Reaching further: Lessons from the implementation of the WHO Basic Emergency Care Course Companion App in Tanzania

Abstract

Introduction The World Health Organization's (WHO's) Basic Emergency Care (BEC) course was developed to address training gaps in low- and middle-income countries (LMICs). Simultaneously, LMICs have experienced an unprecedented increase in the number of cell phone and internet users. We developed a mobile application adjunct to the BEC course (BEC app) and sought to assess the reach of the BEC app. Methods Forty-six BEC course participants, made up of doctors and nurses from three hospital sites in Tanzania, were given access to the BEC app with download instructions. Moderators tracked mobile access characteristics and barriers. This is a descriptive study outlining the implementation of the BEC app and associated findings from the process. Results Fewer than 10% of participants were able to independently download and use the application. The download process revealed three key barrier areas: accessibility (no smartphone, smartphone without charge, no access to data/WiFi to download app, increased cost of data), technical (outdated operating system, inconsistent access to data/WiFi to run the app, insufficient phone storage), and participant-related characteristics (variability in smartphone literary, language discordance, smartphone turnover). Of the 46 participants, 29 (63%) were able to download and use the BEC app successfully with moderator support. Conclusions There is potential utility of mobile health in LMICs. However, barriers still exist to reaching the largest possible audience for these initiatives. The importance of app compatibility with a broad range of operating systems and limitation of the amount of data needed to download and use the app was underscored by our study. Moreover, creative solutions are needed to facilitate large-scale roll-outs of mobile health interventions, such as a distribution model that relies on super user and peer support rather than an individual moderator. Additional local perspectives on the download process and the utilisation and acceptance of the application post-implementation are needed.

Development and pilot test of a smartphone app for midwifery care in Tanzania: A comparative cross-sectional study

“…In research, for example, the Basic Emergency Care course application was developed and applied in Tanzania. The researchers reported limitations in Internet access; however, they found potential utility [10]. Hence, the research team considered that the use of an educational app is possible, especially among professional groups with economic stability.…”

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

“…Finally, FG responses suggested that the BEC app was user-friendly, clear and easy to navigate and a helpful resource in retaining information from BEC course. However, a number of challenges identified both by moderators during the implementation of the BEC app 20 and by participants during the FGs discussions may have limited the impact of the BEC app, resulting in the negative findings of this study.…”

“…This level of resource may not be feasible for mass distribution of such an intervention and barriers to access may be even greater than reported here. However, this enabled a comprehensive understanding of implementation challenges, 20 which can be used to further refine the intervention and its roll-out.…”

“…First, of the 46 participants in the app arm, only 29 (63%) were able to successfully download and use Open access the app by the end of the BEC course with a subset of this group no longer having access to the BEC app at follow-up. Based on a prior analysis of implementation factors, a number of reasons, including accessibility (eg, no smartphone), technical (eg, outdated operating system, insufficient storage space on device) and participant related (eg, smartphone turnover) were identified by moderators 20 and reiterated through the FGs. This limitation in reach of the application was likely a key driver that no group-based differences were seen in knowledge assessments and self-efficacy scores.…”

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

“…In addition to the pilot BEC programs in Zambia, Tanzania, and Uganda, additional iterations have been implemented in emergency facilities in Nigeria, Sierra Leone, Ukraine, and Kiribati and adapted for each clinical context [30][31][32][33]. In these cases, knowledge acquisition was similarly measured by comparing pre-and post-course assessments.…”