IMPLEMENTATION OF HEALTH-RELATED SMARTPHONE APPLICATIONS IN LOW- AND MIDDLE- INCOME COUNTRIES: SCOPING REVIEW AND LEARNINGS FROM THE CHILDSAFE APPLICATION IN MALAYSIA

Abstract

While digital technologies such as smartphone apps have become an increasingly popular way to deliver health interventions, implementation and scale up remains a recognized challenge. Recently, the Johns Hopkins International Injury Research Unit and the Institute for Public Health in Malaysia collaborated in the development of a smartphone app for child injury prevention called ChildSafe that was piloted in Malaysia. The aim of this dissertation was to better understand the implementation of health apps in low- and middle-income countries to identify opportunities and gaps for future research, as well as to strengthen the design, implementation, and dissemination of the ChildSafe app. We had three objectives: 1) to better understand the current state of the peer-reviewed literature on the use and implementation of health apps in low- and middle-income countries; 2) to assess the adoption, fidelity, acceptability, and process of user engagement through the ChildSafe app; and 3) to examine the facilitators and barriers to implementation of the ChildSafe app from the perspective of caregivers of children under five. This dissertation comprises of three manuscript-oriented chapters, each presenting the results from one of these objectives. The first manuscript, “Use and Implementation of Health-Related Smartphone Apps in Low- and Middle-Income Countries” presents the results of a scoping review that identified gaps in the literature on the implementation of health apps in low- and middle-income countries. Building on these learnings, the second manuscript, “Adoption, Fidelity, and Acceptability of a Smartphone App for Child Injury Prevention” assessed the implementation of the ChildSafe app from multiple dimensions to generate insight to strengthen its design, implementation, and dissemination that may be relevant to other similar health apps. Finally, the third manuscript, “Facilitators and Barriers to Use and Implementation of a Smartphone App for Child Injury Prevention in Malaysia” applied an established implementation framework to identify facilitators and barriers to use and implementation of the ChildSafe app to contribute to a broader conceptual understanding of the implementation of health apps. Together, these manuscripts make the case for and demonstrate the value of considering implementation from the early stages of digital development through implementation and scale up