Perceptions of a mobile health intervention for Community Case Management in Malawi: Opportunities and challenges for Health Surveillance Assistants in a community setting

  • Griphin Baxter Chirambo Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu, Malawi School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
  • Victoria Hardy Department of Family Medicine, University of Washington, Seattle, WA, USA
  • Ciara Heavin Health Information Systems Research Centre, University College Cork, Cork, Ireland
  • Yvonne O’Connor Health Information Systems Research Centre, University College Cork, Cork, Ireland
  • John O’ Donoghue Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  • Nikolaos Mastellos Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  • Tammy Tran Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  • Jenny Hsieh Luke International (LIN), Malawi Office, P.O. Box 1088, Mzuzu, Malawi
  • Joseph Tsung-Shu Wu Luke International (LIN), Malawi Office, P.O. Box 1088, Mzuzu, Malawi
  • Sven Carlsson Department of Informatics, Lund University School of Economics and Management, Lund, Sweden
  • Bo Andersson School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi
  • Matthew Thompson Department of Family Medicine, University of Washington, Seattle, WA, USA

Abstract

Abstract
Background Improved availability of mobile phones in low- and middle-income countries (LMICs) offer an opportunity to improve delivery of Community Case Management (CCM). Despite enthusiasm for introducing mHealth into healthcare across LMICs, end-user attitudes towards mHealth solutions for CCM are limited. We aimed to explore Health Surveillance Assistants’ (HSAs) perceptions of the Supporting LIFE electronic CCM Application (SL eCCM App) and their experiences incorporating it as part of their clinical practice. Methods This exploratory qualitative study was part of a mixed methods feasibility study investigating whether children under-5 presenting to village clinics could be followed-up to collect patient outcome data. The convenience sample of 12 HSAs enrolled into the feasibility study participated in semi-structured interviews, which were conducted at village clinics after HSAs had field-tested the SL eCCM App over a 10-day period. Interviews explored HSAs perceptions of the SL eCCM App and their experiences in using the App in addition to paper CCM to assess and treat acutely unwell children. Open coding was used to label emerging concepts, which were iteratively defined and developed into six key themes. Results HSAs’ perceived enhanced clinical decision-making, quality of CCM delivery, and work efficiency as opportunities associated with using the SL eCCM App. HSAs believed the inability to retrieve patient records,, cumbersome duplicate assessments/data entry study procedures, and inconsistencies between the SL eCCM App and paper-based CCM guidelines as challenges to implementation. Adding features to the App, such as, permitting communication between colleagues/supervisors, drug stock-out reporting, and community assessments, were identified as potentially supporting HSAs’ many roles in the community. Conclusion This study identified opportunities and challenges associated with using the SL eCCM App in Malawi. This information can be used to inform future development and evaluation of the SL eCCM App, and similar mHealth solutions for CCM in Malawi and other developing countries.
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Published
2018-03-28
Section
Articles

Journal Identifiers


eISSN: 1995-7262
print ISSN: 1995-7262