title: Acceptability, Usability, and Views on Deployment of Peek, a Mobile Phone mHealth Intervention for Eye Care in Kenya: Qualitative Study.
abstract: BACKGROUND
  The Portable Eye Examination Kit (Peek) is a mobile phone-based ophthalmic testing system that has been developed to perform comprehensive eye examinations. Shortages in ophthalmic personnel, the high cost, and the difficulty in transporting equipment have made it challenging to offer services, particularly in rural areas. Peek offers a solution for overcoming barriers of limited access to traditional ophthalmic testing methods and has been pilot tested on adults in Nakuru, Kenya, and compared with traditional eye examination tools.
  
  
  OBJECTIVE
  This qualitative study evaluated the acceptability and usability of Peek in addition to perceptions regarding its adoption and nationwide deployment.
  
  
  METHODS
  Semistructured interviews were conducted with patients and analyzed using a framework approach. This included analysis of interviews from 20 patients, 8 health care providers (HCPs), and 4 key decision makers in ophthalmic health care provision in Kenya. The participants were purposefully sampled. The coding structure involved predefined themes for assessing the following: (1) the context, that is, environment, user, task, and technology; (2) patient acceptability, that is, patients' perceived benefits, patient preference, and patient satisfaction; (3) usability, that is, efficiency, effectiveness, learnability, and flexibility and operability of Peek; and (4) the benefits of Peek in strengthening eye care provision, that is, capabilities enhancer, opportunity creator, social enabler, and knowledge generator. Emerging themes relating to the objectives were explored from the data using thematic analysis.
  
  
  RESULTS
  Patients found Peek to be acceptable because of its benefits in overcoming the barriers to accessing ophthalmic services. Most thought it to be fast, convenient, and able to reach a large population. All patients expressed being satisfied with Peek. The HCPs perceived it to satisfy the criteria for usability and found Peek to be acceptable based on the technology acceptance model. Peek was also found to have features required for strengthening ophthalmic delivery by aiding detection and diagnosis, provision of decision support, improving communication between provider and patient and among providers, linking patients to services, monitoring, and assisting in education and training. Some of the deployment-related issues included the need for government and community involvement, communication and awareness creation, data protection, infrastructure development including capacity creation, and training and maintenance support.
  
  
  CONCLUSIONS
  According to all parties interviewed, Peek is an acceptable solution, as it provides a beneficial service, supports patients' needs, and fulfills HCPs' roles, overall contributing to strengthening eye health.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom. vaishali.lodhia@gmail.com.
authors.forename: Vaishali
authors.identifier: http://orcid.org/0000-0002-7460-4902
authors.initials: V
authors.lastname: Lodhia
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0001-5275-5534
authors.initials: S
authors.lastname: Karanja
authors.forename: Shelley
authors.identifier: http://orcid.org/0000-0003-0062-7930
authors.initials: S
authors.lastname: Lees
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0001-8179-556X
authors.initials: A
authors.lastname: Bastawrous
keywords: Kenya; acceptability; mHealth; mobile phone; ophthalmic testing; qualitative; usability