People Welcomed This Innovation with Two Hands: A Qualitative Report of an mHealth Intervention for Community Case Management in Malawi

Abstract

Introduction: Community Case Management (CCM) aims to improve health outcomes among children under five with malaria, diarrhea, and pneumonia, but its effectiveness in Malawi is limited by inconsistent standards of delivery characteristic of paper-based interventions. This may lead to negative impacts on child health outcomes and inefficient use of health system resources. This study evaluated the acceptability and impact of the Supporting LIFE Community Case Management App (SL eCCM App) by Health Surveillance Assistants (HSAs) and caregivers in two districts of Northern Malawi. Methods: Data were collected through semi-structured interviews with HSAs and caregivers as part of a nested study within a larger trial. We used deductive and inductive approaches during data analysis. Relevant constructs were identified from the Consolidated Framework for Implementation Research and combined with emerging concepts from the data. The Framework Method was used to chart and explore data, leading to the development of themes. Results: Seventeen HSAs and 28 caregivers were interviewed. Participants were generally enthusiastic about the SL eCCM App. Nearly all HSAs expressed a preference for the App over routine paper-based CCM. Most HSAs claimed the App was more reliable and less error prone, facilitated more accurate diagnoses and treatment recommendations, and enhanced professional confidence and respect in the community. Some HSAs believed additional features would improve usability of the App, others identified mobile network or electricity shortages as barriers. Not all caregivers understood the purpose of the App, but most welcomed it as a health and technological advancement. Conclusion: The SL eCCM App is acceptable to both HSAs and caregivers, and in most cases, preferred, as it was believed to foster improvements in CCM delivery. Our findings suggest that mobile health interventions for CCM, such as the SL eCCM App, may have potential to improve the effectiveness and efficiency of care to children under five.

Effectiveness of smartphone-based Community Case Management on urgent referral, re-consultation and hospitalization of children under-5 in Malawi: Results of a cluster-randomized, stepped-wedge trial

“…Our results add to previous qualitative studies which have shown that HSAs feel empowered using apps such as the one evaluated here (29), and that these tools might support greater adherence to CCM(21). These results support wider implementation and potentially addition of further functionalities, to support HSAs using smartphones to facilitate other tasks, such as reporting requirements or drug stocking.…”

Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial

“…Our results add to previous qualitative studies that have shown that HSAs feel empowered using apps such as the one evaluated here [ 21 ] and that these tools might support greater adherence to CCM [ 32 ]. These results support wider implementation and potential addition of further functionalities to support HSAs using smartphones to facilitate other tasks, such as reporting requirements or drug stocking.…”

“…Decision support systems within these technologies can facilitate clinical decision-making and offer potential advantages over paper-based tools [ 19 , 20 ]. The potential advantages of e-CCM over paper-based CCM include shorter consultation time and a greater likelihood of correct diagnostic and treatment decisions, as noted in previous studies [ 21 , 22 ]. However, adopting mHealth tools as an adjunct (or replacement) for current paper-based assessment and reporting tools requires considerable initial and sustained investment.…”

The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions

“… 59 60 The surge of mHealth used in iCCM and other programs in which CHWs frequently participate can impact the data collection burden on CHWs, as well as dependency on hardware that may not always operate effectively. 61 62 Visibility and visualisation of data, especially at lower levels, have the potential to change the way stakeholders use information to make decisions and influence community understanding of program impacts. 63 64 A comprehensive M&E plan is necessary to track and measure overall program performance.…”

“…Critical to overcoming commonplace bottlenecks of evaluation is ensuring that the data elements actually exist to calculate the indicators needed for decision-making and that they are organised in a format conducive to extracting information 59 60. The surge of mHealth used in iCCM and other programs in which CHWs frequently participate can impact the data collection burden on CHWs, as well as dependency on hardware that may not always operate effectively 61 62. Visibility and visualisation of data, especially at lower levels, have the potential to change the way stakeholders use information to make decisions and influence community understanding of program impacts 63 64.…”