Implementation Status and #usability of Digital Health Interventions Among Health Care Workers and End Users at the Primary Health Care Level in Chandigarh, North India: Cross-Sectional Study
Background: Digital health interventions (DHIs) refers to the use of information and communication technologies to support or facilitate the achievement of health objectives. The Government of India has launched various DHIs at the primary healthcare level to improve health services and health-seeking behaviours. However, there is a paucity of evidence on the effectiveness of the implementation of these interventions and the user response from target end-users within the government health system setting Objective: To assess the implementation status of DHIs and the user response of target end-users i.e., general population and healthcare workers (HCWs) in Health and Wellness Centres (HWCs) in Chandigarh, Union Territory, India Methods: A cross-sectional study was conducted to assess the implementation status of nine DHIs: the Electronic Vaccine Intelligence Network (eVIN), Reproductive and Child Health (RCH), Health Management Information System (HMIS), HWC portal, Comprehensive Primary Healthcare – Non-Communicable Disease (CPHC-NCD), Family Planning Logistics Management Information System (FP_LIMS), eSanjeevani, Integrated Disease Surveillance Platform– Integrated Health Information Platform (IDSP-IHIP) portals, Aarogya Setu, and the #covid19 Vaccine Intelligence Network (CoWin) app. Data were collected from four purposively selected HWCs using a pretested data extraction form and observation checklist during June–September 2022. The implementation status of these DHIs was evaluated by categorizing indicators into input, process, and output components, and estimating cumulative percentage scores using a score-based logic model framework. Pretested interview schedules were used to assess awareness and user response of DHIs among 120 target end-users (clients visiting HWCs) and 120 HCWs (Auxiliary Nurse Midwife, Data Entry Operator, and Medical Officer). The prevalence of user response was then estimated. Results: The implementation status scores of the eVIN and RCH portals ranged from 70–90%. The HMIS portal, HWC portal, CPHC-NCD portal, and FP_LIMS scored between 25–50%, while eSanjeevani and the IDSP_IHIP portal scored between 51–70%. Community awareness of DHIs was poor, ranging from 1% to 22%, except for Aarogya Setu (78.3%) and the CoWIN app (35.8%), despite 87% of participants having access to a mobile phone. Low awareness of DHIs was significantly associated with lower socio-economic status and lower education levels (p-value < 0.05). Sixty-six percent of HCWs reported that working with DHIs was easy; however, 88% stated that dual data entry increased their workload. Frequent technical glitches were most commonly reported for the ANMOL app (92%) by HCWs. Helpdesk or feedback options in DHIs were rarely used by ANMs/MPWs (0–3.8%). Conclusions: The RCH and eVIN portals were effectively implemented; eSanjeevani was moderately implemented, while the HMIS, HWC portal, CPHC, and FP_LIMS were poorly implemented. Community awareness of DHIs was low, except for the Aarogya Setu and CoWIN apps. Although HCWs found DHIs easy to use, increased workload due to dual data entry and frequent technical issues were key concerns Clinical Trial: Not applicable