araya-thesis

Chapter 6
Five (21.7%) of the health workers who preferred the English version of the forms were
midwives whose reasons were that medical terms were more easily understood in
English than in the local language.
Discussion
Health workers used the electronic forms in more than half of the women (59.1%), and
use of the forms across the study period was virtually consistent. Almost all health
workers preferred electronic forms over paper forms and expressed their intention to
continue using the forms in the future. All health workers preferred unrestricted use on
the smartphone and its functions. Most believed this unrestricted use of smartphone
helped and motivated them to get used to the electronic forms and smartphone. Our
analysis showed health workers used 90.2% of their mobile top up for making voice
calls.
In general, health workers who participated in our study perceived the electronic forms
were helpful and useful for their day to day maternal health care service provision.
Similar findings were observed in a study conducted by Rajput et al., who evaluated the
use of an android‐based mHealth system for population surveillance by community
health workers in Kenya [25]. Community health workers who participated in this
surveillance felt the android mHealth platform and electronic survey forms were easy
to use and facilitated their work.
The percentage of pregnant women (59.1%) assessed and entered into our system
using the electronic forms on smartphones by the HEWs and midwives was an
encouraging result for implementing such a platform and interface at scale in the day to
day primary health care provision. We labelled this use as encouraging given the facts
that the health workers participating in this study used the electronic forms on
smartphones for patient assessment and interview in addition to existing paper forms
at their respective health facilities. No incentives or penalties were set for the health
workers regardless of whether they used the forms. No health worker had any previous
exposure to smartphones. Regardless of the introduction of our mHealth application,
not all pregnant women in the study area would have come to health facilities for
maternal health care. Of all pregnant women in Ethiopia in 2011, just 43% had at least
one ANC check up by any health professional, 10% were assisted for birth by a skilled
provider and only 7% sought PNC care [11].
Although the overall use of the electronic forms was promising, this study revealed that
the ANC form was used to a greater extent by the health workers than delivery and PNC
forms. This may indicate that fewer women sought delivery care and PNC, as has also
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