Our partners at iKure have told us numerous times that Community Health Workers generally have at most a 10th standard (high school equivalent) education, and many are unaccustomed to using electronics like smartphones or tablets in their fieldwork, let alone for their personal use.
This insight into the CHWs’ context and environment has brought up an important question about health and technology literacy, and how both are distinct from each other yet intertwined within our project.
What is “health literacy?” From our extensive literature search on health workers in various contexts, CHWs serve as the bridge between marginalized (often rural) communities and formal healthcare systems. From taking diagnostic health information to offering basic medical advice, CHWs must be versed in both procedural and theoretical aspects of health. This requires CHWs to not only communicate health metrics to communities, but more importantly, to understand the significance of these metrics and know the appropriate course of action or advice to deliver alongside the health data.
Although it is important to provide standardized and continuous training to CHWs that focuses on preventive care and health promotion, there is fine line between comprehensive health training, and giving CHWs information that is too academic and granular for them to use effectively in the field.
What is “technology literacy?” This concept has been a little more difficult to define, and has been a key focal point in the development of our project. If we are evaluating the extent of CHWs’ knowledge in using the KOL-Health Application, does this mean assessing their comprehension of the questions and fields they need to fill out? Is it being able to navigate easily through the different screens in the application? Is it understanding the terminology ascribed to each page (e.g. using the term “case” to refer to a new visit, or encounter, with a patient).
Of course, we plan to address all of the above questions through different phases of usability testing with CHWs. By using observational techniques, direct interviews and mock run-throughs of the application, we hope to better understand if:
(1) Language barriers are a significant problem (Hindi-Bengali vs. English script)
(2) The application is easy or difficult for the CHWs to navigate through
(3) The sample content in the application is too mechanistic or academic
(4) CHWs will be competent and comfortable using the KOL-Health App regularly, and feel it a better data collection model over paper forms.
It is one thing to train health workers a piece of technology to use in their work; it is entirely another thing to evaluate the tool, gather input from health workers, and actively consider “literacy” issues to create a product that best enhances healthcare delivery activities of these users.