Table 5.

Key considerations, challenges, and proposed solutions for improvement.

Key considerations		Challenges	Proposed solutions
System level
	Target users	App must support a variety of FLWa roles with different workflows and role requirements as well as their supervisors	Design the app to include role-specific features that can be customized to support site-specific needs as allowed (eg, inclusion of depression screening)
	Integration into the current systems	Potential to increase workload associated with integrating measurement-based peer supervision into current workflows	Integrate the new app with existing EHRsb such as Epic, which can reduce data redundancy and support more comprehensive client care
	Interoperability across operating systems	Prototype is currently only supported as a web application or Android mobile app	Ensure that the app is easily accessible and can support offline data collection on other commonly used devices (eg, iPhones)
Organization level
	Available resources in the implementing health facilities	Inadequate physical space for conducting private and secure counseling sessions Lack of current protocols on supportive supervision to guide FLWs Need for structured peer supervision to implement the app	Assess the availability and accessibility of facilities’ resources before implementing the app Facilitate the development of protocols or updates to current protocols to promote the use of the app Set up or use the existing structured peer supervision mechanisms to support app integration
	Peer supervision model	More structured peer supervision could be cumbersome and time-consuming, especially for FLWs who are used to feedback from supervisors and are more comfortable with informal peer feedback mechanisms	Include specific training and guidance on delivering and receiving peer feedback Ensure supervisor buy-in and system support
	Hybrid workflow	Both in-person and remote (telehealth) client visits are common	Ensure the app can flexibly support recordings either directly in-app or via integration with other tools that may already be used
App related
	Peer ratings	Introducing a mechanism for peers to rate and critique each other may feel uncomfortable	Include positive and encouraging language and features (eg, badges) to support improvement in performance Include space for qualitative feedback to provide more context for ratings
	Navigation	Navigation through parts of the app remains cumbersome	Enhance the app to support the following: Unnested features (eg, client or patient lists) An easy way to view completed self-ratings A way to flag incomplete self- and peer ratings Locating a session recording via multiple search parameters, such as client or patient ID, peer, or date
	Data visualization	Graphs and self-ratings are not intuitive	Simplify current features such that graphs are more easily accessed and usable across device screen sizes Highlight and indicate change in performance over time, noting specific areas that may need improvement

^aFLW: frontline health worker.

^bEHR: electronic health record.