Abstract
Background:
While smartphones are a valuable personalized learning aid, there is a scarcity of Indian studies specifically addressing their use for learning Community Medicine.
Objectives:
To understand the willingness of academic stakeholders to utilize an app in Community Medicine, if developed, and to find out the factors predicting such willingness.
Materials and Methods:
A mixed-methods study using a convergent parallel design was conducted between July 2018 and January 2021 at a government-funded medical institution in Bhopal, India. This included a cross-sectional survey of 421 undergraduate medical students using a semi-structured electronic questionnaire. Multivariable logistic regression analysis was conducted. A total of 12 in-depth interviews with undergraduate students, resident doctors, and faculty were conducted, which were analyzed using thematic content analysis.
Results:
Of the 421 participants, 82.9% were willing to use the app, if developed. Participants with three or more apps currently installed (adjusted OR = 2.12, P = 0.044) and those who used medical apps based on peer recommendations (adjusted OR = 2.31, P = 0.008) were significantly more willing to use a subject-specific app. Conversely, students using medical apps several times a day were less willing (adjusted OR = 0.45, P = 0.004). Qualitative findings highlighted apps’ potential for accessible, updated, and interactive learning, emphasizing time efficiency and self-paced education. Concerns included the inability of apps to replace hands-on experience, development and funding responsibility, potential for distraction, and the need for a robust feedback mechanism.
Conclusion:
There was high willingness of academic stakeholders to use a mobile application for learning Community Medicine. Supplementing this with hands-on experiences and having feedback mechanisms was perceived as essential. Students using multiple apps can act as motivators for their peers to use the proposed app, during actual implementation.
Keywords: Medical education, Mixed method study, Smart phone application, India
INTRODUCTION
Community Medicine departments in Indian medical colleges expose undergraduate students to various aspects of public health and primary care, including preventive, promotive, and curative services, as well as health education.[1] Innovative teaching-learning methods are being explored by researchers to address barriers to learning, which also applies to Community Medicine.[2] Traditionally, learning in this subject has been dependent on group-based, in-person lectures, which are often less personalized. However, the field of medicine is constantly evolving, and access to up-to-date knowledge is crucial.[3] Unlike print textbooks, which are updated every few years, online resources and applications can be easily and quickly modified to reflect the latest information.[4] With the rapid increase in digital literacy among medical students in India and the global embrace of digital tools in education, the integration of technology into medical curricula is no longer a luxury, but a necessity to cater to contemporary learning styles and demands.[5]
Smartphones are perceived as a valuable learning tool due to their convenience and ability to provide a one-to-one, personalized educational experience.[6] They offer flexibility, allowing students to learn at their own pace. The intersection of mobile phone technology and medical education has been explored in various contexts, with some studies highlighting the potential of smartphones for e-learning in fields like nursing education and for preparing for postgraduate entrance exams.[7] For instance, studies from certain Western countries have shown medical apps to enhance knowledge retention, improve clinical reasoning, and provide accessible point-of-care information.[8] While a significant body of research exists on the general use of medical apps for subjects like anatomy and clinical skills, there is a notable lack of studies from India that specifically investigate students’ perceptions and willingness to use smartphone-based apps for public health and primary care education.[9] This gap is particularly pertinent given the unique epidemiological challenges and healthcare delivery models prevalent in India, making context-specific digital learning tools highly valuable.[10]
The present study thus aimed to understand the perceptions of the academic stakeholders regarding their willingness to use a subject-specific app for Community Medicine, if developed, and to find out the factors predicting such willingness. It is expected that this would help identify the factors to be kept in mind for the development of such an application in the future.
MATERIALS AND METHODS
Study settings
The study was conducted at a government-funded tertiary care teaching hospital, located in Bhopal, India. At the time of the study, the annual student intake of medical undergraduates for the MBBS degree was 100 students.
Study population
This included all undergraduate medical students and interns. For the qualitative component, participants included undergraduate medical students, interns, resident doctors, and faculty from the department involved in teaching and learning of the Community Medicine subject.
Study design and duration
This was a mixed-methods study conducted between July 2018 and January 2021, employing a convergent parallel design, which included a quantitative component (cross-sectional study) and a qualitative component (in-depth interviews).
Sampling, inclusion and exclusion criteria
Universal sampling was used. All undergraduate medical students enrolled in the MBBS course at the institute were included for quantitative data collection. For the qualitative component, purposive sampling was used. Undergraduate students were selected based on their academic year of MBBS and gender. Resident doctors were selected based on gender and their residency training type (junior or senior resident), junior residents being the postgraduate students. Faculty were also interviewed. Sample size for the qualitative study was determined by data saturation, that is, data collection continued till the point where no new data or themes emerged from the data However, no specific criteria for guiding data saturation was used.
Detailed data collection methods
The study was approved by the Institutional Human Ethics Committee (IHEC) vide letter no. IHEC-LOP/2017/IM0163. Quantitative data were collected through electronic means by using a semi-structured questionnaire developed using the Kobo Toolbox (Harvard Humanitarian Initiative) application. The link to the questionnaire was circulated among the students via WhatsApp groups of their respective classes and students were invited to participate. The questionnaire comprised sections on sociodemographic information, current smartphone and medical app usage patterns, perceived usefulness, and willingness to use a Community Medicine-specific app. Electronic consent was obtained before enrolling the participants.
For the qualitative data, face-to-face in-depth interviews (IDIs) were conducted by investigators (authors) trained in qualitative research methods and analysis, after obtaining prior appointment and informed consent. They had a background in the community medicine subject. Given their familiarity with the subject area, efforts were made to minimize potential interviewer bias by using a topic guide and maintaining neutrality during data collection. Data collection for IDIs was conducted by two authors, and the coding and analysis were conducted by two other authors, including one who was not specializing/specialized in community medicine, hence decreasing subjectivity or bias. The researchers remained aware of their preconceptions during data collection and analysis to ensure objective interpretation of responses. Interviewers had a prior relationship with some of the participants, as they worked or taught in the same department. However, neither the data collectors, nor those analyzing the data had prior experience of research in the area of smartphones in the subject. Interviews were audio-recorded using a smartphone. The transcripts of interviews were not returned to the participants for feedback due to lack of time.
Data analysis
Quantitative data were exported to Microsoft Excel and analyzed using IBM SPSS Statistics software. Chi-square tests were performed to assess associations between groups, and univariable logistic regression analysis was conducted to identify predictors of willingness to use an app. Variables with a P value less than 0.25 in the univariable analysis were included in the multivariable model. However, variables showing multicollinearity with other predictors were excluded from the final model. A P value of less than 0.05 was considered statistically significant. The qualitative data were analyzed using thematic content analysis to identify the recurring themes and subthemes, following an inductive approach. The process involved transcribing the interviews, coding, categorizing, and generating the themes and subthemes.
RESULTS
A total of 421 students participated in the study, of whom, 282 (66.9%) were males. The mean (SD) age of the participants was 20.4 ± 1.8 years (range, 17–30 years). Out of 421, 38.9% (164) were fourth-year (final year) students or interns, 30.4% (128) were second-year students, 16.4% (69) were first-year students, and 14.3% (60) were third-year students.
Out of the total participants, 54.2% (226) had general medical applications installed on their mobile phone. When asked specifically about a Community Medicine app, 82.2% of participants “agreed” or “strongly agreed” regarding its usefulness. Similarly, 82.9% were willing, that is, “very likely” or “likely,” to use the app if developed by their institute. Community Medicine was the third most desired subject, for which the need for an app was stated (28.7%). The perceived usefulness and willingness to use a Community Medicine-specific app are detailed in Table 1. Top 3 priority areas to be incorporated in the app were identified as epidemiology, biostatistics and clinical approach in primary care [Figure 1].
Table 1.
Medical students’ perception of usefulness and their willingness to use mobile apps for academic learning of Community Medicine subject (n=421)
| Variable and category | n (%) | |
|---|---|---|
| Priority subjects in which medical students want an app | ||
| Medicine | 218 (51.8) | |
| Surgery | 154 (36.6) | |
| Community Medicine | 121 (28.7) | |
| Anatomy | 120 (28.5) | |
| Pharmacology | 106 (25.2) | |
| Others (Pediatrics, Microbiology, etc.) | 102 (24.2) | |
| Community Medicine subject-specific app (n=415) | ||
| An app for community medicine subject will be useful | ||
| Strongly agree | 166 (39.4) | |
| Agree | 180 (42.8) | |
| Neutral | 62 (14.7) | |
| Disagree | 3 (0.7) | |
| Strongly disagree | 10 (2.4) | |
| How likely are you to utilize an app specific to Community Medicine if developed and provided by your medical college? (n=415) | ||
| Very likely | 120 (28.5) | |
| Likely | 229 (54.4) | |
| Neutral | 43 (10.2) | |
| Unlikely | 16 (3.9) | |
| Very unlikely | 13 (3.0) | |
| Preferred mode of learning through app specific for Community Medicine subject* | ||
| Recorded audios and video lectures | 213 (71.2) | |
| Practice question before exams | 202 (67.6) | |
| Sharing of classroom notes/PPTs Public health news updates Books/journals/articles Curriculum and schedules |
187 (62.5) 157 (52.5) 146 (48.8) 121 (40.5) |
|
| Other (Case discussions, clinical simulations, etc.) | 3 (1) |
*Multiple answers were possible
Figure 1.
Priority areas for learning Community Medicine through mobile app as suggested by undergraduate medical students (n = 421)
The findings of univariable and multivariable logistic regression analyses are summarized in Tables 2 and 3, respectively. Participants with three or more apps currently installed in their mobile phones, and those who used medical apps on recommendation of their peers were more than twice as willing to use a subject-specific app. However, students who used apps several times a day were almost half as willing to use the app.
Table 2.
Predictors of willingness of undergraduate medical students to utilize a subject-specific medical app for learning the Community Medicine subject if developed by their institute)
| Variables | Willingness for subject-specific medical app |
P* | Unadjusted odds ratio | |||||
|---|---|---|---|---|---|---|---|---|
| No | Yes | |||||||
| Age | ||||||||
| <20 years | 37 (16.6) | 186 (83.4) | 0.48 | 1.19 (0.72–1.96) | ||||
| >20 years (ref) | 38 (19.2) | 160 (80.8) | - | - | ||||
| Gender | ||||||||
| Female | 23 (16.5) | 116 (83.5) | 0.63 | 1.14 (0.66–1.95) | ||||
| Male (ref) | 52 (18.4) | 230 (81.6) | - | - | ||||
| Semester | ||||||||
| First year | 8 (11.6) | 61 (88.4) | 0.14 | 1.79 (0.819–3.92) | ||||
| Second, third, and fourth year (ref) | 67 (19.0) | 285 (81.0) | ||||||
| Currently using medical app | ||||||||
| Yes | 57 (25.2) | 169 (74.8) | <0.001 | 3.31 (1.87–5.86) | ||||
| No (ref) | 18 (9.2) | 177 (90.8) | ||||||
| How many app used | ||||||||
| One | 22 (19.0) | 94 (81.0) | 0.75 | 1.10 (0.57–2.15) | ||||
| Two (ref) | 14 (20.6) | 54 (79.4) | ||||||
| Three and above | 9 (21.4) | 33 (78.6) | <0.001 | 3.33 (1.68–6.60) | ||||
| Frequency of usage of medical application | ||||||||
| Several times a day (ref) | 8 (15.7) | 43 (84.3) | ||||||
| Once or twice a day | 7 (10.8) | 58 (89.2) | 0.67 | 0.84 (0.37–1.87) | ||||
| One to three times a week | 7 (12.1) | 51 (87.9) | 0.21 | 0.51 (0.20–1.16) | ||||
| Never or rarely used | 9 (17.3) | 43 (82.7) | 0.22 | 0.59 (0.25–1.36) | ||||
| Time spent using medical apps on a smartphone | ||||||||
| Never used medical apps (ref) | ||||||||
| <15 min | 12 (13.0) | 80 (87.0) | 0.46 | 1.26 (0.67–2.38) | ||||
| 15–30 min | 6 (14.0) | 37 (86.0) | 0.12 | 0.44 (0.15–1.28) | ||||
| 31–60 min | 5 (12.5) | 35 (87.5) | 0.35 | 0.63 (0.24–1.67) | ||||
| >1 hour | 8 (15.7) | 43 (84.3) | 0.67 | 1.18 (0.53–2.64) | ||||
| People recommended in medical college | ||||||||
| Medical student | 47 (26.4) | 131 (73.6) | <0.001 | 2.77 (1.66–4.76) | ||||
| Resident doctors/Faculty (ref) | 28 (11.5) | 215 (88.5) | ||||||
*P<0.05 taken to be statistically significant
Table 3.
Predictors of willingness of undergraduate medical students to utilize a subject-specific app for learning Community Medicine
| Variables | Adjusted OR (95%CI) | P* | ||
|---|---|---|---|---|
| Subject-specific app | ||||
| - Having ≥ 3 apps currently installed | 2.12 (1.02–4.29) | 0.044 | ||
| - Specific medical app recommended by a fellow medical student | 2.31 (1.24–4.29) | 0.008 | ||
| - Used medical apps several times a day | 0.45 (0.26–0.78) | 0.004 |
*P<0.05 taken to be statistically significant
Qualitative findings
A total of 12 in-depth interviews were conducted. Each interview lasted approximately 30–45 minutes.
Theme: Perceived usefulness and advantages
Participants across all groups expressed strong support for a subject-specific app for Community Medicine, highlighting its potential to enhance learning and provide practical benefits. The subthemes that emerged are described below.
Content and accessibility
Participants believed that an app could provide a centralized, easy-to-access repository of essential information.
“First of all, they will have the case studies, model prescription writing……., spotters can be put in a file [electronic folder] and made available for students.”
[P1, Third year undergraduate student, male]
“We won’t need to actively search for any new update, because it will be constantly updated by the ones who will create it [the app], so we can rely on it. The information is correct, that is the biggest advantage.”
[P2, Academic faculty, male]
Time and efficiency
Participants frequently cited the ability to learn the subject efficiently, and at one’s own pace, as a major advantage of the mobile app, which directly addresses the time constraints of a demanding medical curriculum:
“About Community Medicine specific app, definitely it would be useful, means, we are also very busy and we are not able to give time for some reason and if this app is developed, it would help in self-paced learning.”
[P3, Second year undergraduate student, female]
“App based learning for Community Medicine is very good. Uhh.it’s easy there, that we can do it anytime.or.mmm. with the help of videos you will get prior sensitization. With practical classes, it is good.”
[P4, Academic faculty, male]
“I think it [mobile app] saves time and it is good for medical undergraduate students.”
[P5, Intern, male]
Interactive and engaging learning
The visual and interactive nature of apps was seen as a way to make learning more interesting and effective, as compared to the traditional books:
“Subject specific app would increase the interest of students, like if creative methods are used, then that is better than book, because by reading only, we get some, like 30% of it is imbibed. But through the app if various modes are used, we can imbibe more of it, like 50 to 70% we can understand.”
[P6, Third year undergraduate student, female]
Theme: Expectations and desired features
Participants had specific ideas about the content and features an app for learning Community Medicine should include to be truly useful and to address the unique challenges of the subject.
Focus on foundational and practical knowledge
The app should focus on essential, foundational knowledge and practical application, helping students build a strong base before moving on to complex topics:
“My expectation is that, it should cover the essential domains and under this, what are the basics, which everyone should know should definitely be covered.”
[P6, Third year undergraduate student, female]
“If subject wise application is developed, it should have basic study material; formula, flowcharts, etc., which will be useful.”
[P7, Intern, female]
“My expectation for application for community medicine subject is basically related to preparation for exams, that can be one part, and preparation for the postings, okay, our preparation for their [students’] practicals, clinical postings, theory material, all those things should be there, along with research and survey.”
[P8, Academic faculty, male]
Curriculum-specific conten
Participants opined that there is a need for an app that addresses specific, often challenging, topics within the Community Medicine curriculum:
“Some information about the program, then basic things about epidemiology and other small things.”
[P9, Second year undergraduate student, male]
“In case of data analysis, there should be a simulation of the process. Students should be provided a set of data and a scenario, and then asked to provide answers.”
[P10, Academic faculty, male]
Theme: Concerns and limitations
A number of concerns were raised, highlighting that an app cannot be a complete solution and requires careful implementation to be effective.
Cannot replace hands-on learning
The most prominent concern was that apps cannot substitute for real-world, hands-on experience in learning:
“Students should not be completely dependent on the apps. Classroom is essential for building concepts. I think classroom teaching should be there, and apps act as a supplement for learning, where faculty can put in important study material.”
[P5, Intern, male]
“.mandatory field visits in Community Medicine, as well as interaction with the community, are necessary to grasp the situation on the ground and the community’s healthcare challenges.”
[P11, Second year post graduate student of Community Medicine, Male]
Funding, development and responsibility of maintenance
Participants expressed apprehension about who would take responsibility for the app’s development, maintenance, and funding:
“Subject-specific smartphone-based applications can be used and should be done, but who will do it, that is the most important part of the question. It is not that much easy. It will require some expenditure also. Who will be responsible?”
[P11, Second year post graduate student of Community Medicine, male]
Distractions and dependency
There was a strong concern that students would become overly dependent on the app, leading to superficial learning without other sources of learning. The app was also believed to be a source of distraction:
“They will think that they can depend completely on that application, this could be a limitation for them.”
[P5, Intern, male]
“The other thing is that they might not even open the application, maybe every time they open the phone to get the application, they get lured by the social media thing.”
[P7, Intern, female]
Need for a feedback mechanism
Students felt that a feedback feature is essential for addressing problems and improving the app, thereby ensuring its ongoing relevance and quality:
“There should definitely be a feedback area for problems, that should be kept in mind. it should be done like that, so they [students] can put forward the problem they are also facing.”
[P12, Second year undergraduate student, Female]
A joint display integrating quantitative and qualitative findings is presented in Table 4, demonstrating convergence across key domains.
Table 4.
Integration of quantitative and qualitative findings
| Quantitative Findings | Qualitative Themes | Integrated Interpretation | ||
|---|---|---|---|---|
| 85.5% of participants expressed willingness to use a mobile app for learning Community Medicine | Students perceived app-based learning to be useful, convenient, and accessible | Strong convergence indicating high willingness to use mobile app due to its perceived usefulness, convenience and accessibility | ||
| Students were significantly more likely to utilize a subject-specific app if recommended by another fellow medical student as compared to recommendation by a faculty/resident doctor | Greater familiarity and comfort with mobile technology among students | Digital familiarity among younger users may explain higher acceptance | ||
| Frequent app users showed higher willingness to adopt a subject-specific app | Habitual use and dependence on mobile applications for academic purposes | Prior exposure enhances perceived usefulness and acceptance | ||
| Majority preferred features such as question banks and concise content | Need for exam-oriented, structured, and time-efficient learning resources | Highlights demand for targeted and efficient learning tools, including focus on examinations |
DISCUSSION
We found high willingness of medical students to use a Community Medicine-specific app and its perceived usefulness (over 82% of the participants). Also, student’s willingness to use a subject-specific app was significantly predicted (more than two times) if they had three or more apps installed on their smartphones. This suggests that students who are already technology-savvy and engaged with mobile learning are more receptive to new app-based educational tools. This is a critical insight for future app development and promotion strategies.[11,12,13] However, we also found that students who used medical apps several times a day, were less (close to 50%) willing to use the proposed app. This may hint toward excessive screen time in these students, leading to exhaustion, eye strain, fatigue etc., which may be having a negative impact on their willingness. In the qualitative component, the participants identified convenience and better time management as major advantages. The ability to access information “at any time” and “pause” lectures was seen as a key benefit over fixed classroom hours. This aligns with studies by Gavali et al.[14] and Robinson et al.,[15] which also identified instant access to information and improved communication as major benefits of using smartphones.
We found that students were more than two times likely to use the proposed app, if specific medical apps were already being recommended by fellow medical students. This shows that peer suggestion is an important factor in adopting newer apps among students, which can be utilized as a strategy to disseminate the usage of a new app. Participants also expected this app to provide authentic and up-to-date information directly, which also addresses a major limitation of generic online content, which is often seen as unreliable.
An important finding of the present study was the students’ desire to use the app for topics they find particularly challenging to learn through conventional methods. The identified priority areas for app content: epidemiology, biostatistics, and clinical approach in primary care are subjects that often involve complex thought, analysis and practical application, which lend themselves well to interactive, app-based learning. This finding resonates with a previous study where poor knowledge of medical students was reported in various areas of epidemiology and biostatistics.[16] Although preference for opting for post-graduation in Community Medicine has been traditionally lower among medical students, in India, as compared to other clinical subjects, we found that it was the third most preferred subject for app development.[17,18,19] Students seem to realize that a subject-specific app is required to learn this subject, which is vast, multidimensional, dynamic, complex and often requires a combination of learning strategies. Previous literature from India suggests that innovative ways and platforms should be utilized by Community Medicine professionals to share their work with medical students, which can inspire medical graduates to opt for this subject for post-graduation.[20]
Despite the enthusiasm, participants in the present study expressed certain limitations and concerns. It was opined that apps are not a complete substitute for clinical skills and practical exposure, and cannot replace the indispensable hands-on clinical and community experiences, a finding in line with previous literature.[21] Participants emphasized that “Hand-to-hand practice is not there” in apps for skills like suturing, and that field visits are necessary to “gain a true sense of the neighbourhood.” This reinforces the view that apps should serve as a supplementary tool, and not as a replacement for fundamental, practical training in Community Medicine, a finding supported by Koh KC et al.[22] The other barriers identified were technical issues, the funding acquisition and maintenance issues of such an app, and the potential for distractions. The concern about the authenticity of information is a well-documented issue, supported by Giebel et al.,[23] who found that unreliability can lead to students acquiring incorrect knowledge. Similarly, the fear of superficial learning without internalization was reported by Pimmer et al.[24] and Wallace et al.,[25] who noted that smartphone use may be associated with “superficial learning” and adopting a “copy-paste” habit. The study by Das et al.[26] and Putri et al.[27] also observed similar barriers, including a lack of time and small screen size, which were implicitly mentioned by the participants of our study as well.
According to the best of our knowledge, this is the first study from India, exploring the willingness to use an institutional Community Medicine-specific mobile app. Another strength was the mixed-methods design, along with inclusion of all type of key stakeholders for in-depth interviews. This allowed to explore nuances not typically addressed in purely quantitative or qualitative studies. One limitation of the study was the inclusion of a single central government-funded medical college; thus, the findings may not be completely generalizable to the students of private or state medical colleges. The data collection period spanned from 2018 to early 2021, partially overlapping with the COVID-19 pandemic, which could influence the findings; however, the findings remain relevant in the current context, as well as for similar pandemic scenarios in the future.[28] The pandemic could have actually accelerated the adoption of digital learning tools in medical education, further strengthening the need for structured, subject-specific mobile applications.[29]
The institutional promotion efforts for increasing uptake of the proposed app should target students who are already digitally engaged, leveraging their existing comfort with mobile learning. These students can suggest to peer medical students to use the app. High-priority areas, namely epidemiology, biostatistics, and clinical approaches to primary care, should be given more weightage content-wise, as compared to other areas. Concerns regarding the authenticity of the content, the financial barriers posed, regular maintenance, and technical issues like internet connectivity highlight the need for institutionally supported, high-quality, and accessible solutions. In light of these findings, we propose an education model where a subject-specific app is carefully integrated into the curriculum, not as a replacement for traditional methods, but as a powerful, supplementary tool designed to enhance learning in specific, well-defined domains. Future studies may benefit from using established theoretical frameworks to better understand factors influencing adoption of mobile learning tools, in case newer technologies such as Artificial Intelligence, etc., are also included in app-based learning.
CONCLUSION
The findings of the present study indicate a strong and clear demand for such a tool, driven by a desire for a more flexible and efficient learning experience. More than 82% of the participants expressed willingness to adopt a Community Medicine-specific app, particularly those, who are already accustomed to using multiple medical apps and those who used apps based on peer suggestion. These findings can serve as a useful guide for developers, educators and administrators of academic institutions (where the Community Medicine subject is taught), particularly those who plan to design a highly relevant and effective educational digital tool.
Ethical Approval
The study was approved by the Institutional Human Ethics Committee (IHEC), AIIMS Bhopal, vide letter no. IHEC-LOP/2017/IM0163.
Consent to Participate
Electronic consent was obtained from all survey participants before enrollment. Prior informed consent was obtained for all in-depth interviews.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
We acknowledge all the participants for their active participation and the institutional authorities for extending their support.
Funding Statement
Nil.
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