The clinic-level perspective on mHealth implementation: a South African case study

ABSTRACT

This exploratory investigation presents a case study of the deployment of an mHealth service in established public clinics, and assesses the findings using Activity Theory. We contribute to the limited empirical research on mHealth implementation in established public facilities, and build on work on the use of Activity Theory to frame investigations of ICT4D interventions.

The study investigates the perspective of clinic staff responsible for registering women for a free maternal health messaging service. Open-ended interviews and observation sessions were used to reveal staff experiences of the implementation, and their work practices. Activity Theory analysis was adopted to help interpret the data, and identify likely dynamics leading to these specific practices.

Some themes that emerged were the hierarchical nature of the medical profession and implications for task shifting, the influence of technical design choices on use patterns and issues arising from the developing-country context.

KEYWORDS:

• mHealth
• Activity Theory
• empirical study
• exploratory study
• maternal health
• South Africa

Acknowledgements

The authors would like to acknowledge the kind cooperation of the Department of Health of the City of Johannesburg in providing permission to access clinics, and the clinic staff who made time available in their busy schedules.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Brendon Wolff-Piggott is a doctoral candidate in the Department of Information Systems at the University of Cape Town. His prior experience as an information systems practitioner has given him a keen interest in how users appropriate and make use of information technology in their everyday routines. While his current focus is on qualitative investigation, he also has expertise and experience in quantitative analysis. Brendon’s current research interests include mHealth in low resource environments, eHealth more broadly, and the mutual implications of information systems implementation and work practices at multiple levels of scale, including policy implementation issues.

Jesse Coleman is the mHealth Programme Manager at Wits Reproductive Health & HIV Institute (RHI) based in Johannesburg South Africa. He is a Public Health PhD candidate at Karolinska Institute in Stockholm, Sweden and is also a Researcher at the University of the Witwatersrand in Johannesburg, South Africa. Jesse’s research interest areas include mHealth, global public health, maternal health, PMCTC, HIV care and support, Information and Communication Technology (ICT) for health and randomized clinical trials.

Ulrike Rivett is a Professor in the Department of Information Systems at the University of Cape Town. Her research contribution over the last decade has been to “connect the dots” between the academic knowledge of ICT4D and the creation of solutions that offer an innovative approach to existing problems. She heads up the iCOMMS research team, which focuses on understanding the use of ICT systems for the benefit of society. Her work and publications have been in the field of mHealth, ICT4D and ICT in the Water and Sanitation sector.

ORCID

Brendon Wolff-Piggott http://orcid.org/0000-0002-2351-4157

Additional information

Funding

Funding from the National Research Foundation in the form of a Scarce Skills Doctoral Scholarship helped to make this research possible.