Community health workers’ usability and acceptability of an mHealth tool for post-cesarean assessments: A mixed-methods study in rural Rwanda

Cesarean sections (c-sections) are one of the most common surgical procedures globally. Compared to vaginal birth there is an increased risk of postpartum complications following c-section. Returning to health facilities for postpartum monitoring can be challenging due to physical, logistic, and financial barriers, particularly for rural communities. With 94% of Kirehe District’s population being rural, this district is an excellent proxy for Rwanda as a whole. Community health workers (CHWs) provide a crucial link between communities and health services, but in Rwanda they do not currently follow women after cesarean due to medical complexity. Our team developed a mobile-health (mHealth) tool to enable CHW-led community-based post-cesarean care. In this study, we assessed the usability and acceptability of the mHealth tool among CHWs in Kirehe District, Rwanda. The study took place from March-April 2023. We randomly selected 30 CHWs serving in Kirehe District, Rwanda and trained them to use the mHealth-CHW tool, including symptom-based questionnaire administration and image capture. We then administered three vignettes each replicating home visits and recorded CHWs’ ability to use the tool. CHWs then completed a validated Community Health Worker mHealth Usability and Acceptability Assessment Tool survey followed by a focus group discussion. We report the overall vignette scenario scores, and the average score, percentage, and standard deviation of each category. We analyzed the proportion of CHWs who “Agreed” or “Strongly agreed” with the survey questions, conducted a thematic analysis of the focus group discussions, then convergently analyzed both quantitative and qualitative results. The average evaluation scores from the vignette scenarios was 8.53 (± 0.95) out of 10 possible points. All CHWs “Agreed” or “Strongly agreed” with 80% or more of the usability statements presented, surpassing our pre-specified threshold for success. Similarly, focus group discussion results found that the mHealth-CHW tool was a usable and acceptable tool to facilitate post-cesarean care. Given that the mHealth-CHW tool was quantitatively and qualitatively determined to be highly usable and acceptable, we have advanced to a community validation of the clinical features of this tool. The mHealth tool could be valuable for CHWs to provide post-cesarean follow-up in other settings.