A holistic view of the social and technical factors that Influence the assimilation of an mHealth tool in developing countries

The integration of smartphones and mobile devices into healthcare systems has been proposed to address some of the physical barriers to healthcare delivery in rural areas of developing countries. This has prompted a number of intervention initiatives to develop novel mHealth tools for specific regions. However, despite all the research and the investment, there has been slow practical progress. This thesis attributes this slow progress to compartmentalised thinking and limited holistic exploration. In order to understand these problems, this thesis undertook a number of studies, i.e., a review-focused, a past-focused, a future-focused, and policy-focused studies to understand how an mHealth tool could be assimilated in rural areas of developing countries. These studies took place in the context of an mHealth app being explored for introduction to assist with the diagnosis and treatment of sick children under the age of five in Enugu State, Nigeria. Therefore, the objective of this thesis is to create a more socially and technologically holistic understanding of the factors that influence the introduction of mHealth tools into rural areas of developing countries. First, findings from the review-focused study illustrate two key trends in existing research. Most strikingly, little research has looked at the role of patient-to-patient interactions. Furthermore, the interactions between system developers and the other stakeholder groups are notably under-represented. Second, findings from the past-focused study indicate that, (i) at the social-level, there is a perceived limitation of services, human resources and a sense of exclusion from the urban health system; (ii) at ‘material-level, observations were made of the significant infrastructural and technological limitations that discourage rural healthcare workers (RHCWs) and parents/guardians (PGs) from spending prolonged periods at the rural health centres; (iii) at the ‘practice-level’, there is the formal diagnosis treatment method practiced by the RHCWs in the midst of the PGs diagnosis and treatment practices and African traditional healing practices, and (iv) at ‘imbrication-level’, the entanglement of phones with internet access have exposed PGs to a range of health information outside the control or guidance of health professionals. Third, from the future-focused study, findings show a set of factors which are bound as an emerging explanatory model which influence primary appraisal of an mHealth tool in a new context. These factors describe a set of individual and social influences that governments, funding bodies and non-governmental organisations should consider before the introduction of an mHealth tool. Fourth, from the policy-focused study, a framework is proposed that differentiates between interventions targeting traits and states, the latter being situation-specific, and the former which seeks to improve individual’s abilities, job knowledge, and skills as they relate to an mHealth tool. Furthermore, the framework differentiates between individual and social interventions, the former being resilient to personnel change, and the latter seeking to improve crucial situations that would otherwise cause social systems to break down around an mHealth tool. These findings have implications for theory, practice, and future research. These implications are discussed in the final chapter of this thesis