schools, universities and workplaces to close. The University of Cape Town was about to complete its first term when this occurred. With campuses closed, students were asked to vacate residences and return home. The university went into emergency remote teaching, with all teaching and learning moving online. Students were provided with the necessary resources to access content via the university learning platform, but strict guidelines were set to ensure that the delivery of content was not data or bandwidth intensive. For our master’s-level course on Health Innovation and Design, this posed many challenges. Health Innovation and Design is part of the curriculum for the MPhil in Health Innovation and the MSc in Biomedical Engineering. It utilises design thinking methodologies as an approach to innovate for improvements in health and wellbeing. The course comprises group-based action learning with a project partner and endeavours to promote engaged scholarship (UCT, 2020) by interacting with constituencies outside the university for public good. For 2020, we had secured the provincial Department of Health as our project partner. Our students were going to work with a team on designing and developing an operating theatre information system for scheduling. We would have had our first hospital visit the week after the university closed its on-campus activities.

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