Qualitative evaluation of SAFE method for implementation in less developed countries

Background: The Structured Application Framework for Epi Info (SAFE) was created to promote practice of industry standards application development in the design of information systems in resource-poor countries using Epi Info. SAFE was created by the data management groups in CDC Global Immunization Division and Global AIDS Program. SAFE enables Epi Info developers to create scalable information systems by reusing application code blocks that are easy to maintain, modify and improve. To date 7 public health applications built upon SAFE operate in 40 countries at four administrative tiers.

Objectives: We aim at qualitatively evaluating the SAFE method for developing case-based surveillance applications. Specifically, we compare SAFE with Epi Info using non-SAFE and other commercial software: (1) Speed, flexibility, reusability and scalability of application development (2) Speed and quality of application customization by end users in adding ad-hoc analyses, modifying existing menu, and customizing analysis output.

Methods: We propose a framework of evaluation. A group of developers were identified as either SAFE or non-SAFE developers. The two groups were similar in their training and work experience. Both groups were given a task to develop the same collection of functionalities based on stated requirements. We measured the development time, and the quality of final product. We also measured the same criteria of the two groups to modify an existing application to add extra functionalities and change the user interface.

Results: The results of the study demonstrate the ability of programmers in the utilization of SAFE method to develop applications more efficiently than using non-SAFE methods. The ability to quickly and safely modify existing applications and sharing of best-practice will encourage more standardized approach to application development. This will, in turn, improve the quality of data collected in the field and increase the ability of program managers to use data for decision making.