Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants
Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants
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DOI：
10.2196/16081
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发表时间：
2020-02-13
影响因子：
5
通讯作者：
Najmi, Rabia
中科院分区：
文献类型：
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作者：
Zaidi, Shehla;Shaikh, Saqib Ali;Najmi, Rabia
背景：最近，低收入和中等收入国家大量使用移动医疗 (mHealth) 应用程序来解决免疫接种和其他公共卫生问题。然而，最近的证据主要集中在应用程序开发或对认知度或服务覆盖范围的前后影响。几乎没有证据表明促进采用移动医疗计划的因素，而移动医疗计划对于有效地将数字技术嵌入主流卫生系统至关重要。目的：本研究旨在为一线卫生人员和地区管理人员提供定性体验，同时利用实时数字技术来提高巴基斯坦服务不足的农村地区常规儿童免疫接种的覆盖率。方法：迭代开发了一款基于 Android 的应用程序，并在 Tando Muhammad Khan 地区的 11 个工会理事会使用了 2 年。巴基斯坦一个服务不足、免疫覆盖率低的农村地区。我们使用迭代方法来检查（1）应用程序的可接受性和可操作性，（2）收集数据的有效性，以及（3）收集数据的使用。此外，我们还收集了移动医疗应用程序的使用障碍和推动因素。我们进一步探讨了与工作变化以及应用程序使用的有利因素和障碍相关的每个主题。对 11 个工会理事会的 26 名疫苗接种员进行了深入访谈，并有目的地选择了 7 名参与扩大免疫计划的关键信息提供者（政府地区经理）。调查结果根据三大研究领域进行了三角测量。结果：数字免疫跟踪被疫苗接种员和地区经理认为是可以接受的。实时免疫数据用于监测疫苗接种量、跟踪疫苗接种不完整的儿童、制定外展访问计划、纠正现有的微观计划，并为外展活动发放燃料津贴。人们认为应用程序数据的有效性优于手动记录的数据。易于操作、对数据的满意度、个人认可、现场支持链接以及授权感都是强大的推动因素。花费两倍的时间来完成手动和数字输入以及随着时间的推移过时的手机被认为是限制。意想不到的连锁反应是通过数字化数据改善了地区利益相关者之间的免疫扩大计划审查平台的协调和加强。结论：将数字技术嵌入主流卫生系统取决于最终用户和地区利益相关者的使用。易于操作性、对数据可靠性的满意度、个人认可、现场支持链接和授权是强大的推动因素，而通过简单、透明的数据访问而改善的协调可能是数字化的重要副产品。研究结果不仅与巴基斯坦大规模实施免疫追踪应用程序相关，而且还为一线卫生工作者使用数字技术进行基于结果的交付提供信息。
Background: There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems.Objective: This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan.Methods: An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization Findings were triangulated in line with the three broad research areas.Results: Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data.Conclusions: Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers.