Leveraging mHealth usage logs to inform health worker performance in a Resource-Limited setting: Case example of mUzima use for a chronic disease program in Western Kenya

Simon Savai; Jemimah Kamano; Lawrence Misoi; Peter Wakholi; Md Kamrul Hasan; Martin C Were

doi:10.1371/journal.pdig.0000096

Leveraging mHealth usage logs to inform health worker performance in a Resource-Limited setting: Case example of mUzima use for a chronic disease program in Western Kenya

PLOS Digit Health. 2022 Sep 1;1(9):e0000096. doi: 10.1371/journal.pdig.0000096. eCollection 2022 Sep.

Authors

Simon Savai¹, Jemimah Kamano^{2

3}, Lawrence Misoi³, Peter Wakholi⁴, Md Kamrul Hasan⁵, Martin C Were⁶

Affiliations

¹ Institute of Biomedical Informatics, Moi University, Eldoret, Kenya.
² School of Medicine, Moi University, Eldoret, Kenya.
³ Moi Teaching and Referral Hospital, Eldoret, Kenya.
⁴ School of Computing and Informatics Technology, Makerere University, Kampala, Uganda.
⁵ Department of Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America.
⁶ Department of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.

Abstract

Background: Health systems in low- and middle-income countries (LMICs) can be strengthened when quality information on health worker performance is readily available. With increasing adoption of mobile health (mHealth) technologies in LMICs, there is an opportunity to improve work-performance and supportive supervision of workers. The objective of this study was to evaluate usefulness of mHealth usage logs (paradata) to inform health worker performance.

Methodology: This study was conducted at a chronic disease program in Kenya. It involved 23 health providers serving 89 facilities and 24 community-based groups. Study participants, who already used an mHealth application (mUzima) during clinical care, were consented and equipped with an enhanced version of the application that captured usage logs. Three months of log data were used to determine work performance metrics, including: (a) number of patients seen; (b) days worked; (c) work hours; and (d) length of patient encounters.

Principal findings: Pearson correlation coefficient for days worked per participant as derived from logs as well as from records in the Electronic Medical Record system showed a strong positive correlation between the two data sources (r(11) = .92, p < .0005), indicating mUzima logs could be relied upon for analyses. Over the study period, only 13 (56.3%) participants used mUzima in 2,497 clinical encounters. 563 (22.5%) of encounters were entered outside of regular work hours, with five health providers working on weekends. On average, 14.5 (range 1-53) patients were seen per day by providers.

Conclusions / significance: mHealth-derived usage logs can reliably inform work patterns and augment supervision mechanisms made particularly challenging during the COVID-19 pandemic. Derived metrics highlight variabilities in work performance between providers. Log data also highlight areas of suboptimal use, of the application, such as for retrospective data entry for an application meant for use during the patient encounter to best leverage built-in clinical decision support functionality.

Copyright: © 2022 Savai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was made possible by the support of the American people through the United States Agency for International Development (USAID, grant number 7200AA18CA00019) and the Norwegian Agencies for Development Cooperation under the NORHED program (Norad: Project QZA-0484). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.