Usability and Effectiveness of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana

Most cancer diagnoses are expected to be in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths occur in LMICs. Treatment adherence and patient monitoring are essential to cancer care but are often not possible in LMICs. OP Care, a smartphone application developed to fill this gap, stores medical records virtually and texts appointment reminders to patients. This study assessed its usability and effectiveness. OP Care was piloted at Princess Marina Hospital in Gaborone, Botswana. The study was a cross-sectional study using surveys. All providers using the application were surveyed, along with all patients who were previously enrolled in the application and attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reaction, opinions on usability, and patients’ reactions to appointment reminders were collected. Answers were recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the application’s usability and the effectiveness of the text reminders. The University of Pennsylvania Institutional Review Board and the Ministry of Health and Wellness in Botswana gave approval for the study. Patients provided written consent before enrollment. Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses, all of whom own a smartphone and use a computer at home. Most staff (78%) did not feel OP Care would increase their work burden and were willing to use the application if implemented permanently (median response, 6; interquartile range [IQR], 1). Most usability questions (17 of 19), such as “I feel comfortable using this system,” scored a median of 6. Most patients believed that the reminder text messages were helpful (median, 6; IQR, 1) but wanted the text reminders to be in the Setswana language (median, 7; IQR, 1). High usability scores indicate the application is adaptable to other clinics. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated. A potential limitation is that patients for whom the appointment reminders were not helpful were not necessarily included, because only patients in the clinic were surveyed. Strengths were inclusion of all involved staff, uniformity in survey administration, and inclusion of numerical analysis.