Rajesh Vedanthan1, Evan Blank2, Nelly Tuikong3, Jemima Kamano3, Lawrence Misoi3, Deborah Tulienge3, Claire Hutchinson2, Deborah D Ascheim2, Sylvester Kimaiyo4, Valentin Fuster5, Martin C Were6. 1. Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: rajesh.vedanthan@mssm.edu. 2. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Academic Model Providing Access to Healthcare, Eldoret, Kenya. 4. Academic Model Providing Access to Healthcare, Eldoret, Kenya; Moi University, College of Health Sciences, School of Medicine, Department of Medicine, Eldoret, Kenya. 5. Icahn School of Medicine at Mount Sinai, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. 6. Academic Model Providing Access to Healthcare, Eldoret, Kenya; Indiana University School of Medicine & Regenstrief Institute, Inc., Indianapolis, IN, USA.
Abstract
BACKGROUND: Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. OBJECTIVE: To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. METHODS: Usability testing consisted of "think aloud" exercises and "mock patient encounters" with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. RESULTS: Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. CONCLUSIONS: This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions.
BACKGROUND: Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. OBJECTIVE: To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertensionpatients at the community level in a resource-limited setting in western Kenya. METHODS: Usability testing consisted of "think aloud" exercises and "mock patient encounters" with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. RESULTS: Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. CONCLUSIONS: This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions.
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