araya-thesis

Mobile health data collection
Discussion
Addressing health workers’ needs, expectations and taking into account the reality of
their working environment is a key issue for success when introducing mHealth
applications and electronic forms at primary health care in resource‐poor settings
[15‐17]. The present study assessed the feasibility of using such application and forms
mainly from the health workers’ perspectives and their setting. This study showed that
health workers easily adapted to smartphone based mHealth applications and
electronic forms. Health workers’ acceptance and demand for such an application
seemed positive. Many believed the application and forms were helpful for their work
and expressed their intention to continue using it. Actual use of the application was
also promising, given the health workers’ high mobility and that no incentive was
provided for using it. However, lack of a unique and consistent patient identifier,
absence of standardized health services, high turnover of health workers and low
mobile network coverage would remain as potential barriers for a successful
implementation and integration of such an application and forms at primary health
care in Ethiopia on a larger scale.
Though it would be difficult to compare the findings of our study with previous mHealth
studies, given the difference that many of them deployed SMS based applications
and/or tested mHealth applications for a one‐time survey by trained data collectors,
the high acceptance and demand for an mHealth application observed in this study was
also noted in previous studies. A very similar study to ours, conducted in Western
Kenya, evaluated the use of an android‐based mHealth system for population
surveillance [18]. In this study a structured survey was implemented and administered
by Community Health Workers (CHWs). Similar to our study, CHWs who participated in
this study found the system easy to use and facilitated their work. Similarly, another
study also conducted in Kenya found health workers’ had high acceptance for mobile
phone text messaging for malaria case management [19]. The high acceptance in our
study might be attributed to the facts that 1) we did not put any restriction on the
health workers in using the smartphone and its functions, 2) the electronic forms
helped health workers conduct a step‐by‐step patient assessment, 3) health workers
had the option to use electronic forms in both local language and English, and 4) most
importantly, health workers were provided feedback on their performance and tasks
through the mobile scorecard.
By way of comparison, non‐technical challenges were more difficult to solve than the
technical, in the implementation of a smartphone based mHealth application and
electronic forms. The technical challenges identified in this study regarded the shorter
battery life of the smartphones, touch screens becoming insensitive over time, fear of
losing the phone and discomfort of carrying two phones. Unlike other studies [5,20], we
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