Table 1

Findings and implications of various methodological approaches

Research methodsResearch questionsFindings/resultsImplications
Literature review
  • Which databases were searched for the scoping review?

  • How many articles were included?

  • What were the major findings/recommendations?

  • A scoping review was conducted using five databases (Ovid MEDLINE, Embase, Scopus, PsycINFO and ProQuest) to identify eligible articles from January 2000 to July 2020.23

  • Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria.

  • A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health records (2/31, 6%) and mixed ICT interventions (14/31, 45%).

  • Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills and reluctance to use technologies.

  • Advantages of using ICT interventions include their non-pharmacological nature, provision of health education, encouragement for continued physical activity and maintenance of a healthy diet.

  • We concluded that there is a need to improve awareness and education about ICT interventions among the patients, caregivers and healthcare providers.

The scoping review helped us design the app with the specific aim of supporting ASHAs. We also identified the features of the app required from the perspective of users and service providers.
Site observations
  • What were the major observations made?

  • What were the challenges observed?

  • We observed service delivery by ASHAs, their documentation practices and their use of mobile technologies.

  • Prior to the current study, ASHAs did not provide screening services for NCDs in the study areas. However, we observed how ASHAs provide maternal and child healthcare services in the community.

  • We also visited primary healthcare centres and found a lack of quality infrastructure, a dearth of qualified medical personnel, and difficulty for patients with regard to access to essential medicines and medical facilities.

  • Public health facilities were overburdened with patients.

This component of the project allowed us to assess the patient flow and referral system with regard to NCD services provided by community and primary health centres.
Meeting with stakeholders (investigators, clinicians and app developers)
  • What recommendations arose from stakeholder consultation?

  • A patient flow system and a clinical algorithm were drafted based on clinical practices. All investigators provided feedback.

  • Investigators assessed the pros and cons of creating a decision support tool for the ASHAs to facilitate NCD care.

  • The investigators explained the functional requirements of an app.

  • Technical specifications for developing the software (eg, front-end, back-end, cloud integrations and database) were described by the app developers.

  • Simple sketches were prepared for a set of screens and discussions were made on how to link between screens. A field test was also planned to assess the operation of the planned design of the app.

  • Investigators estimated a timeline and budget to develop a simple app for ASHAs and to test it at the study site.

  • The necessity of a dashboard web application, for health managers and supervisors to track data collection, was identified. The investigators also drafted the interface and content of the web dashboard.

Stakeholder consultation allowed us to make major decisions and develop insights in the early stage of app development processes:
  • All investigators endorsed the overall patient flow system and clinical algorithm required for the app.

  • The decision was taken to incorporate a ‘clinical decision support’ function in the app.

  • The requirements, time and budget for developing the app and conducting field tests were finalised.

  • A decision was taken to develop a dashboard web application for visual display of data.

  • What are the findings generated from the interviews?

  • ASHAs suggested incorporating the Community Based Assessment Checklist in the app.

  • They suggested that reminder, adviser and guide functions should be added to the app.

  • ASHAs suggested incorporating an in-built dashboard for visual display of all the enrolled patients.

Reminder, adviser and guide functions were built into the app dashboard.
  • ASHAs, Accredited Social Health Activists; ICT, information and communication technology; NCDs, non-communicable diseases.