Implementing a Tablet-based Application Used by Traditional Birth Attendants for Community-based Pregnancy Monitoring: A Mixed-method Study on Acceptability and Feasibility in the Central African Republic

Methods: We employed a mixed-methods design. In-depth individual interviews were conducted with TBAs, HCWs, women, husbands, community leaders and district representatives. All TBAs also completed a questionnaire and a subset participated in a focus group discussion. Conceptual frameworks were used to analyse qualitative and quantitative data. Then, findings were integrated through joint analysis.

Findings: The tablet-based application, designed with pictograms, was perceived as usable by TBAs, provided that regular supervision was ensured. Its use was well accepted by TBAs who reported enhanced credibility and increased confidence, as well as by HCWs and community members. The application was perceived as a relevant tool for improving high-risk pregnancy identification at  community level, and for strengthening links between the community and the healthcare system. However, power outages limited its optimal use. Nevertheless, all interviewees expressed strong willingness to sustain this intervention.

Interpretation: The use of a tablet-based digital application by TBAs was well accepted and feasible, provided regular supervision of TBAs and community leaders involvement. Anticipating and addressing logistical challenges is also essential for the successful implementation and sustainability of such digital maternal health interventions.