Decreasing workload among community health workers using interactive, structured, rich-media guidelines on smartphones
Abstract
BACKGROUND: Currently, in developing countries, there is considerable interest in using mobile phones as job-aids for community health workers (CHWs) to improve the care they provide. However, acceptance of new technologies can be inhibited if the workload imposed is perceived as excessive compared to existing methods. OBJECTIVE: To compare perceived workload of CHWs using clinical care guidelines presented on mobile phones versus using conventional paper-based guidelines. METHODS: Validated clinical practice guidelines were developed as Interactive Structured Rich-Medical guidelines (ISRMGs) on Windows Mobile 6.5 mobile phones. A prospective randomized controlled study was performed in Colombia in which 50 CHWs used the ISRMGs, and paper-based materials with the same information, in a cross-over design to diagnose and treat 15 matched pairs of medical cases presented on Human Patient simulators. The NASA Task Load Index, a validated measure of perceived workload, was administered and results compared by means of a mixed model analysis. RESULTS: When using the ISRMGs on mobile phones the health workers reported statistically significant decreases in mental demand, frustration, and overall workload as compared to using paper-based job-aids. CONCLUSIONS: Use of ISRMGs on mobile phones by community health workers in developing countries has the potential to decrease their perceived workload, fatigue, and enhance their ability to provide better care for more patients.
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Additional testing demonstrated mHealth decision aids also reduced mental demand, frustration, and overall workload compared to paper aids.
“Additional testing demonstrated mHealth decision aids also reduced mental demand, frustration, and overall workload compared to paper aids (69).”
From Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? (2014) · cites this paper as [69]
Cites
Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research
(1988) · Advances in Psychology · doi:10.1016/s0166-4115(08)62386-9 · Cited by 15,003 · see citing works
The World Health report 2006 1 : Working together for health 2
Guilbert, J.-J. (2006) · Education for Health · doi:10.1080/13576280600937911 · Cited by 2,657 · see citing works
How can we achieve and maintain high-quality performance of health workers in low-resource settings?
Rowe, A. K., de Savigny, D., Lanata, C. F., & Victora, C. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67028-6 · Cited by 1,048 · see citing works
Efficiency in learning: Evidence-based guidelines to manage cognitive load
Clark, R. C., Nguyen, F., Sweller, J., & Baddeley, M. (2006) · Performance Improvement · doi:10.1002/pfi.4930450920 · Cited by 820 · see citing works
Casagrande, J. T., Pike, M. C., & Smith, P. G. (1978) · Biometrics · doi:10.2307/2530613 · Cited by 431 · see citing works
SMS STI: A Review of the Uses of Mobile Phone Text Messaging in Sexual Health
Lim, M. S. C., Hocking, J. S., Hellard, M. E., & Aitken, C. K. (2008) · International Journal of STD & AIDS · doi:10.1258/ijsa.2007.007264 · Cited by 293 · see citing works
Epidemiology of Job Stress and Health in Japan: Review of Current Evidence and Future Direction.
Kawakami, N., & Haratani, T. (1999) · Industrial Health · doi:10.2486/indhealth.37.174 · Cited by 231 · see citing works
Reactions to increased workload: Effects on professional efficacy of nurses
Greenglass, E. R., Burke, R. J., & Moore, K. A. (2003) · Applied Psychology · doi:10.1111/1464-0597.00152 · Cited by 176 · see citing works
Molenberghs, G. (2011) · International Encyclopedia of Statistical Science · doi:10.1007/978-3-642-04898-2_338 · Cited by 155 · see citing works
Griffiths, K., Mackey, M., & Adamson, B. (2007) · Journal of occupational rehabilitation · doi:10.1007/s10926-007-9108-x · Cited by 98 · see citing works
Using cell phones to collect postpartum hemorrhage outcome data in rural Ghana
Andreatta, P., Debpuur, D., Danquah, A., & Perosky, J. (2011) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2010.11.020 · Cited by 88 · see citing works
Performance factors of mobile rich media job aids for community health workers
Florez-Arango, J. F., Iyengar, M. S., Dunn, K., & Zhang, J. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.010025 · Cited by 87 · see citing works
Self-citationRowe, S., Kelly, J. M., Olewe, M. A., Kleinbaum, D. G., McGowan, J. E., McFarland, D. A., Rochat, R. W., & Deming, M. S. (2006) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1016/j.trstmh.2006.02.023 · Cited by 85 · see citing works
Kim, I., Geiger-Brown, J. M., Trinkoff, A. M., & Muntaner, C. (2010) · Health & Social Care in the Community · doi:10.1111/j.1365-2524.2010.00916.x · Cited by 55 · see citing works
Kratzke, C., Wilson, S., & Vilchis, H. (2013) · Journal of Community Health · doi:10.1007/s10900-012-9579-3 · Cited by 55 · see citing works
Occupational stress in the operating theatre suite: Should employers be concerned?
Johnstone, P. (1999) · Australian Health Review · doi:10.1071/ah990060 · Cited by 21 · see citing works
Iyengar, M. S., Florez-Arango, J. F., & Garcia, C. A. (2009) · doi:10.1145/1541948.1541990 · Cited by 18 · see citing works
Self-citationCarga mental y fatiga en servicios especiales de enfermería
González, J. L., Jiménez, B. M., Garrosa, E., & López‐López, A. (2005) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 16 · see citing works
Morrison, J., & Lindberg, P. (2008) · AAOHN Journal · doi:10.3928/08910162-20080901-06 · Cited by 10 · see citing works
Job aids in the technology age
Elsenheimer, J. (1998) · Performance Improvement Journal · doi:10.1002/pfi.4140370808 · Cited by 7 · see citing works
A review of the literature on design of informational job performance aids.
Folley, J. D., & Munger, S. J. (1961) · PsycEXTRA Dataset · doi:10.1037/e461542004-001 · Cited by 3 · see citing works
Flagged first, then by citations
2 of the 23 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Hall, C. S., Fottrell, E., Wilkinson, S., & Byass, P. (2014) · Global Health Action · doi:10.3402/gha.v7.25606 · Cited by 384 · see citing works
“Additional testing demonstrated mHealth decision aids also reduced mental demand, frustration, and overall workload compared to paper aids (69).”
BackgroundWinters, N., Langer, L., & Geniets, A. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019827 · Cited by 71 · see citing works
“20 21 Screening and coding of primary studies All primary studies allocated to the eligible intervention categories explained above were screened at full text by two reviewers.”
Schoen, J., Mallett, J. W., Grossman-Kahn, R., Brentani, A., Kaselitz, E., & Heisler, M. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0245-9 · Cited by 45 · see citing works
Costa, N. D. R., Bellas, H. C., da Silva, P. R. F., de Carvalho, P. V. R., Uhr, D., Vieira, C., & Jatobá, A. (2021) · Work · doi:10.3233/wor-205000 · Cited by 46 · see citing works
Iyengar, S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814309-4.00012-4 · Cited by 27 · see citing works
dos Santos, R. C., da Silva, L. I. M., Santos, L. D. P. D. J., Méllo, L. M. B. D. D. E., & Santos, L. (2023) · Trabalho Educação e Saúde · doi:10.1590/1981-7746-ojs2146 · Cited by 15 · see citing works
Alvarez, A. G., Sasso, G. T. M. D., & Iyengar, S. (2015) · JMIR Medical Education · doi:10.2196/mededu.4958 · Cited by 8 · see citing works
“For some authors [26], this result is justified by the low physical demand required for the handling of small mobile devices, which are very popular nowadays.”
Development and usability of a mobile tool for identification of depression and suicide risk in Fiji
Iyengar, M. S., Chang, O., Florez-Arango, J. F., Taria, M., & Patel, V. L. (2020) · Technology and Health Care · doi:10.3233/thc-202132 · Cited by 7 · see citing works
Self-citationPoliteness in security directives: Insights in browser compliance for the human element
House, D., & Giordano, G. (2020) · Computers & Security · doi:10.1016/j.cose.2020.102007 · Cited by 6 · see citing works
Yuan, Y., Chen, J., Wang, X., & Song, J. (2023) · Technology and Health Care · doi:10.3233/thc-220478 · Cited by 5 · see citing works
dos Santos, R. C., da Silva, L. I. M., Santos, L. D. P. D. J., Méllo, L. M. B. D. D. E., & Santos, L. (2023) · Trabalho Educação e Saúde · doi:10.1590/1981-7746-ojs2146en · Cited by 2 · see citing works
Iyengar, S., Ngaybe, M. G. B., Gonzalez, M., & Arora, M. (2024) · Interactive Journal of Medical Research · doi:10.2196/54687 · Cited by 2 · see citing works
Iyengar, M. S., Pinzon, O. E., & Campbell, R. R. (2020) · Technology and Health Care · doi:10.3233/thc-192100 · Cited by 2 · see citing works
“This was an experimental technology first created at NASA Johnson Space Center for easy development of media-rich clinical guideline apps without programming [9,22,23].”
Self-citationDigital health, work and workers’ mental health: A systematic review
Barroso, B. I. D. L., da Silva, T. N. R., Rodrigues, D. D. S., Nogueira, L. D. F. Z., do Carmo, A. C. F., Vasconcelos, S. C., & Alonso, C. M. D. C. (2026) · Work · doi:10.1177/10519815261432939 · Cited by 1 · see citing works
“31 Nurses indicated a reduced workload and relief using an autonomous vital signs assessment system when monitoring covid-19 patients.”
Mobile health for community participation: Research patterns and directions
Kim, D. H., Hong, J., Ha, E., & Yoo, S. (2015) · 보건교육·건강증진학회지 · doi:10.14367/kjhep.2015.32.4.67 · Cited by 1 · see citing works
Implementing mHealth in Lowand Middle-Income Countries: What Should Program Implementers Consider?
Hull, T. D. (2014) · CRC Press eBooks · doi:10.1201/b17724-16 · Cited by 1 · see citing works
Iyengar, M. S., Smith, J. W., & Florez-Arango, J. F. (2017)
Self-citationEze, E. (2018) · Cork Open Research Archive (University College Cork, Ireland)
(2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814309-4.09998-5
Zekioğlu, A., Uluçam, E., Taş, A., Baltacıoğulları, H., & Özkeçeci, E. (2025) · Work · doi:10.1177/10519815251346452
“31 In a study conducted with nurses, it was determined that healthcare workers with high workload were willing to use digital technologies and digital change affected the work fl ow and job satisfaction of healthcare workers 32 Unlike the results of our study, in a systematic review study examining…”
- Authors
- Iyengar, M. S., & Florez-Arango, J. F.
- Affiliations
- School of Biomedical Informatics, University of Texas, Houston, TX, USA
- Universidad de Antioquia (CO)
- Venue
- Technology and Health Care
- Publisher
- SAGE Publications
- Published
- 2013-02-28
- Volume
- 21
- Issue
- 2
- Pages
- 113-123
- ISSN
- 0928-7329 (ISSN-L)
- 1878-7401
- OpenAlex
- W1558036224
- Cited by
- 22
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 3 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 2 · 2015: 2 · 2014: 2 · 2013: 2
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Technology and Health Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Microsoft Research
- Johnson Space Center
- Telemedicine and Advanced Technology Research Center
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- community health workers, perceived workload, mobile devices, job aids, NASA-TLX, human patient simulator, mental demand, fatigue, developing countries
- MeSH terms
- Colombia, Community Health Workers, Female, Humans, Male, Manikins, Workload, Practice Guidelines as Topic, Cross-Over Studies, Cell Phone, Young Adult
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