Usability and acceptability of the software ‘Arogya Sahyog’ to assess non-communicable diseases in rural India

Background: In rural regions with few doctors to manage non-communicable diseases (NCDs), people rely on community health workers (CHWs). We developed a tablet-based decision support application (app), called ‘Arogya Sahyog’, to support CHWs in the field. Objective: To assess usability of the app for screening, providing lifestyle advice, and referring patients with NCDs to health centers. Methods: Sixteen CHWs in the Tehri Garhwal district of India underwent a five-day training program in November 2019. We assessed: (i) acceptability: through a self-administered questionnaire; (ii) fidelity: by comparing the app data with ‘pre-set’ responses, and (iii) usability: through the validated system usability scale (SUS). The ‘Strengths, Weaknesses, Opportunities and Threats (SWOT)’ framework was used to identify enablers of, and barriers to, use of the app. Results: Usability on the SUS was 88.3% (95% confidence interval 85.6-92.0%), with ratings between ‘excellent’ and ‘best imaginable’. Most CHWs (87-93%) reported that the app was user-friendly, had a pleasing color scheme, and was entertaining to use. Human error on data entry was < 4%, with most errors being in free-text fields. Four main themes were identified in using the app: ‘strengths’ (clear instructions), ‘weaknesses’ (difficulty in using the inbuilt keyboard), opportunities’ (high motivation), and ‘threats’ (increased workload and interference with their routine work). Conclusion: Arogya Sahyog was well accepted and achieved an excellent usability rating, supporting its use by CHWs. The next step is to test whether CHWs can use the app to identify and manage people with NCDs in the community.