Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study

BACKGROUND: Mobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting. METHODS: We conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction. RESULTS: All of the participants were women, ranging from 18–64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas. CONCLUSION: In a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health

Characteristics associated with the patient-centered posture of medical graduates

O cuidado centrado no paciente se mostra hoje como uma dimensão fundamental no cuidado em saúde e um dos requisitos para a formação de um médico de excelência. O presente trabalho se propõe a analisar os fatores associados ao cuidado centrado no paciente em uma amostra de egressos de medicina no ano de 2020. A coleta de dados foi realizada na matrícula dos programas de residência de acesso direto de um grande hospital da cidade de São Paulo, Brasil (o hospital da Irmandade da Santa Casa de Misericórdia de São Paulo). Do universo de 199 matriculados, 145 indivíduos responderam a pesquisa que constava de um questionário sociodemográfico e um questionário para a mensuração da orientação médico paciente, a Escala de Orientação Médico Paciente (EOMP). Os resultados apontam para uma tendência de cuidado centrado no paciente em indivíduos do gênero feminino, apesar de médias absolutas da EOMP centradas no médico e uma tendência de cuidado centrado no médico em indivíduos que optaram por carreiras cirúrgicas. As variáveis religiosidade e percepção de felicidade não mostraram associação com o cuidado centrado no paciente. Em vista dos resultados discute-se a hipótese de que a carreira médica ainda não apresente espaços seguros e role models para a representação feminina e que o cuidado centrado no médico dos indivíduos que optaram pelas carreiras cirúrgicas faça parte de um habitus do grupo social dos cirurgiões que tem raízes na construção histórica da Faculdade de Medicina atualPatient-centered care is shown today as a fundamental dimension in health care and one of the requirements for training a doctor. This study aims to analyze the factors associated with patient-centered care in a sample of medical graduates in 2020. Data collection was performed on enrollment in direct access residency programs at a large hospital in the city of São Paulo. Paulo, Brazil (the Hospital of the Irmandade da Santa Casa de Misericórdia de São Paulo). From the universe of 199 enrolled, 145 individuals responded to a survey that consisted of a sociodemographic questionnaire and a questionnaire for measuring patient-physician guidance, the Patient-practitioner orientation scale (PPOS). The results point to a trend toward patient-centered care in females, despite absolute physician-centered PPOS means and a trend toward physician-centered care in individuals who have opted for surgical careers. The variables religiosity and perception of happiness showed no association with patient-centered care. In view of the results, the hypothesis is discussed that the medical career does not yet present safe spaces and role models for female representation and that the physician-centered care of individuals who opted for surgical careers is part of a habitus of the surgeons\' social group which has roots in the historical construction of the current Faculty of Medicin

Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study.

BackgroundMobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting.MethodsWe conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction.ResultsAll of the participants were women, ranging from 18-64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas.ConclusionIn a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health