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 restrict effective management. Community health workers (CHWs) are critical in delivering care in these settings, and when equipped with mobile health (mHealth applications), they can greatly enhance chronic disease management. Involving CHWs in the design and development at all stages is essential for the success of such programs. Yet relatively little research discusses CHW feedback on mHealth interventions.

Objective:

This study evaluates CHW feedback on a hypertension program employing a novel tablet-based mHealth tool designed for CHW 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 data 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 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 identified training protocols as 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. Larger structural concerns identified included cultural sensitivity of certain mHealth application questions, compensation and incentives for the work, and access challenges for hard-to-reach patients. Participants also highlighted benefits of the program. These included enhanced patient care and improved hypertension management in their communities, empowerment provided by the educational tools, as well as the pride and community trust fostered by the hypertension program.

Conclusions:

Our findings suggest that iteratively integrating user feedback into the development of mHealth interventions is key to improve usability, cultural appropriateness, and overall effectiveness of chronic disease management in resource-constrained settings. However, due to the small number of CHW participants, as well as a reliance on self-reported perceptions, these findings should be interpreted as exploratory and hypothesis-generating rather than generalizable. This study contributes to the growing literature on mHealth applications for non-communicable diseases in LMICs and provides insights into CHW experiences. Addressing the technical barriers and systemic challenges identified in this study can help improve future implementations of mHealth-enabled chronic disease programs in LMICs.