Agile Development of a Smartphone App for Perinatal Monitoring in a Resource-Constrained Setting.

Area of Science:

• Global Health Technology
• Digital Health Interventions
• mHealth in Low-Resource Settings

Background:

• Smartphone technology offers a platform to empower healthcare workers with limited training and literacy, especially in low- and middle-income countries.
• Augmented audiovisual aids on smartphones can support illiterate or untrained users in healthcare settings.
• Perinatal surveillance in rural Guatemala faces challenges with lay midwives possessing low literacy and technology exposure.

Purpose of the Study:

• To describe the iterative design and refinement of a smartphone application prototype for perinatal surveillance.
• To address technical and cultural challenges in developing a robust in-field system for indigenous Maya lay midwives.
• To evaluate the system's feasibility, acceptance, utilization, and data quality in a real-world setting.

Main Methods:

• Agile development approach with remote and in-country collaboration with end-users (midwives).
• Two-phase prototype refinement with expanding end-user groups.
• Iterative review of data quality, user feedback, and analysis of system usage and support requirements.

Main Results:

• Identified and addressed weaknesses such as user error with hardware interfaces and poor data upload bandwidth.
• Developed safety nets to mitigate identified issues.
• The resultant system demonstrated high acceptance and utilization by end-users, with monthly increases in high-quality recordings.

Conclusions:

• Iterative design and user collaboration are crucial for developing effective mHealth tools in low-resource settings.
• The smartphone application shows promise for improving perinatal surveillance among low-literacy healthcare providers.
• Further analysis from an ongoing randomized controlled trial is pending to determine the system's impact on clinical outcomes.