Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 18, 2019
Date Accepted: Dec 16, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Mobile app for tracking routine immunization performance in rural Pakistan: Operable, acceptable and used for decision making?
ABSTRACT
Background:
There has been a recent spate of M-Health Applications in LMICs in the area of immunizations as well as other public health concerns, however emerging evidence is largely focused on application development or before-after effects on awareness or service coverage. There is scanty evidence on factors that facilitate adoption of mHealth programs and is critical to effectively embed digital technology into mainstream health systems.
Objective:
We bring here qualitative experiences of frontline health staff and district managers in engaging with digital real time technology for improving coverage of routine childhood immunization from an underserved rural district in Pakistan.
Methods:
An android-based application (app) was iteratively developed and applied for a two-year period in 11 union councils of district Tando Muhammad Khan, a rural underserved district with poor immunization coverage in Pakistan. Iterative methods examine the acceptability and operability of the application, validity of collected data, use of collected data, probing barriers and enablers to uptake of the mHealth application. Each of the topics was further probed in terms of i) changes from past working after introduction of immunization app, ii) barriers and enablers from app experience. In-depth interviews were conducted with all 26 vaccinators posted in the 11 union councils and 7 purposively selected key informant (government district managers) involved with EPI. Findings were triangulated in line with three broad research areas examined.th EPI.
Results:
Digital immunization tracking was commonly accepted by vaccinators and district managers. Immunization real time data was used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, course correct existing micro-plans and disburse fuel allowance for outreach sessions. Validity of app data was perceived to be superior to manual records. Easy of operability, satisfaction with data, personal recognition, links to field support and sense of empowerment served as powerful enablers. Constraints related to double consumption of time in manual and digital entries and out-dating of phone sets over time. An unintended knock on effect was improved coordination and strengthening of EPI review platforms across district stakeholders through use of digitalized data.ized data.
Conclusions:
Embedding digital technology into mainstream health systems relies on co-option by end users and district stakeholders. Easy of operability, satisfaction with data reliability, personal recognition, links to field support and empowerment are powerful enablers, whereas improved coordination as a result of transparent easy access data can be an important by-product of digitalization. Findings are relevant not only to application of digital technology for performance tracking of immunization coverage but also for result based delivery by frontline health workers. frontline health workers.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.