JMIR Publications

ABSTRACT

Background:

Documenting the development of mobile health (mHealth) tools is crucial for enabling future projects to build on existing knowledge. Effective documentation supports the refinement of design, implementation, and evaluation processes, facilitating the scale-up and adaptation of health interventions across diverse contexts.

Objective:

In this paper, we describe how we developed the eCase Manager, a WhatsApp-based chatbot designed to facilitate linkage-to-care for household contacts of TB patients by providing nudges, reminders, and personalised support. We developed the eCase Manager to address the human resource capacity challenges posed by South Africa's new universal TB testing and tuberculosis preventive treatment (TPT) policies.

Methods:

We applied a design thinking framework with seven phases—empathise, discover, define, prototype, build and launch, improve, and evaluate—to develop the eCase Manager. The process started with gathering insights from TB contact tracing studies and consulting with global and local experts to address the challenges of universal TB testing and TPT. From these findings, we defined the core functionalities of the eCase Manager and incorporated the health belief model (HBM) to encourage health-seeking behaviour. In collaboration with Reach Digital Health, we developed the WhatsApp-based chatbot, selecting WhatsApp for its wide accessibility and user-friendliness.

Results:

We successfully developed and launched the eCase Manager in September 2023, with implementation expected to continue until March 2025. Ongoing evaluations, guided by the RE-AIM framework, assess the tool’s impact on reducing community health worker workloads and improving linkage-to-care efficiency. Additionally, we plan to translate the chatbot into local languages to enhance accessibility and scale it up for broader use in programmatic settings.

Conclusions:

Documenting the development of mHealth technologies is crucial for guiding future projects and improving health interventions. In our study, frameworks like design thinking and the health belief model aligned the eCase Manager with user needs and programmatic goals. This approach addressed challenges in TB linkage-to-cares and allowed for iterative improvements through stakeholder feedback. Sharing this process offers insights for future mHealth developers, helping them tackle common issues like limited human resources and patient engagement. Comprehensive documentation may help assess the chatbot's performance and guide future improvements, supporting scalability and efficiency in mHealth interventions across public health settings.