The Vinyasa Tool for mHealth solutions: supporting human-centered design in nascent digital health ecosystems.

Abstract

mHealth systems have been deployed widely in Lower- and Middle-Income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by healthcare workers. A human-centered design approach to improve mHealth system use requires an exploration of users' perceptions of mHealth systems including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration prior to full-scale development and deployment. To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design, and consequently, successful adoption. We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann (2017) to label, sort and collate findings and themes into a list of questions which explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. We developed the Vinyasa Tool - to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based healthcare workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections which unpack and explore multiple aspects of mHealth systems from the perspectives of its users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow and adoption behavior of a system's users; the security, privacy and interoperability afforded by a system; and the artifacts of an information system - the data, information, knowledge, algorithms and technology which constitute the system. The tool can be deployed in whole or in part, depending on the context of study. The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it will find wide application among mHealth developers, health system administrators and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human centered design with the goal of improving relevance and usability, and therefore, adoption.