Table 4.

Barriers to effective use of Geohealth application

Technical barrier: inefficiency	The negative side is that Geohealth would crash or freeze in the middle of a visit. It would stop all of a sudden and oh, how it would make you angry. You can get an interview done in less time than it takes to open the application. [The mobile application] wasn’t a good interface. You had to jump from screen to screen in a random order to get what you wanted. You could organize the pages so it is more efficient. You had to jump between all these different screens. It would be better to have it all on just one screen. Sometimes there is duplicated data [with the mobile application]. So I always write down my numbers and can check them against Geohealth. If one day Geohealth says I have 202 families, but I have written down that I have 198, and I haven’t registered any new families, I know there is a problem in Geohealth. Geohealth doesn’t always remember the changes we make. For example, when a community member dies, we delete the record from Geohealth. But then later it keeps popping up again, and we know that person is dead. We take community members out of the system and then they reappear. Paper doesn’t delete the information. The only annoying thing is when I type a huge amount about the visit, then look up from the phone to the community member, and accidentally hit the home button. The phone leaves Geohealth and I lose everything I wrote. I accidentally delete it all.
Technical barrier: signal strength	It’s just the device that doesn’t work. We always have to wait for the signal and for it to start working. The signal. The signal could be better. Sometimes it gets stuck searching for a signal and you have to force quit. Then you have to re-type everything. That’s annoying.
Technical barrier: the device	I used it [Geohealth] for just over a year, but then the device broke on me. I sent it in to be fixed. After 6 months, it came back, but it was still broken in the same way. Now I don’t have one [a smartphone]. The biggest problem is the reception. After that, the battery. After charging it in the morning, the battery is dead by the afternoon. The device is terrible but the computer system helps us a lot. I use it a lot on the computer. I didn’t like the Geohealth phone. The computer was much better. I couldn’t pay attention to the community members when I was using the phone. Cell phones are distracting. Their keys are too small. I update Geohealth information on my computer at home.
Social barrier: community member perceptions	The community members, especially the older ones, complain. They say, look at me! I’m telling you a story, pay attention! Eye contact is so important. Sometimes a community member doesn’t say he’s in pain, but you see it in their face. Keeping an elderly person company has no need for Geohealth. The idea of having Geohealth is to make your life easier, but that doesn’t mean it makes the lives of the community members easier. I use Geohealth on the computer. Like I said, I don’t use the Geohealth cell phone. It sits in the closet. I never use it. It isn’t good for community members. You have to listen to them, and you can’t listen if you are sitting there trying to type. Community members lose their connection with you when you’re on the cellphone. You can’t show them that you’re not texting and that you’re completing the work if they’re illiterate.
Social barrier: safety	I work in a risky area. There is a lot of drug trafficking. If the police pass by, and they see my typing on the Geohealth, they think I’m alerting drug traffickers that they are here. Or if a drug trafficker sees you typing they think you are alerting the police. But I also have to be more discrete with Geohealth. There is some danger of robberies. We are a little hesitant to use it on the street. We have to be. Even though it is an old phone, someone might think it is nice. Anything we use has to be discrete so it doesn’t catch the attention of thieves. What I do to prevent it from being stolen is I show the drug dealers the phone. I know them because they are the same kids from the preschool where I worked previously. I show them the phone and say ‘you could steal it if you wanted to. You’d be able to unlock all the functions that are blocked. But I’ll have to report it because it isn’t mine. It is public property, so I’ll have to report it to the police. I have no choice. And if I lose it, I have to pay for it out of my own salary.’