dissertationOne out of every six children in sub-Saharan Africa dies from treatable diseases before reaching age 5. Millions of these deaths could be averted if health care providers followed evidence-based protocols, such as the Integrated Management of Childhood Illnesses (IMCI), to provide care. IMCI assists providers to diagnose and treat problems for children under 5, and specifies key information for the provider to teach to the child's caretaker. While IMCI has been adopted as official policy throughout Tanzania, the protocol has been neither universally used nor consistently followed. An innovative IMCI-based protocol that runs on a mobile phone, called eIMCI, was designed for this study using user-centered design (UCD) principles to assist provider navigation of the protocol and improve provider-caretaker communication of key information points, including the problem and treatment of the child, and when to return to the clinic. The electronic protocol, eIMCI, was compared to an equivalent paper-based protocol, pIMCI. This study was based on the mHealth Communications Theoretical Framework. The aims of the study were to (1) utilize UCD design principles to develop eIMCI and evaluate its usability, and (2) evaluate the effect of protocol delivery platform on (a) provider communication and (b) caretaker recall of key information points. A randomized cluster trial was conducted in which health care clinics in Tanzania were randomized to implement each platform. Results suggested that electronic protocol use led to improved provider-caretaker communication. Providers who used eIMCI were more likely to give counseling that covered the key information points specified, and caretakers in the eIMCI arm recalled more of these key information points overall. The implications of this work suggested that the eIMCI mobile protocol may lead to improved provider-caretaker communication, which may result in a greater ability for caretakers to carry out treatment plans in the home. When utilizing mobile devices to deliver such interventions, the structure, clarity, and direction enabled by the electronic platform are suggested to promote adoption of the complete sphere of high-quality clinical care. As such adoption is continued, understanding of key health information may become firmly rooted in caretaker health literacy levels
