What Encourages Community Health Workers (CHWs) to Use Mobile Technologies for Health Interventions? Emerging Lessons from Rural Rwanda

This paper explores the determinants of the utilisation of mobile phone technologies for public health (mHealth) through a June 2014 fieldwork among community health workers (CHWs) in rural Rwanda. Using a socio-technical approach, user, program and technical characteristics were tested and deemed influential in determining use. It focused on 72 CHWs in two districts in Southern Rwanda who were using the mHealth tool, RapidSMS. While not purporting to be a comprehensive evaluation of Rwanda¿s RapidSMS project, it makes three contributions to our understanding of mHealth: First, a combination of user centric approach and the socio-technical systems theory affords this study the ability to identify the multiplicity of factors most likely to impact CHWs use of RapidSMS. Second, the study identifies possible factors contributing to the relative success of RapidSMS in rural Rwanda and third, it identifies gaps that ought to be addressed in future mHealth research. This study reports the findings of those factors that were deemed most interesting, novel, counterintuitive- and least well established in the literature. Technical characteristics (reminders and alerts) were by far the strongest predicting factors of use. The user characteristic, age, had no apparent influence on utilization while supports though training and supervision (program characteristics) revealed mixed findings. These findings illustrate the uniqueness of each context and reiterate the need to consider social and technical factors when implementing mHealth projects.