JMIR Publications

ABSTRACT

Background:

Although mobile health technologies hold great promise in improving the delivery of high-quality healthcare services, little research has demonstrated that a mobile health (mHealth) platform can improve the quality of stroke care in rural China and in other similar resource-constrained settings.

Objective:

This paper presented the design and development of a smart and multifaceted mHealth system and its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) for strengthening the secondary prevention of stroke in rural China.

Methods:

The design and development of the SINEMA mHealth system was enabled by a multi-disciplinary team comprising public health researchers, neurologists and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following five steps: 1) assessing the broad needs of relevant stakeholders through in-depth interviews of 49 participants in Nanhe County, Hebei Province, China; 2) designing the functional modules and evidence-based content; 3) designing the system’s structure and user interface and developing system; 4) improving and enhancing the system through a three-month pilot testing in four villages; 5) finalizing the system and evaluating its feasibility through a user trial and survey.

Results:

Primary healthcare providers (including 12 village doctors and 5 township physicians) involved in the interviews demonstrated great needs in receiving appropriate training and support for delivering high-quality services for stroke patients living in the villages, and they also showed great interests in using the mHealth technologies and tools. Based on these findings from 49 in-depth interviews, we designed a multifaceted mHealth system with seven functional modules by following the iterative design and software development approach. The mHealth system, involving an Android-based mobile application for three different types of end-users, was developed, which was then utilized in a study trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients during July 2017 to July 2018. A survey on the usability and functions of the mHealth system among village doctors (one main group of end-users, n=24) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study.

Conclusions:

Designed and developed by a multidisciplinary team, the mHealth system was feasible for assisting primary healthcare providers in rural China in delivering a system-integrated, technology enabled model of care on the secondary prevention of stroke. Further research and initiatives on how to scale up the innovative SINEMA approach and this mHealth reference system to other resource-limited areas will likely enhance the quality and accessibility of essential secondary prevention among stroke patients. Clinical Trial: The trial was registered with clinicaltrials.gov (NCT03185858).