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Cited by 19Mobile Health and mHealth ApplicationsHIV/AIDS Research and InterventionsUsability and User Interface Design

Development and Implementation of a Mobile Phone–Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique

Open access
Kawakyu, Nami, Nduati, Ruth, Munguambe, Khátia, Coutinho, Joana, Mburu, Nancy, DeCastro, Georgina, Inguane, Celso, Zunt, Andrew +3 more·2019·JMIR mHealth and uHealth
DOI 10.2196/13963PMC PMC6535976

Published version of a preprint

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Abstract

BACKGROUND: Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses' clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone-based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. OBJECTIVE: The objective of this study was to understand and improve the mPCAT's core usability factors and assess the health workers' experience with using the mPCAT. METHODS: Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT's core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. RESULTS: Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff-critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. CONCLUSIONS: The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements.

AI snapshot

Written from the paper’s full text.

TL;DR

The mobile phone–based PMTCT cascade analysis tool (mPCAT) was adapted through usability testing and then assessed for feasibility in Kenya and Mozambique. Health workers and facility managers found it easy to use, used it regularly, and intended to continue using it, with high acceptability across three high-volume clinics.

Key findings

  • Usability testing led to a revised mPCAT with a home page, one data entry field per page, visible Back/Next buttons, save-and-exit, a summary results page with data visualization, color-coded losses/gains, and WhatsApp sharing.
  • In feasibility testing (N=16), mean scores were 4.19 (SD 0.98) for ease of use, 4.00 (SD 1.16) for regular use, and 4.75 (SD 0.58) for intent to use; responses averaged 1.1 points higher in Mozambique than Kenya.
  • All 3 study facilities reported using the mPCAT, and participants described improved communication and team building across services such as ANC and laboratory.
  • One facility used mPCAT to identify low CD4 testing among HIV-positive women and then tracked missed CD4 tests and increased provider awareness.

Methods

  • Two rounds of usability testing were conducted March–June 2017 with 12 nurses and 11 maternal and child health experts in Kenya and Mozambique, using videotaped think-aloud tasks and semistructured group interviews guided by the Nielsen Usability Framework.
  • Feasibility testing ran September–December 2017 in 3 high-volume clinics over 12 weeks; 16 nurses, nurse managers, and support staff completed a 5-point Likert questionnaire, 10 participated in focus group discussions, and 3 nurse managers completed in-depth interviews.
  • Qualitative data were coded into usability themes and a cognitive demands table; feasibility questionnaire data were analyzed descriptively in R Studio, and FGD/IDI transcripts were coded in ATLAS.ti using Bowen et al’s feasibility framework.

Limitations

  • Stated: findings may not generalize beyond study sites because the number of participants was small and not representative of all Option B+ providers in Kenya and Mozambique.
  • Stated: self-reported mHealth app use can be biased; objective usage frequency and duration data from the app were not collected, though FGD/IDI examples triangulated self-reported use.
  • Stated: sustained mPCAT use after the study period was not evaluated; evident from the text, the study assessed usability and feasibility rather than effectiveness or clinical outcomes, and feasibility testing included only 3 facilities (2 in Kenya, 1 in Mozambique).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/13963

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 69 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Participants had difficulty viewing and interpreting the numeric results displayed on the same page as the data entry page.

    “Participants had difficulty viewing and interpreting the numeric results displayed on the same page as the data entry page.”
    Quote in the paperSubstantial claim
  • Findingown data

    Health care workers and facility managers reported using the mPCAT regularly during the study period (mean=4.00, SD 1.16).

    “reported to use it regularly during the study period (mean=4.00, SD 1.16)”
    • Also stated in: § Results · plain
      “used the tool very often (mean=4.1)”
    Quote in the paperSubstantial claim
  • Findingown data

    The difficulty understanding what data should be entered was partly because of differences in terminologies used in national data collection forms and the initial mPCAT.

    “This was partly because of the differences in terminologies used in the national data collection forms and the initial mPCAT.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants expressed that mPCAT, as part of the SAIA intervention, helped improve communication and team building across different services such as ANC and laboratory.

    “Participants expressed that mPCAT, as part of the SAIA intervention, helped improve communication and team building across different services such as ANC and laboratory.”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was variability among FGD participants on the perceived effect of mPCAT on workload.

    “There was variability among FGD participants on the perceived effect of mPCAT on workload.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 47
  • May combine two claims. 35
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One participant responsible for data analysis and reporting expressed that the mPCAT decreased their workload by streamlining workflow.

    “One participant responsible for data analysis and reporting expressed that it decreased their workload by streamlining workflow.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    A summary results page with 3 component parts was added.

    “a summary results page with 3 component parts were added.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants were able to provide feedback on what was confusing or difficult about the app, but they were often unsure of how the app could be changed to be more usable.

    “Although the participants were able to provide feedback on what was confusing or difficult about the app, they were often unsure of how the app could be changed to be more usable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp.

    “Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    A clearly visible Back button at the top of the screen was added along with an adjacent Next button.

    “A clearly visible Back button at the top of the screen was added along with an adjacent Next button.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In usability testing, participants were observed skipping data entry fields, which led to errors in the results.

    “In usability testing, participants were also observed skipping data entry fields, which led to errors in the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The option to save and exit was added so that users could return at a later time to enter data or retrieve reports.

    “The option to save and exit was also added so that users could return at a later time to enter data or retrieve reports.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Improvements to the mPCAT's interface, including changes to its appearance, navigation, and input fields, were made during usability testing.

    “Improvements to the mPCAT’s interface, including changes to its appearance, navigation, and input fields, were made during usability testing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Navigation was changed so that each page only had 1 data entry field and users had to answer the item before being able to advance to the next page.

    “Navigation was changed so that each page only had 1 data entry field and users had to answer the item before being able to advance to the next page (Figure 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The mPCAT flagged that a facility was systematically missing CD4 testing of HIV-positive women, leading the facility to track women with missed CD4 tests and increase awareness among providers of this service delivery gap.

    “The mPCAT flagged that the facility was systematically missing CD4 testing of HIV-positive women, leading the facility to track women with missed CD4 tests and increase awareness among providers of this service delivery gap.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many participants had difficulty finding the Next button and took many tries to advance to the next screen.

    “Many participants had difficulty finding the Next button and took many tries to advance to the next screen.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making.

    “Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The initial app had no Save feature, so users needed to complete data entry in 1 sitting without interruption.

    “Another design challenge identified in the initial app was that, because there was no Save feature, users needed to complete data entry in 1 sitting without interruption.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants in another facility described how using the mPCAT and making system changes increased their workload as once inefficiencies were identified, strategies needed to be adapted to rectify the challenges.

    “Participants in another facility described how using the mPCAT and making system changes increased their workload as once inefficiencies were identified, strategies needed to be adapted to rectify the challenges.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    Coding was simplified to enable future revisions by nontechnical staff.

    “Coding was simplified to enable future revisions by nontechnical staff—critical for context-specific adaptations for scale-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page.

    “The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingreasoning

    Data points are not enumerated on national forms in Mozambique; therefore, the toggling feature was not added for the Mozambique version.

    “Data points are not enumerated on national forms in Mozambique; therefore, this feature was not added for the Mozambique version.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The numeric results were color coded where red indicated losses and green indicated gains.

    “Third, the numeric results were color coded where red indicated losses and green indicated gains.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    A home page was added to orient the user to the app.

    “a home page was added to orient the user to the app (Figure 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants emphasized that the mPCAT made data interpretation easy and accessible, and that this facilitated data-driven decision making.

    “Participants emphasized how the mPCAT made data interpretation easy and accessible, and how this facilitated data-driven decision making:”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingreasoning

    A feature to export the results was added, including the ability to share the results through WhatsApp.

    “a feature to export the results was added, including the ability to share the results through WhatsApp.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The large font size in the first version of the mPCAT was well received by users, many of who needed but did not wear glasses, and preserved.

    “The large font size in the first version of the mPCAT was well received by users, many of who needed but did not wear glasses, and preserved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants in a third facility found that the mPCAT neither increased nor decreased their workload, as the initial learning phase increased the workload but the improvements resulted in more efficient services, thereby reducing the workload.

    “Participants in a third facility found that the mPCAT neither increased nor decreased their workload, as the initial learning phase increased the workload but the improvements resulted in more efficient services, thereby reducing the workload.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants found it challenging to scroll up and down a page to enter multiple data entry fields on 1 page and expressed a preference for scrolling left to right.

    “Participants also found it challenging to scroll up and down a page to enter multiple data entry fields on 1 page and expressed a preference for scrolling left to right.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    A summary of where the greatest drop-off in the cascade occurs and where the greatest potential is for gains was added.

    “another, a summary of where the greatest drop-off in the cascade occurs and where the greatest potential is for gains.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Health care workers and facility managers found the mPCAT easy to use (mean=4.19, SD 0.98).

    “Overall, users found the mPCAT app easy to use (mean=4.19, SD 0.98)”
    • Also stated in: § Results · plain
      “Health care workers and facility managers found the tool easy to use (mean=4.3)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Acceptability and adoption of the mPCAT was high.

    “Acceptability and adoption of the mPCAT was high, with users describing the app easy to use, both for entering and interpreting data.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Toggling functionality was introduced in the Kenya version so users could toggle over labels and be shown which form and data variable point should be used to input data.

    “toggling functionality was introduced in the Kenya version so that users could toggle over the labels and they could be shown which form and data variable point should be used to input data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants expressed a preference for sharing results through WhatsApp, as it was a commonly used tool by nurses and other health care staff.

    “participants expressed a preference for sharing results through WhatsApp, as it was a commonly used tool by nurses and other health care staff.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In the early version of the mPCAT app, coding for data entry items and results were scattered throughout the code, making it difficult for any nondeveloper to find the codes to change a data entry item.

    “In the early version of the mPCAT app, coding for data entry items and results were scattered throughout the code, making it difficult for any nondeveloper to find the codes to change a data entry item.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    A data visualization feature was added to graphically present the results.

    “One was a data visualization feature to graphically present the results”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Terminologies used for data entry labels were revised to match national forms.

    “terminologies used for data entry labels were revised to match national forms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Developers observed that participants often skipped data entry inputs, which would lead to errors in the results.

    “For example, developers observed that participants often skipped data entry inputs, which would lead to errors in the results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Through this study, the mPCAT is being used by health workers in all health facilities in Maniça Province with PMTCT services.

    “Through this study, the mPCAT is being used by health workers in all health facilities in Maniça Province with PMTCT services.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    FGD participants from 1 facility explained that although all those who were aware of the intervention were supportive of making changes to workflow and patient flow, it was challenging to get involvement and acceptance of proposed changes among those who were not trained on the mPCAT and SAIA.

    “FGD participants from 1 facility explained that although all those who were aware of the intervention were supportive of making changes to workflow and patient flow, it was challenging to get involvement and acceptance of proposed changes among those who were not trained on the mPCAT and SAIA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    The accessibility and literacy of mobile phones in sub-Saharan Africa makes it an advantageous platform for scale-up and provides an opportunity for facility-level health care staff to use it for data-driven decision making.

    “The accessibility and literacy of mobile phones in SSA makes it an advantageous platform for scale-up and provides an opportunity for facility-level health care staff to use it for data-driven decision making.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The SAIA intervention increased antiretroviral coverage by 3-fold and screening of HIV-exposed infants by 17-fold in Kenya and Mozambique.

    “The SAIA intervention increased antiretroviral coverage by 3-fold and screening of HIV-exposed infants (HEI) by 17-fold in Kenya and Mozambique [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mobile phone systems for surveillance and data collection improve data quality and are more time- and cost-efficient than the traditional pen-and-paper method.

    “Mobile phone systems for surveillance and data collection have been found to improve data quality [30-32] and be more time- and cost-efficient [30,32-35] than the traditional pen-and-paper method.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [30] source

      Not checked in the free run.

    • cites [31] Hall, CS, 2014, Glob Health Action source

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    • cites [32] source

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    • cites [33] source

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    • cites [34] source

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    • cites [35] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Understaffing and undertraining of nurses lead to long wait times, inefficient patient flow, gaps in patient tracking, and suboptimal adherence and retention of HIV-positive women.

    “Consequently, understaffing and undertraining of nurses lead to long wait times, inefficient patient flow, gaps in patient tracking [20,21], and thus, suboptimal adherence and retention of HIV-positive women [23-25].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [20] source

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    • cites [21] source

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    • cites [23] source

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    • cites [24] source

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    • cites [25] source

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  • Classified as probably not a substantial claim.

    Premisecitation

    SAIA is a 5-step process using systems engineering theory to guide facility-level staff and managers to maximize effectiveness of PMTCT services.

    “The systems analysis and improvement approach (SAIA) is a 5-step process using systems engineering theory to guide facility-level staff and managers to maximize effectiveness of PMTCT services [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The World Health Organization introduced Option B+ in 2013, by which HIV-positive women initiate lifelong antiretroviral therapy during pregnancy regardless of CD4 count.

    “the World Health Organization introduced Option B+ in 2013 by which HIV-positive women initiate lifelong antiretroviral therapy (ART) during pregnancy regardless of CD4 count [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] World Health OrganizationWorld Health Organization2012Geneva, SwitzerlandWorld Health OrganizationProgrammatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: executive summary https://apps.who.int/iris/handle/10665/70892

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Malawi, Option B+ prevented infant infections and increased the mother's 10-year survival rate by more than 4-fold compared with standard of care.

    “A study in Malawi found that Option B+ not only prevented infant infections, but also increased the mother’s 10-year survival rate by more than 4-fold compared with the standard of care [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PMTCT studies in sub-Saharan Africa have reduced HIV transmission rates among breastfed infants to as low as 1% to 3%.

    “Although PMTCT studies in SSA have been shown to reduce HIV transmission rates among breastfed infants to as low as 1% to 3% [4,5]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source

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    • cites [5] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Usability testing is an important part of designing effective mHealth tools that are easy to use, increasing the likelihood for adoption of mHealth projects.

    “Usability testing is an important part of designing effective mobile health (mHealth) tools that are easy to use [37], increasing the likelihood for adoption of mHealth projects [32,33,38].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [37] Nielsen, J, 1993, Usability Engineering

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    • cites [32] source

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    • cites [33] source

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    • cites [38] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Option B+ is cost-effective.

    “Since then, studies have found Option B+ to be cost-effective [16-19].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [16] source

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    • cites [17] source

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    • cites [18] source

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    • cites [19] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The ethics review board of the University of Eduardo Mondlane in Mozambique (CIBS FM&HCM/49/2016) approved the study.

    “The ethics review board of Kenyatta National Hospital and University of Nairobi in Kenya (P221/03/2016), as well as the ethics review board of the University of Eduardo Mondlane in Mozambique (CIBS FM&HCM/49/2016) approved the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisereasoning

    Software applications, including mHealth apps, require continuous updating.

    “Software applications, including mHealth apps, require continuous updating.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Study data were stored in password-protected files that were only available to study staff for the purpose of data analysis.

    “Study data were stored in password-protected files that were only available to study staff for the purpose of data analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Simplified coding and use of open-access software are 2 strategies that can ensure ease of adaptation of the mPCAT to local contexts.

    “Simplified coding and use of open-access software are 2 strategies that can ensure ease of adaptation of the mPCAT to local contexts such as changing the language of the app (eg, from English to Portuguese) or revising data entry fields to match national data collection forms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow.

    “The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    No unique identifiers were collected, and confidentiality was emphasized during training of data collectors and at the start of group interviews and FGDs.

    “No unique identifiers were collected, and the importance of maintaining confidentiality was emphasized during training of data collectors and at the start of group interviews and FGDs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The ethics review board of Kenyatta National Hospital and University of Nairobi in Kenya (P221/03/2016) approved the study.

    “The ethics review board of Kenyatta National Hospital and University of Nairobi in Kenya (P221/03/2016), as well as the ethics review board of the University of Eduardo Mondlane in Mozambique (CIBS FM&HCM/49/2016) approved the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study procedures were reviewed and ethics approval obtained from the Institutional Review Board at the University of Washington (number 51026).

    “The study procedures were reviewed and ethics approval obtained from the Institutional Review Board at the University of Washington (number 51026).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    One study staff and the principal investigator concurrently and independently coded 2 feasibility transcripts and then discussed and revised the codebook.

    “One study staff and the principal investigator concurrently and independently coded 2 transcripts and then discussed and revised the codebook.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Simplified coding is critical for context-specific adaptations for scale-up.

    “Coding was simplified to enable future revisions by nontechnical staff—critical for context-specific adaptations for scale-up.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    The limited availability of a skilled electronic health and mHealth workforce in SSA is a critical gap that needs investment to ensure the continued success and sustainability of mHealth.

    “In addition, the limited availability of a skilled electronic health and mHealth workforce in SSA [32,46-48] is also a critical gap that needs investment to ensure the continued success and sustainability of mHealth in strengthening health systems and improving health outcomes.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [32] source

      Not checked in the free run.

    • cites [46] World Health Organization, Regional Office for AfricaWorld Health Organization2010Malabo, Equatorial GuineaWorld Health Organization, Regional Office for AfricaEhealth Solutions in the African Region Current Context and Perspectives (‎Document AFR/RC60/5) https://apps.who.int/iris/bitstream/handle/10665/19931/AFR-RC60-R3.pdf?sequence=1&isAllowed=y

      Not checked in the free run.

    • cites [47] source

      Not checked in the free run.

    • cites [48] MechaelPBataviaHKaongaNSearleSKwanAGoldbergAFuLOssmanJmHealth Alliance and Columbia University2010mHealth Alliance and Columbia UniversityBarriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper http://www.globalproblems-globalsolutions-files.org/pdfs/mHealth_Barriers_White_Paper.pdf

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Written consent was obtained from all participants.

    “Written consent was obtained from all participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Feasibility studies are critical for the development of mHealth interventions to ensure smooth integration into health systems and successful scale-up.

    “Feasibility studies are critical for the development of mHealth interventions to ensure smooth integration into health systems and successful scale-up [32,33].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [32] source

      Not checked in the free run.

    • cites [33] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Coding discrepancies in usability testing were discussed with the principal investigator, who acted as a facilitator and tiebreaker.

    “Coding was discussed with the principal investigator, who acted as a facilitator and tiebreaker.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Changes to keep mHealth apps relevant require long-term funding, a challenge, given limited funding opportunities for long-term mHealth projects.

    “Changes to keep mHealth apps relevant require long-term funding, a challenge, given limited funding opportunities for long-term mHealth projects [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The sample size for feasibility testing was determined based on previously published feasibility studies testing mobile phone technology to promote behavior change.

    “The sample size was determined based on previously published feasibility studies testing mobile phone technology to promote behavior change [39,40].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Collins, R, 2003, Exp Clin Psychopharmacol source

      Not checked in the free run.

    • cites [40] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Coding of usability think aloud exercises and interview transcripts was completed independently and concurrently by 2 staff members in Kenya and 2 staff members in Mozambique.

    “Coding was completed independently and concurrently by 2 staff members in Kenya and 2 staff members in Mozambique.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Care should be taken when generalizing these findings to health settings beyond the study sites.

    “First, care should be taken when generalizing these findings to health settings beyond the study sites.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Self-reported measurement of mHealth app use can be biased.

    “Second, self-reported measurement of mHealth app use can be biased; a more objective measure would be to collect usage data on frequency and duration from the app itself, a feature to consider for future app updates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    The purpose and benefit of feasibility studies is to assess how an intervention or strategy is implemented in uncontrolled, real-world settings, to inform future effectiveness trials, implementation, and scale-up.

    “However, the purpose and benefit of feasibility studies is to assess how an intervention or strategy is implemented in uncontrolled, real-world settings, to inform future effectiveness trials, implementation, and scale-up [32,35,42].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [32] source

      Not checked in the free run.

    • cites [35] source

      Not checked in the free run.

    • cites [42] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The collaborative process between software developer and user led to the development of an optimally usable and feasible mPCAT tool that was easy to use and easy to integrate into work routines.

    “The collaborative process between software developer and user led to the development of an optimally usable and feasible mPCAT tool that was easy to use and easy to integrate into work routines.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The mPCAT allows health workers and managers to quickly, clearly, and autonomously identify system inefficiencies in the delivery of Option B+ services and make data-driven decisions for system improvements.

    “The mPCAT allows health workers and managers to quickly, clearly, and autonomously identify system inefficiencies in the delivery of Option B+ services and make data-driven decisions for system improvements.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Findings from this study are critical in informing the development of a future controlled trial to determine the effectiveness of the mPCAT in reducing PMTCT dropout rates and contribute to the elimination of new pediatric HIV infections in SSA.

    “Findings from this study are critical in informing the development of a future controlled trial to determine the effectiveness of the mPCAT in reducing PMTCT dropout rates and contribute to the elimination of new pediatric HIV infections in SSA.”
    Quote in the paperNot a substantial claim
68 of 68

  • The paper relies on this without support.

    The mPCAT's calculations from routinely collected facility data are accurate enough to identify cascade inefficiencies.

    “Staff enter routinely collected facility data and the tool calculates the number and proportion of women and children flowing through each step of the PMTCT cascade, broken down into the flow from antenatal care (ANC) through birth and the subsequent postpartum period.”

  • The paper relies on this without support.

    The mPCAT's results are correct enough to guide facility-level improvement decisions.

    “The results are reviewed by the health facility staff to prioritize improvements by cascade steps to optimize overall PMTCT services using CQI tools as part of the SAIA.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Teledermatology proved to be a highly beneficial and efficient tool.

    “teledermatology proved to be a highly beneficial and efficient tool”

    From Current evidence on the use of mHealth approaches in Sub-Saharan Africa: A scoping review (2023) · cites this paper as [57]

    The Abstract Results and Discussion Conclusions (page numbers unavailable) describe usability testing of mPCAT, a mobile tool for HIV prevention-of-mother-to-child-transmission services. Searches for “teledermatology” and “dermatology” found no passage assessing whether teledermatology is beneficial or efficient. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Ease-of-use mean differs between abstract and results

    Minor

    The abstract reports a mean of 4.3 for ease of use, but the results and Table 1 report 4.19, which rounds to 4.2 at one decimal place.

  • Tool-use mean differs between abstract and results

    Minor

    The abstract reports a mean of 4.1 for tool use, while the results and Table 1 report 4.00 for regular use.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Leonard, D, 1997, Harv Bus Rev, 75, 102

Cited by

Sorted by citations

Related

Authors
Kawakyu, N., Nduati, R., Munguambe, K., Coutinho, J., Mburu, N., DeCastro, G., Inguane, C., Zunt, A., Abburi, N., Sherr, K., & Gimbel, S.
Affiliations
  • University of Washington (US)
  • University of Nairobi (KE)
  • Eduardo Mondlane University (MZ)
  • Health Alliance International (US)
  • Network of AIDS Researchers of Eastern and Southern Africa (KE)
Corresponding author
Kawakyu, Nami
ORCID
Venue
JMIR mHealth and uHealth
Publisher
JMIR Publications Inc.
Published
2019-05-13
Volume
7
Issue
5
Pages
e13963
ISSN
2291-5222 (ISSN-L)
DOI
10.2196/13963
PMC
PMC6535976
OpenAlex
W2942276329
Cited by
19
References
47
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1
FWCI
3.41
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR mhealth and uhealth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute of Allergy and Infectious Diseases (R21AI124399, P30AI027757)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Physical Sciences › Computer Science › Human-Computer Interaction › Usability and User Interface Design
Keywords
prevention of mother-to-child transmission of HIV, cascade of care, mobile health, decision support system, usability, nurse managers, cognitive demand, data visualization, WhatsApp, care facility management, Kenya, Mozambique, sub-Saharan Africa, pediatric HIV prevention, user-centered design, empathic design
MeSH terms
Adult, Feasibility Studies, Female, Humans, Infant, Kenya, Male, Mozambique, HIV Infections, Focus Groups, Infectious Disease Transmission, Vertical, Cell Phone, Mobile Applications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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