Design and development of a clinical decision support system for community health workers to support early detection and management of non-communicable disease

Background: Numerous groups have developed software applications (apps) for use by community health workers (CHWs) in hard-to-reach settings. However, these have either not been based on clinical guidelines or are not freely available. Our objectives were to (1) design and develop an app for use by CHWs; and (2) conduct preliminary testing of the app to identify potential obstacles. Methods: We used the principle of human-centred design to develop an app programmed to an Android operating system. We used a mixed-methods approach which included site observations, meetings with stakeholders and the app development team, and laboratory simulation to fine tune the design. The 'Mobile Application Rating Scale' (MARS) was used for testing reliability and quality. We also assessed the validity of the app by matching the uploaded data with 'gold standard' preset answers. Results: Depending on human-computer interactions, the app has reminder, advisor, critic and guide functions which can facilitate CHWs to make clinical decisions. We found the app is usable based on the final score of the MARS tool, and that the entered data were accurate. We present the simple procedures that were followed to develop this Android app. The app, including all of its code, is freely available. Conclusion: The app shows promise as a tool for the management of non-communicable disease in a rural setting in India. The next step will be to refine the app in a field setting and then to evaluate its efficacy in a large-scale clinical trial.