Acceptability of mHealth tools by auxiliary midwives in Myanmar: A qualitative study

Myanmar’s fragile health system and suboptimal health workforce negatively affect quality of care. An NGO pilots Myanmar’s first point-of-care mHealth-project, providing smartphones to auxiliary midwives (AMWs) with patient registration and algorithm-based decision-making applications. Behavioural theories suggest that external stimuli increase clinical compliance, thereby improving quality of care, ultimately contributing to reduced maternal and neonatal mortality. With (inter)national evidence being scarce, this first known study of mHealth in Myanmar provides formative feedback to the implementing organization.

Operationalizing a conceptual framework based on Davis’ (1989) Technology Acceptance Model (TAM), acceptability, use and contextual barriers/facilitators were assessed through in-depth-interviews and focus groups with all AMWs (n=20). TAM’s premise: if mHealth tools are perceived as useful, easy to use, and important others in AMWs' social environment support its use, AMWs will accept mHealth tools (acceptance predictor for use), whereas contextual barriers/facilitators influence use of tools directly.

Acceptability was very high: smartphone and electronic applications were perceived as useful, easy to use, and AMWs’ social environment as supportive. All AMWs reported using the voice option; the majority used the applications. Organizational support (training, technical, material, financial), economic advantages (electronic reporting cheaper than paper) and political interest (MOH announced all reporting to be electronic soon) were contextual facilitators to use. Technical problems with applications and Internet network problems represented the main contextual barriers.

As mHealth was believed to be the future norm and its tools perceived as superior to the traditional system, AMWs were determined to use the mHealth tools despite important barriers, of which notably the technical need improvement.