JMIR Publications

ABSTRACT

Background:

Hypertension remains a leading global health challenge, particularly in low- and middle-income countries (LMICs), where limited healthcare infrastructure and resources limit effective management. Community health workers (CHWs) are critical in delivering care in these settings, and mobile health (mHealth) applications offer a promising strategy to enhance chronic disease management. Involving CHWs in the design and development at all stages is essential for the success of the program, yet this is not common in the literature.

Objective:

This study aims to evaluate CHW involvement through feedback on a hypertension program employing a novel tablet-based mHealth tool designed for hypertension diagnosis and management in rural Guatemala.

Methods:

We conducted a mixed-methods analysis as part of a pilot study in San Lucas Tolimán, Guatemala, involving six CHWs over a six-month period. Quantitative data were collected using the System Usability Scale (SUS) and Likert-scale surveys before and after study completion. Qualitative insights were gathered through written surveys and focus group interviews conducted in Spanish by bilingual team members. These methods assessed the application’s ease of use, workflow integration, and cultural appropriateness. CHWs provided detailed perspectives on technical challenges, training adequacy, and patient engagement, which guided iterative refinements to both the mHealth application and the overall hypertension management program.

Results:

The mHealth application was generally well-received. Average SUS scores exceeded 70, surpassing established usability thresholds. Likert scale data revealed CHWs found the application to be useful and easy to use, but found technician support and training protocols as key areas for improvement. Through focus groups and written surveys, participants identified practical short term areas for improvement regarding training, medication dosing, transparency in treatment protocols, fasting for laboratory testing, and survey burden and redundancy. Larger structural concerns identified by participants highlighted cultural sensitivity of certain mHealth application questions, compensation and incentives for the work, and access challenges for hard-to-reach patients. Participants shared the benefits of the program, with key themes including enhanced patient care and improved hypertension management in their communities, the empowerment provided by the educational tools, the streamlined workflow and visit efficiency, as well as the pride and community trust fostered by the hypertension program.

Conclusions:

Our findings demonstrate that iteratively integrating user feedback into the development and refinement of mHealth interventions is key to improve usability, cultural appropriateness, and overall effectiveness of chronic disease management in resource-constrained settings. This study contributes to the growing literature on mHealth applications for non-communicable diseases in LMICs and provides a scalable model for incorporating local insights into health technology design. Addressing both technical barriers and systemic challenges is essential for sustainable impact, improved CHW performance, and ultimately, a reduction in the burden of hypertension in underserved communities. Clinical Trial: Our ongoing clinical trial: NCT06444308 (ClinicalTrials.gov ID)