Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study
Department of Computer Science, University of Botswana, Gaborone (with the University of Rochester, the University of Pennsylvania and Princess Marina Hospital)
How they used Delve
Digital health researchers at the University of Botswana used Delve to code interviews with 17 healthcare workers against a predefined ten-code framework, with three researchers coding independently, producing four themes on the governance, infrastructure, capacity and usability barriers to a dermatology decision support system.
“Interview transcripts were uploaded to the Delve software for coding. Qualitative interview data were analyzed using the widely accepted principles of thematic analysis by Terry et al [32] to categorize data into key themes, which were later aligned to TAM constructs. Iterative transcript review and deductive coding [33] were performed independently by NS, RG, and M Molwantwa.”
- Field
- Digital health and technology acceptance; a dermatology clinical decision support system in a resource-limited setting
- Data
- Semi-structured interviews with 17 of the 28 healthcare workers who took part (61%), alongside REDCap surveys of all 28 and VisualDx app usage logs covering 681 recorded uses, captured March to August 2021
- Approach
- Explanatory sequential mixed methods informed by the Technology Acceptance Model, with thematic analysis following Terry et al.; iterative transcript review and deductive coding performed independently by three researchers against a predefined list of ten descriptive codes agreed by all authors, with subcodes for finer categorisation, then grouped into four broad themes and aligned to TAM constructs
- Data types
- Interviews, Open-ended survey responses
Abstract
BACKGROUND: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx-an exemplar CDSS-was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users’ perceptions about the technology. OBJECTIVE: This study aims to determine health care workers’ acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. METHODS: The study’s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. RESULTS: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants’ survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. CONCLUSIONS: Participants’ responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries.
Citation
Kagiso Ndlovu, Nate Stein, Ruth Gaopelo, Michael Annechino, Mmoloki Cornelius Molwantwa, Mosadikhumo Monkge, Amy Forrestel, Victoria Williams (2023). Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study. JMIR Formative Research. https://doi.org/10.2196/48946