Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study

Abstract

BackgroundMobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting.MethodsWe conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction.ResultsAll of the participants were women, ranging from 18–64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas.ConclusionIn a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health.

Cervical cancer data and data systems in limited‐resource settings: Challenges and opportunities

“…Limited coordination, training, and standardization of data practices result in low‐quality data. Conversely, failure to recognize the benefits of data use contributes to a lack of investment in the collection of high‐quality data …”

“…Limited‐scale implementation of applications—for data collection, clinical decision support, and follow‐up visit reminder systems—has provided valuable information regarding feasibility, usability, acceptability, and ability to promote quality data collection. Common lessons learned are the need to understand local conditions in‐depth prior to implementation, continually evaluate systems to ensure they meet user needs, and provide periodic supervision to enhance data quality and use …”

“…In other applications, data exchange over mobile networks has been facilitated by cloud‐based data storage, multimedia messaging service or MMS, and electronic medical pathways . While mHealth technologies offer promising solutions for low‐resource settings, additional evidence on scalability and impact on health outcomes is needed …”

“…Common lessons learned are the need to understandlocalconditionsin-depthpriortoimplementation,continuallyevaluatesystemstoensuretheymeetuserneeds,andprovide periodicsupervisiontoenhancedataqualityanduse. 19,40,41 In Zambia, a system for telemedicine and quality assurance that combinesmobiletelecommunicationsanddigitalcervicographyplayed avitalroleinimprovingandscalingupvisualinspectionwithaceticacid (VIA)-based cervical cancer screening. 42,43 A similar approach using smartphonestocaptureandtransmitdigitalcervicalimageshasbeen successfullytestedinMadagascar, 44 andscaled-upinBotswana.…”

“…11,49 While mHealth technologies offer promisingsolutionsforlow-resourcesettings,additionalevidenceon scalabilityandimpactonhealthoutcomesisneeded. 19,36…”