Medhanyie Araya Abrha, Little Alex, Yebyo Henock, Spigt Mark, Tadesse Kidane, Blanco Roman, Dinant Geert-Jan
Department of Public Health, College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia.
Hum Resour Health. 2015 Jan 15;13(1):2. doi: 10.1186/1478-4491-13-2.
Mobile health (mHealth) applications, such as innovative electronic forms on smartphones, could potentially improve the performance of health care workers and health systems in developing countries. However, contextual evidence on health workers' barriers and motivating factors that may influence large-scale implementation of such interfaces for health care delivery is scarce.
A pretested semistructured questionnaire was used to assess health workers' experiences, barriers, preferences, and motivating factors in using mobile health forms on smartphones in the context of maternal health care in Ethiopia. Twenty-five health extension workers (HEWs) and midwives, working in 13 primary health care facilities in Tigray region, Ethiopia, participated in this study.
Over a 6-month period, a total of 2,893 electronic health records of 1,122 women were submitted to a central computer through the Internet. Sixteen (69.6%) workers believed the forms were good reminders on what to do and what questions needed to be asked. Twelve (52.2%) workers said electronic forms were comprehensive and 9 (39.1%) workers saw electronic forms as learning tools. All workers preferred unrestricted use of the smartphones and believed it helped them adapt to the smartphones and electronic forms for work purposes. With regards to language preference, 18 (78.3%) preferred using the local language (Tigrinya) version of the forms to English. Indentified barriers for not using electronic forms consistently include challenges related to electronic forms (for example, problem with username and password setting as reported by 5 (21.7%), smartphones (for example, smartphone froze or locked up as reported by 9 (39.1%) and health system (for example, frequent movement of health workers as reported by 19 (82.6%)).
Both HEWs and midwives found the electronic forms on smartphones useful for their day-to-day maternal health care services delivery. However, sustainable use and implementation of such work tools at scale would be daunting without providing technical support to health workers, securing mobile network airtime and improving key functions of the larger health system.
移动健康（mHealth）应用程序，如智能手机上的创新电子表单，有可能提高发展中国家医护人员的工作表现和卫生系统的效能。然而，关于可能影响大规模采用此类医疗服务界面的卫生工作者的障碍和激励因素的背景证据却很匮乏。
采用预先测试的半结构化问卷，在埃塞俄比亚孕产妇保健背景下，评估卫生工作者在使用智能手机上的移动健康表单方面的经验、障碍、偏好和激励因素。在埃塞俄比亚提格雷地区的13个初级卫生保健机构工作的25名卫生推广工作者（HEW）和助产士参与了本研究。
在6个月的时间里，共有1122名妇女的2893份电子健康记录通过互联网提交到中央计算机。16名（69.6%）工作人员认为这些表单是关于该做什么和需要问什么问题的良好提醒。12名（52.2%）工作人员表示电子表单内容全面，9名（39.1%）工作人员将电子表单视为学习工具。所有工作人员都希望能不受限制地使用智能手机，并认为这有助于他们为工作目的而适应智能手机和电子表单。关于语言偏好，18名（78.3%）工作人员更喜欢使用当地语言（提格雷尼亚语）版本的表单，而非英语版本。确定的未持续使用电子表单的障碍包括与电子表单相关的挑战（例如，5名（21.7%）工作人员报告的用户名和密码设置问题）、智能手机相关的问题（例如，9名（39.1%）工作人员报告的智能手机死机或锁定）以及卫生系统相关的问题（例如，19名（82.6%）工作人员报告的卫生工作者频繁调动）。
卫生推广工作者和助产士都发现智能手机上的电子表单对他们日常的孕产妇保健服务提供很有用。然而，如果不向卫生工作者提供技术支持、确保移动网络通话时间并改善更大卫生系统的关键功能，大规模可持续地使用和实施此类工作工具将是一项艰巨的任务。
