Usability and quality evaluation of the World Health Organization SkinNTDs app among frontline health workers in Cameroon: A mixed methods study.

Background: Originally adapted from a paper-based guide for skin-related neglected tropical diseases (NTDs), version 3.0.0 of the World Health Organization (WHO) SkinNTDs app aims to strengthen disease surveillance and frontline health worker capacity in NTD-endemic settings. Evidence on its usability in routine care remains limited.

Objective: To assess the usability and perceived quality of the SkinNTDs app in a real-life setting.

Methods: This mixed methods evaluation was conducted between April and September 2024 among frontline health workers in five regions of Cameroon. Data included online questionnaires, based on the user version of the Mobile Application Rating Scale (uMARS), completed by 180 participants, and focus group discussions with 214 participants. Analyses were performed using jamovi 2.6.13 for quantitative analyses, and NVivo 12 Plus for qualitative analyses.

Results: Participants reported limited dermatology experience (46.1% untrained or unexperienced), and nearly half were trained to use the app (66.1%). The app received moderate overall quality (mean = 3.61/5), with functionality and information scoring highest (both 3.69) and engagement lowest (3.50). Perceived impact was strong (3.88), and users were highly willing to recommend the app (3.96) but reluctant to pay (1.82). Prior app training to use the app was identified as the strongest predictor of higher quality ratings. Qualitative feedback highlighted critical needs: offline functionality (essential in low-connectivity areas), multilingual support, inclusion of darker skin tone images, and data-saving features. Digital barriers (e.g., data storage) and contextual adaptation were emphasized for effective implementation, alongside formal training integration.

Conclusion: The app is a promising diagnostic support and educational tool, particularly when user training is provided. However, enhancements in engagement, cultural relevance (e.g., diverse imagery and local languages), offline utility, and reduced technical demands are critical for wider adoption. Scaling up adoption may be enhanced by integrating training modules into health system programs government endorsement, and addressing digital access barriers.