araya-thesis

General discussion
Cost implications of using electronic forms on smartphones
Despite the absence of adequate evidence, electronic forms on smartphones are
potentially useful to cut and minimise costs of using paper forms [30,32]. The decision
whether to put restrictions on the use of smartphone and internet connectivity when
employing smartphone‐based electronic forms may affect the running cost of
implementing such an interface. Policy‐makers may not be interested in scaling up such
initiatives if they are not proven to be cost‐effective. Thus, along with the usability
assessment, we investigated the running costs and usage of mobile top up cards by
health workers and found that 90.2% of mobile top ups were used for making voice
calls, 9.0% for mobile internet connectivity and 0.8% for SMS. On average, each health
worker had made approximately 163 minutes of voice calls every month. Additionally,
as health workers become handier with their smartphone, the use of internet
connectivity through their smartphone for other purposes such as Google and
Facebook may increase. Though this may be beneficial and encouraging in that it may
help health workers to gain access to information and other resources on the internet,
it could compromise the primary purpose of using electronic forms for patient
assessment and incur additional costs to the health system. Thus, it would be necessary
to manage and restrict health workers’ use of mobile top ups. Covering such mobile top
up expenses in a larger scale implementation of similar projects for a longer period may
be difficult and unfeasible. Hence, implementers of such interfaces should solicit a
mechanism to provide health workers free airtime for uploading forms, or restrict the
use of mobile top ups only for the required purpose.
Methodological considerations
In this subsection of the chapter, we summarise the overall methodological strengths
and limitations of the research presented in this thesis. Specific strengths and
limitations of each separate study presented in this thesis are discussed in their
respective chapter.
Strengths
For our mHealth study, we chose and followed a user‐centered approach. Such a
method is recommended for mHealth studies in developing countries where there may
not be a baseline understanding of mobile technologies [36,37].
Instead of introducing the complete set of the mHealth application at once, we chose a
phase‐by‐phase implementation, spread over a longer period of time (approximately 22
months). We involved health workers for the full duration of the study. Health workers
participated in the development and testing of the mHealth application and maternal
health care protocols, which helped not only to refine the application based on health
workers’ feedback but also create a sense of ownership among the health workers.
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