The application of a mobile phone-based system for seeking healthcare and infectious disease surveillance in Ghana: users’ experiences

Digital Health offers tremendous potential to change the face of health systems in all countries. Although the application of digital technologies in the health sector has become central to global health thinking, various implementation barriers still exist. One of the most significant is the process of user acceptance and adoption of new interventions, which still remains a neglected research area in sub-Saharan Africa. The synopsis is a synthesis of the findings of a three-year research study embedded within a larger research consortium that developed and piloted a mobile phone-based Electronic Health Information and Surveillance System for sub-Saharan Africa (eHISS) in Ghana. The system aimed to support sick children to assess the disease severity, to advice appropriate treatment and to collect data on the occurrence of symptom clusters. The thesis evaluated the usability and acceptance among users of the mobile health (mHealth) system (caregivers of children) by soliciting their views on their experiences while using the system. The doctoral thesis followed a human-centred design (HCD) circle and consisted of the following research activities; (i) the assessment of the state of research, (ii) the innovative field test of a prototype of the eHISS system and an assessment of users’ needs to drive the design, (iii) the evaluation of the clinical decision algorithm as backbone of the electronic system and (iv) the evaluation of experiences with the system after a six-month pilot phase of the system. A manuscript was developed from each research activity for publication, thus making a total of four papers that form the empirical basis of this thesis. Results showed that users are generally open to mHealth and interested in new technologies, and comprehensive knowledge on critical factors favouring and disfavouring the integration of the system in the daily life of participants, and suggestions on how the system could be improved has been gained. The thesis thus confirmed and highlighted the key role of user experiences in the design process of new mHealth approaches, and provided insights on how to develop and evaluate mobile health approaches from the user perspective. Based on the results of the user evaluation, two possible directions for the future of eHISS have been developed. We further conclude that programs and initiatives must be guided by robust strategies to overcome existing barriers for implementation. Like all digital health interventions, the presented eHISS system is not a silver bullet and has significant limitations, but taking the requirements discussed in the thesis into consideration we believe that systems developed based on the eHISS experiences in future can make a real impact on health service delivery and disease response. Link to dissertation: urn:nbn:de:0070-pub-29402635