Evaluating Feasibility and Acceptance of a Mobile Clinical Decision Support System in Botswana

Abstract Background The health workforce in Botswana consists mainly of medical officers and primary care nurses working in remote areas with limited training and insufficient reference materials to support diagnosis and management of diseases in dermatology and other subspecialties. This suggests a need for clinical decision support tools for these healthcare providers. VisualDx, a well-established mobile clinical decision support system, offers a promising solution with documented benefits. However, implementation of eHealth systems is commonly associated with challenges. To inform sustainable implementation of VisualDx in Botswana, it is important to evaluate intended users’ perceptions of the technology. This study aims to determine healthcare workers acceptance of VisualDx to gauge feasibility of future adoption in Botswana and other similar healthcare systems. Methods The study's design was informed by constructs of the technology acceptance model. A convergent mixed methods feasibility study involving surveys and semi-structured interviews was conducted. The Research Electronic Data Capture (REDCap) platform supported online data capture from March 2021 through August 2021. Twenty eight healthcare workers across Botswana participated in the study and their usage data was tracked over time. Descriptive statistics were generated and analyzed using Excel and REDCap. Thematic analysis of interview transcripts was performed using Delve. Results All initial survey participants (n = 28) expressed interest in using mHealth technology to support their daily work. Prior to VisualDx access, participants referenced textbooks, journal articles, and Google search engines among others. Overall, participants' survey responses showed their confidence in the VisualDx platform (94.7%); however, some barriers were noted. Frequently used features included generating a differential diagnosis through manual entry of patient symptoms (48.5%) or using the artificial intelligence feature (22.0%). Seventeen (60.7%) participated in virtual interview sessions at different times and ultimately 4 themes (governance, infrastructure, human resource capacity development and usability) were derived. Conclusions Participants' responses indicated acceptance of the VisualDx platform. The ability to access information quickly without internet connection is crucial in resource constrained environments. Select enhancements to VisualDx may further increase the feasibility of a national roll-out in Botswana, improving acceptance and successful adoption of the platform by general practitioners needing decision support for dermatology and other subspecialties.