Building quality mHealth for low resource settings

Abstract

In low- and middle-income countries (LMIC), community health care workers (CHCW) are the primary point of care for millions of people. Mobile phone health applications (mHealth app) are the preferred technology platform to deliver clinical support to CHCW. In LMIC, limited regulatory oversight exists to guide quality and safety for medical devices, including mHealth. During the development of a mHealth app to assist CHCW with patient assessment and clinical diagnosis in rural South Africa, we applied human-centred design (HCD) and a bioethics consultation. The HCD approach enabled us to develop a mHealth app that responded to the needs and capacities of CHCW. The bioethics consultation prompted early consideration of safety concerns, social implications of our mHealth app and our technology’s impact on the CHCW-patient relationship. In this study, we found that combining a HCD approach with bioethics consultation improved the design quality and reduced safety concerns for our mHealth app.

Keywords:

• Usability
• mobile health
• safety
• development
• bioethics

Acknowledgements

We would like to thank to all the CHCW that participated in this study. The authors would like to thank all staff of Ukwanda Rural Health Centre of University of Stellenbosch in Worcester and Rusthof home care in Paarl, South Africa, for their keen interest and input to the design of ClinicalGuide and Wayne Swart, Erin Cooke and Isabel Chan who assisted with transcribing the ethics consultation interviews. Our gratefulness also belongs to the late Prof. Cornie Scheffer who always supported our work.

Disclosure statement

The authors have no conflicting interests. Kate Ettinger is a bioethics consultant at Mural institute and founder of the non-commercial, open source initiative, OpenQRS (http://www.openqrs.org/). Walter Karlen has published ClinicalGuide as open source project (https://github.com/ecemgroup/clinicalguide). Reymound Buckman is a freelance research consultant for Syte, a private e-health consulting firm.