title: User Perceptions of an mHealth Medicine Dosing Tool for Community Health Workers.
abstract: BACKGROUND
  Mobile health (mHealth) technologies provide many potential benefits to the delivery of health care. Medical decision support tools have shown particular promise in improving quality of care and provider workflow. Frontline health workers such as Community Health Workers (CHWs) have been shown to be effective in extending the reach of care, yet only a few medicine dosing tools are available to them.
  
  
  OBJECTIVE
  We developed an mHealth medicine dosing tool tailored to the skill level of CHWs to assist in the delivery of care. The mHealth tool was created for CHWs with primary school education working in rural Mexico and Guatemala. Perceptions and impressions of this tool were collected and compared to an existing paper-based medicine dosing tool.
  
  
  METHODS
  Seventeen Partners In Health CHWs in rural Mexico and Guatemala completed a one-day training in the mHealth medicine dosing tool. Following the training, a prescription dosing test was administered, and CHWs were given the choice to use the mHealth or paper-based tool to answer 7 questions. Subsequently, demographic and qualitative data was collected using a questionnaire and an in-person interview conducted in Spanish, then translated into English. The qualitative questions captured data on 4 categories: comfort, acceptability, preference, and accuracy. Qualitative responses were analyzed for major themes and quantitative variables were analyzed using SAS.
  
  
  RESULTS
  82% of the 17 CHWs chose the mHealth tool for at least 1 of 7 questions compared to 53% (9/17) who chose to use the paper-based tool. 93% (13/14) rated the phone as being easy or very easy to use, and 56% (5/9) who used the paper-based tool rated it as easy or very easy. Dosing accuracy was generally higher among questions answered using the mHealth tool relative to questions answered using the paper-based tool. Analysis of major qualitative themes indicated that the mHealth tool was perceived as being quick, easy to use, and as having complete information. The mHealth tool was seen as an acceptable dosing tool to use and as a way for CHWs to gain credibility within the community.
  
  
  CONCLUSIONS
  A tailored cell phone-based mHealth medicine dosing tool was found to be useful and acceptable by CHWs in rural Mexico and Guatemala. The streamlined workflow of the mHealth tool and benefits such as the speed and self-lighting were found to be particularly useful features. Well designed and positioned tools such as this may improve effective task shifting by reinforcing the tasks that different cadres of workers are asked to perform. Further studies can explore how to best implement this mHealth tool in real-world settings, including how to incorporate the best elements of the paper-based tool that were also found to be helpful.
authors.affiliation: Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States. dpalazuelos@pih.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palazuelos
authors.forename: Assiatou B
authors.initials: AB
authors.lastname: Diallo
authors.forename: Lindsay
authors.initials: L
authors.lastname: Palazuelos
authors.forename: Narath
authors.initials: N
authors.lastname: Carlile
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Payne
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
keywords: Guatemala; Mexico; cellular phone; community health worker; decision support techniques; medical order entry systems; mobile health
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