Effect of mobile application user interface improvements on minimum expected home visit coverage by community health workers in Mali: a randomised controlled trial

Jane E Yang; Diego Lassala; Jenny X Liu; Caroline Whidden; Isaac Holeman; Youssouf Keita; Yasamba Djiguiba; Sory Ibrahima N'Diaye; Fatou Fall; Kassoum Kayentao; Ari D Johnson

doi:10.1136/bmjgh-2021-007205

Effect of mobile application user interface improvements on minimum expected home visit coverage by community health workers in Mali: a randomised controlled trial

BMJ Glob Health. 2021 Nov;6(11):e007205. doi: 10.1136/bmjgh-2021-007205.

Authors

Jane E Yang¹, Diego Lassala², Jenny X Liu³, Caroline Whidden², Isaac Holeman^{4

5

6}, Youssouf Keita², Yasamba Djiguiba², Sory Ibrahima N'Diaye², Fatou Fall⁷, Kassoum Kayentao^{2

8}, Ari D Johnson^{9

10}

Affiliations

¹ Muso, San Francisco, California, USA jemilieyang@gmail.com.
² Muso, Bamako, Mali.
³ Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.
⁴ Medic, San Francisco, California, USA.
⁵ Department of Human Centered Design & Engineering, University of Washington, Seattle, Washington, USA.
⁶ Department of Global Health, University of Washington, Seattle, Washington, USA.
⁷ Medic, Dakar, Senegal.
⁸ Malaria Research & Training Centre, University of Sciences Techniques and Technologies, Bamako, Mali.
⁹ Muso, San Francisco, California, USA.
¹⁰ Department of Medicine, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.

Abstract

Background: Proactive community case management (ProCCM) has shown promise to advance goals of universal health coverage (UHC). ProCCM community health workers (CHWs) face operational challenges when pursuing their goal of visiting every household in their service area at least twice monthly to proactively find sick patients. We developed a software extension (UHC Mode) to an existing CHW mobile application featuring user interface design improvements to support CHWs in planning daily home visits. We evaluated the effect of UHC Mode on minimum expected home visit coverage.

Methods: We conducted a parallel-group, two-arm randomised controlled trial of ProCCM CHWs in two separate regions in Mali. CHWs were randomly assigned to UHC Mode or the standard mobile application (control) with a 1:1 allocation. Randomisation was stratified by health catchment area. CHWs and other programme personnel were not masked to arm allocation. CHWs used their assigned intervention for 4 months. Using a difference-in-differences analysis, we estimated the mean change in minimum expected home visit coverage from preintervention to postintervention between arms.

Results: Enrolment occurred in January 2019. Of 199 eligible CHWs randomised to the intervention or control arm, 196 were enrolled and 195 were included in the analysis. Households whose CHW used UHC Mode had 2.41 times higher odds of minimum expected home visit coverage compared with households whose CHW used the control (95% CI 1.68 to 3.47; p<0.0005). Minimum expected home visit coverage in the UHC Mode arm increased 13.6 percentage points (95% CI 8.1 to 19.0) compared with the control arm.

Conclusion: Our findings suggest UHC Mode is an effective tool that can improve home visit coverage and promote progress towards UHC when implemented in the ProCCM context. User interface design of health information systems that supports health workers' daily practices and meets their requirements can have a positive impact on health worker performance and home visit coverage.

Trial registration number: NCT04106921.

Keywords: health services research; other diagnostic or tool; prevention strategies; public health; randomised control trial.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Community Health Workers
House Calls*
Humans
Mali
Mobile Applications*

Associated data

ClinicalTrials.gov/NCT04106921