How can smartphones be used to support health workers in low and middle income countries?

A report from the workshop on mobile health, Green Templeton College, Oxford, May 2018
By Chris Paton & Alan Silman, Oxford University
 
Background
Adoption of smartphones and other mobile technologies for supporting healthcare workers has reached ubiquity in many high-income settings, and is increasing dramatically across low- and middle-income countries. Digital health interventions have the potential to increase access to healthcare services and make the delivery of healthcare more efficient and effective. Sending healthcare information electronically in digital form can reduce errors and the message can get through much more quickly than through paper systems. However, digital health systems can also introduce a range of new problems and large-scale implementations can magnify negative consequences.
 
National regulators have recently produced guidance that highlights the need for new evidence for effectiveness of digital health applications that are used by healthcare workers. However, there are no clear answers to how digital health applications can be best utilised and implemented to improve health.
 
Over the 2-day workshop in May 2018, we brought together global experts on digital health co-design from around the world.
 
There were a number of key messages that emerged:
 
1. There is a disconnect between the current suite of design and development methodologies and the evidence that supports the adoption or non-adoption of digital health interventions in a robust and scientifically valid manner.
 
2. Co-design needs to be embedded in the digital health projects by bringing in end-users and stakeholders early in the design process and using iterative development to ensure their views and interests are met.
 
3. Many of the digital health interventions are informed by behaviour-change frameworks but should also use evidence from human factors studies to ensure that applications are safe and resistant to human error and ensuring acceptability and performance in real-world use.
 
4. Regulators in high-income countries are increasingly required evidence to support the effectiveness of digital health interventions. Using evidence-based features and implementation case studies based on NASSS may offer more cost-effective guide to potential clinical effectiveness for low-risk apps and contribute to more efficient development of apps that will eventually require RCTs while minimising the potential for non-adoption or abandonment.
 

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