title: Decreasing workload among community health workers using interactive, structured, rich-media guidelines on smartphones.
abstract: BACKGROUND
  Currently, in developing countries, there is considerable interest in using mobile phones as job-aids for community health workers (CHWs) to improve the care they provide. However, acceptance of new technologies can be inhibited if the workload imposed is perceived as excessive compared to existing methods.
  
  
  OBJECTIVE
  To compare perceived workload of CHWs using clinical care guidelines presented on mobile phones versus using conventional paper-based guidelines.
  
  
  METHODS
  Validated clinical practice guidelines were developed as Interactive Structured Rich-Medical guidelines (ISRMGs) on Windows Mobile 6.5 mobile phones. A prospective randomized controlled study was performed in Colombia in which 50 CHWs used the ISRMGs, and paper-based materials with the same information, in a cross-over design to diagnose and treat 15 matched pairs of medical cases presented on Human Patient simulators. The NASA Task Load Index, a validated measure of perceived workload, was administered and results compared by means of a mixed model analysis.
  
  
  RESULTS
  When using the ISRMGs on mobile phones the health workers reported statistically significant decreases in mental demand, frustration, and overall workload as compared to using paper-based job-aids.
  
  
  CONCLUSIONS
  Use of ISRMGs on mobile phones by community health workers in developing countries has the potential to decrease their perceived workload, fatigue, and enhance their ability to provide better care for more patients.
authors.affiliation: School of Biomedical Informatics, University of Texas, Houston, TX, USA. m.sriram.iyengar@uth.tmc.edu
authors.forename: M Sriram
authors.initials: MS
authors.lastname: Iyengar
authors.forename: Jose F
authors.initials: JF
authors.lastname: Florez-Arango
mesh_terms: D040421:Cell Phone; D003105:Colombia; D003150:Community Health Workers; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D017410:Practice Guidelines as Topic; D016526:Workload; D055815:Young Adult