Iterative Development of a Mobile Phone Application to Support Community Health Volunteers during Cervical Cancer Screening in Western Kenya: Qualitative Study (Preprint)

Abstract

To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)-based screening at a population level. While mobile health (mhealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mhealth interventions is dependent upon context-specific development that is acceptable and useable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products which reflect the needs, desires, and capabilities of target users.

We sought to develop a mobile health application (“mSaada”) to support HPV-based screening in partnership with community health volunteers and program planners in western Kenya.

A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through two waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience delivering screening services. During sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality.

Eighteen Community Health Volunteers (CHVs) and clinicians took part in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included: altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real-time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility- and health system-level, specifically the inclusion of a report generating tool consistent with Ministry of Health standards.

Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile application ready for pilot testing in HPV-based screening programs led by CHVs.