Greenberg Anya L, Rose Christian C, Nicholaus Paulina, Mfinanga Juma A, Sawe Hendry R, Tenner Andrea G
School of Medicine, University of California, San Francisco, CA, United States of America.
Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States of America.
Afr J Emerg Med. 2021 Jun;11(2):325-330. doi: 10.1016/j.afjem.2021.04.001. Epub 2021 May 4.
The World Health Organization's (WHO's) Basic Emergency Care (BEC) course was developed to address training gaps in low- and middle-income countries (LMICs). Simultaneously, LMICs have experienced an unprecedented increase in the number of cell phone and internet users. We developed a mobile application adjunct to the BEC course (BEC app) and sought to assess the reach of the BEC app.
Forty-six BEC course participants, made up of doctors and nurses from three hospital sites in Tanzania, were given access to the BEC app with download instructions. Moderators tracked mobile access characteristics and barriers. This is a descriptive study outlining the implementation of the BEC app and associated findings from the process.
Fewer than 10% of participants were able to independently download and use the application. The download process revealed three key barrier areas: accessibility (no smartphone, smartphone without charge, no access to data/WiFi to download app, increased cost of data), technical (outdated operating system, inconsistent access to data/WiFi to run the app, insufficient phone storage), and participant-related characteristics (variability in smartphone literary, language discordance, smartphone turnover). Of the 46 participants, 29 (63%) were able to download and use the BEC app successfully with moderator support.
There is potential utility of mobile health in LMICs. However, barriers still exist to reaching the largest possible audience for these initiatives. The importance of app compatibility with a broad range of operating systems and limitation of the amount of data needed to download and use the app was underscored by our study. Moreover, creative solutions are needed to facilitate large-scale roll-outs of mobile health interventions, such as a distribution model that relies on super user and peer support rather than an individual moderator. Additional local perspectives on the download process and the utilisation and acceptance of the application post-implementation are needed.
世界卫生组织（WHO）的基础急救护理（BEC）课程旨在解决低收入和中等收入国家（LMICs）的培训差距。与此同时，低收入和中等收入国家的手机和互联网用户数量经历了前所未有的增长。我们开发了一款BEC课程的移动应用程序辅助工具（BEC应用程序），并试图评估BEC应用程序的覆盖范围。
46名BEC课程参与者，由来自坦桑尼亚三个医院站点的医生和护士组成，获得了带有下载说明的BEC应用程序。主持人跟踪移动访问特征和障碍。这是一项描述性研究，概述了BEC应用程序的实施情况以及该过程中的相关发现。
不到10%的参与者能够独立下载和使用该应用程序。下载过程揭示了三个关键障碍领域：可及性（没有智能手机、智能手机无费用、无法访问数据/无线网络来下载应用程序、数据成本增加）、技术（操作系统过时、运行应用程序时无法持续访问数据/无线网络、手机存储空间不足）以及与参与者相关的特征（智能手机知识的差异、语言不一致、智能手机更换）。在46名参与者中，29名（63%）在主持人的支持下能够成功下载并使用BEC应用程序。
移动健康在低收入和中等收入国家具有潜在效用。然而，要让这些举措覆盖尽可能多的受众，障碍仍然存在。我们的研究强调了应用程序与广泛操作系统的兼容性以及下载和使用应用程序所需数据量的限制的重要性。此外，需要有创造性的解决方案来促进移动健康干预措施的大规模推广，例如一种依赖超级用户和同伴支持而非单个主持人的分发模式。还需要关于下载过程以及应用程序实施后其使用和接受情况的更多当地视角。
