DECENT: A sociotechnical approach for developing mobile health apps in underserved settings

Area of Science:

• Digital Health
• Human-Computer Interaction
• Health Informatics

Background:

• User engagement is crucial for mobile health (mHealth) intervention effectiveness in the Global South.
• Many mHealth interventions fail due to overlooking sociotechnical aspects during development.
• Care professionals are the intended users for the mHealth technologies studied.

Purpose of the Study:

• To identify facilitators and barriers to user engagement in mHealth apps for care professionals.
• To understand how sociotechnical factors influence engagement with mHealth interventions.
• To propose a framework for designing more engaging mHealth apps.

Main Methods:

• Conducted five semi-structured interviews and one pilot interview.
• Analyzed interview data using NVivo software.
• Applied the Capability, Opportunity, Motivation - Behaviour (COM-B) model to map engagement factors.

Main Results:

• Capability facilitators include learning resources and routine-building features; barriers include lack of skills and cognitive overload.
• Social connectedness and offline functionality facilitate engagement, while non-user-friendly design and cultural factors are barriers.
• Motivational facilitators include early engagement and rewards; barriers include perceived non-utility and lack of encouragement.

Conclusions:

• Several factors across COM-B components can enhance mHealth app engagement.
• A techno-centric approach neglecting sociotechnical factors reduces user engagement.
• The Design Process Engagement Enhancement System (DECENT) framework is proposed based on study findings.