Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants

Zaidi, Shehla; Shaikh, Saqib Ali; Sayani, Saleem; Kazi, Abdul Momin; Khoja, Adeel; Hussain, Syed Shahzad; Najmi, Rabia

doi:10.2196/16081

Cited by 31 publications

(27 citation statements)

References 27 publications

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“…Offline features of the app and awareness videos were reported to be most useful when conducting outreach visits, supporting the use of videorecorded health messages for raising awareness in communities. Findings reported from a study conducted in Pakistan indicated the usefulness of an offline feature; however, awareness videos on routine immunization were reported as a less-used feature by the vaccinators [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cellphone penetration >90% in LMICs, coupled with falling call prices and increased network connectivity options, has improved the feasibility of mobile health (mHealth) programs [ 13 ] in remote areas of LMICs, creating the possibility for strengthening weak health systems. CHWs around the globe are using mHealth technology for data collection, training, communication, mobile job aids, decision support tools, and behavior change communication in the community.…”

Section: Introductionmentioning

confidence: 99%

“…The app was implemented to improve vertical accountability through digitalization of records and was supported by the government of Punjab (Punjab Information Technology Board) [ 16 ]. This led the way for other provinces to adopt digital immunization solutions to improve vaccination coverage, a prime example being the introduction of the Teeko app in the rural districts of the province of Sindh [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Another recent mHealth study aiming to inform how digital technology can be embedded within district health systems in LMICs highlighted the need for co-option by end users and district stakeholders. It also reported that ease of operability, satisfaction with reliable data, personal recognition, links to field support, and empowerment are powerful enablers of the shift towards digitalization [ 13 ].The purpose of our study was to explore the necessary facets of the initial version of the Hayat app revolving around user centeredness to provide an evidence base informed by the understanding of experiences and needs of CHWs in remote areas of Pakistan and Afghanistan [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

Zaidi¹,

Kazi²,

Riaz³

et al. 2020

J Med Internet Res

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Background The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

Zaidi¹,

Kazi²,

Riaz³

et al. 2020

J Med Internet Res

Self Cite

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“…If mHealth is capable of increasing patients’ satisfaction with the clinical approach, this higher satisfaction may translate into increased attendance at clinical visits, which may ultimately reduce adverse obstetric and neonatal outcomes. However, current evidence on this topic is scarce, and little is known about how mHealth can influence the clinical practice of health care providers and the quality of services [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study

Benski¹,

Schmidt

Viviano³

et al. 2020

JMIR Mhealth Uhealth

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Background Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers. Objective This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients. Methods We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman. Results Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P<.001). In 2019, fewer women attended their first ANC visit in the third trimester (57/277, 20.6%) than in 2015 (147/343, 42.9%). There were statistically significant associations between the ANC visit durations and the risk factors, including age (>35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school–level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system. Conclusions This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time.

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The promise of telemedicine in Pakistan: A systematic review

Mahdi

Allana

Battineni

et al. 2022

Health Science Reports

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Background Telemedicine offers the possibility of provision of medical assistance to remote patients, and it has great potential in developing countries like Pakistan. Telemedicine solves logistical barriers, gives support to weak health systems, and helps to establish worldwide networks of healthcare professionals. Because of the high implementation costs, it is not possible yet to adopt telehealth systems for low‐ and middle‐income nations. Objective To present a revision of region‐based telemedical services in Pakistan. Methods Libraries such as PubMed (Medline), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus (EMBASE), and Google Scholar were used for document search. Newcastle‐Ottawa Scale (NOS) was adopted to conduct study quality. Many of the studies (n−8) included in the review were of high quality as assessed through the Newcastle‐Ottawa scale. Selected study characteristics were further analyzed based on different parameters such as publication year, sample size, study design, methods, motivation, and outcomes. Results Search produced 955 articles and 11 items were ultimately selected to conduct the review. These studies were further characterized as region‐based telemedicine implementation. Out of 11, eight studies were conducted in the urban region and three studies were conducted in the rural areas of Pakistan. Many studies produced evidence on telehealth interventions by smartphone services such as SMS, apps, and web‐based telemedicine. Conclusions Telehealth interventions such as mHealth, eHealth, telemedicine, and telepharmacy in Pakistan were introduced starting from the last two decades. For obtaining the full benefits of these technologies, it is necessary that they but certainly need to become an integral part of Pakistan's current health infrastructure.

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Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants

Cited by 31 publications

References 27 publications

Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study

Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study

The promise of telemedicine in Pakistan: A systematic review

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