Evaluating the acceptability, feasibility, and implementation fidelity of a multipurpose mobile health (mHealth) app used for Tuberculosis (TB) contact tracing by Ward-Based Outreach Teams (WBOTs) in South Africa
6 affiliations
- 1The Aurum Institute, Johannesburg, South Africa
- 2University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
- 3Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- 4TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- 5Durban University of Technology, Faculty of Health Sciences, Durban, South Africa
- 6Health Economics and Epidemiology Research Office (HE²RO), Johannesburg, South Africa
Abstract
Mobile health (mHealth) technologies are increasingly used to support community-based healthcare. However, their real-world impact often remains unclear. Understanding implementation factors is essential for advancing their use and achieving meaningful health outcomes. We evaluated an mHealth tool (AitaHealth) after customising its modules and workflows for household Tuberculosis (TB) contact tracing and other community-based data collection by community health workers (CHWs). We describe the acceptability, feasibility, and implementation fidelity of this approach. We conducted a mixed-methods evaluation in two South African districts: uMkhanyakude and Ekurhuleni. We collected qualitative data through focus group discussions (FGDs) and in-depth interviews (IDIs) with CHWs, team leaders, and key stakeholders. We used deductive thematic analysis grounded in the Technology Acceptance Model (TAM) to assess the acceptability and implementation feasibility of the mHealth tool. We used quantitative data from the AitaHealth metadata to assess implementation fidelity. CHWs appreciated AitaHealth’s efficiency, data security, and credibility. Across the two districts, 103 CHWs recorded data for 2,452 households and 10,649 household members. However, they reported challenges in ease of use, with unreliable devices, weak support, and safety concerns hindering data collection. These issues led to inconsistent engagement, with 48.5% of CHWs logging in fewer than 15 times during implementation. Despite these challenges, when used, AitaHealth ensured high-quality data collection and household coverage, with TB-related fields completed in over 94% of households, demonstrating its potential under better conditions. AitaHealth`s limitations stemmed from system constraints rather than user resistance. To achieve full impact, mHealth tools require reliable infrastructure and supportive environments for both the tools and their implementers.
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BibTeX
@article{mudzengi2026evaluating,
title = {{Evaluating the acceptability, feasibility, and implementation fidelity of a multipurpose mobile health (mHealth) app used for Tuberculosis (TB) contact tracing by Ward-Based Outreach Teams (WBOTs) in South Africa}},
author = {Don Lawrence Mudzengi and Lindiwe Tsope and Piotr Hippner and Fezeka Mboniswa and Thapelo Mpanza and Tanyaradzwa Dube and Richard Lessells and Indira Govender and Dumile Gumede and Alison D. Grant and Katherine Fielding and Candice M. Chetty-Makkan and Kavindhran Velen and Salome Charalambous},
journal = {PLOS Global Public Health},
year = {2026},
month = aug,
doi = {10.1371/journal.pgph.0007120},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007120},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluating the acceptability, feasibility, and implementation fidelity of a multipurpose mobile health (mHealth) app used for Tuberculosis (TB) contact tracing by Ward-Based Outreach Teams (WBOTs) in South Africa
AU - Don Lawrence Mudzengi
AU - Lindiwe Tsope
AU - Piotr Hippner
AU - Fezeka Mboniswa
AU - Thapelo Mpanza
AU - Tanyaradzwa Dube
AU - Richard Lessells
AU - Indira Govender
AU - Dumile Gumede
AU - Alison D. Grant
AU - Katherine Fielding
AU - Candice M. Chetty-Makkan
AU - Kavindhran Velen
AU - Salome Charalambous
PY - 2026
DA - 2026/08/31
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007120
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007120
AB - Mobile health (mHealth) technologies are increasingly used to support community-based healthcare. However, their real-world impact often remains unclear. Understanding implementation factors is essential for advancing their use and achieving meaningful health outcomes. We evaluated an mHealth tool (AitaHealth) after customising its modules and workflows for household Tuberculosis (TB) contact tracing and other community-based data collection by community health workers (CHWs). We describe the acceptability, feasibility, and implementation fidelity of this approach. We conducted a mixed-methods evaluation in two South African districts: uMkhanyakude and Ekurhuleni. We collected qualitative data through focus group discussions (FGDs) and in-depth interviews (IDIs) with CHWs, team leaders, and key stakeholders. We used deductive thematic analysis grounded in the Technology Acceptance Model (TAM) to assess the acceptability and implementation feasibility of the mHealth tool. We used quantitative data from the AitaHealth metadata to assess implementation fidelity. CHWs appreciated AitaHealth’s efficiency, data security, and credibility. Across the two districts, 103 CHWs recorded data for 2,452 households and 10,649 household members. However, they reported challenges in ease of use, with unreliable devices, weak support, and safety concerns hindering data collection. These issues led to inconsistent engagement, with 48.5% of CHWs logging in fewer than 15 times during implementation. Despite these challenges, when used, AitaHealth ensured high-quality data collection and household coverage, with TB-related fields completed in over 94% of households, demonstrating its potential under better conditions. AitaHealth`s limitations stemmed from system constraints rather than user resistance. To achieve full impact, mHealth tools require reliable infrastructure and supportive environments for both the tools and their implementers.
SN - 2767-3375
ER -