Development and Usability of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana

The majority of new cancer cases are expected to be diagnosed in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths currently occur in LMICs. Treatment adherence, patient monitoring, and follow-up are essential to cancer care but are often not possible in these settings. Out Patient (OP) Care, a smartphone application (app) developed to fill this gap, texts appointment reminders to patients and electronically stores medical records confidentially.

This study aims to present the development of this app and evaluate its usability and feasibility as defined by provider and patient experiences in the context of a multidisciplinary cancer clinic in Gaborone, Botswana.

OP Care was piloted at a multidisciplinary team gynecologic oncology clinic in Gaborone, Botswana. The app was developed through an iterative process with feedback from clinic staff and physicians. The usability was evaluated using a cross-sectional survey. All staff members in the gynecologic oncology clinic, which typically consists of one doctor and four nurses, as well as a portion of the staff in the (Princess Marina Hospital general) oncology ward used the app. All providers using the app were surveyed, along with all patients who attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reactions, and opinions on usability, as well as patients' reactions to the appointment reminders were collected. Agreement to the ease-of-usability statements was recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the app's usability and the feasibility of text reminders from the patient's perspective.

Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses and encompassed all of the staff in the gynecologic oncology clinic as well as a portion of the general oncology ward. All surveyed staff owned a smartphone and used a computer at home. Most (78%) staff did not feel that OP Care would increase their work burden and were willing to use the app if implemented permanently (median: 6; interquartile range [IQR]: 1). Seventeen out of the nineteen usability questions, such as "I feel comfortable using this system," scored a median of 6, corresponding to "very much so." Patients reported that the reminder text messages were helpful (median: 6; IQR: 1) and preferred the text reminders to be in Setswana (median: 7; IQR: 1).

High usability scores indicate that the app can be scaled up to usage in this clinic and others. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated.