Table 5.

Recommended improvements to Geohealth

Include more data	Include ALL of our paperwork. Have you seen our paperwork? [she goes into another room and brings back a stack of different papers that CHWs use for their work and for their monthly tallies of data at the end of each month. She shows me each form and how tedious it is to do the counts.] All of this could be done automatically on Geohealth. And then at the end of the month, we’d just print it and be all set. The end of the month days when we have to do these counts. It’s very tense. It is a lot of work: everybody is stressed out. Sometimes I wake up at 3 am to finish. And when you’re new, it is even worse. Oh, it’s a real headache. The point of technology should be to get rid of all these papers and little papers. They should integrate ALL of our forms, not just form A and the home visits.
Communication	It would be wonderful if we could send and receive messages because right now we use WhatsApp. We could contact the family directly if we needed some kind of information. If community members could send text messages with questions for the CHW’s from their personal phone to the CHW’s Geohealth app, that would be incredibly helpful. It [the mobile application] couple be improved if it allowed more communication between the team. I have no way of communicating with my team except for my personal cell phone. I don’t give my WhatsApp number to my community members because I need a barrier between personal and work life—it doesn’t work out to mix them. I have to cut it off somewhere. It would be nice if we could send texts with the Geohealth phone. We could alert community members if their exam results arrived, or if they have an appointment coming up. Something like WhatsApp to communicate with community members. My Geohealth phone sits in the closet. But if I were able to use it to send messages to community members, then I would use it.
Logistic improvements	Also, there is no way to get a signature on the cell phone. I have all my community members sign on paper when I visit their house so that I have a way of keeping track, or proving that I visited them, so they can’t say I didn’t go later. I ask for a signature at every visit. Why don’t they add a function for a digital signature? Like a fingerprint? They could just put their thumbprint into the cell phone to sign. That also helps the illiterate community members too. It would also be nice if it had little alerts or reminders for individual community members who needed exams. Like if I went to someone’s house, when I opened the visit form it would remind me that this person needs a mammogram, and I could talk about that at the visit. I don’t always remember everything every person needs. This would make it more effective. She said that the information collected could be used to educate community members. It could be used to show them “research” about their health. She gave the example of community members who buy medication on the street and ask her about it. Again, she would like to be able to give them information that she doesn’t know during the visit rather than waiting a month to get back to them. She would also like to record her visits. She also thought that Geohealth could be used to connect community members to health resources. For example, it could have our work cards—instead of writing down when we come and leave work each day, it could be recorded in Geohealth. It could have our teams, calendars, and keep track of all the work I do. I know what I do each day so I’m not keeping track for myself. It would be nice if there was a built-in tracker of how many visits we had done each month to keep track of our monthly goals. Everything could be compact in this one device. It is necessary for us to have more information about health. Most of what I learn about health is from the news—TV journals. Sometimes our community members see health programs on TV and it is something we don’t know. We say, oh, really? I would want that information in my smart phone.
Individually suggested innovations	There are Facebook groups for lots of things. I had a cousin who had her gallbladder removed and needed advice. She found a Facebook group for other patients recovering from the same surgery. That would be good. We have a garden here that we use to teach community members and CHAs about herbs and teas for different conditions- like hypertension. You could have different groups with the garden. There are many people who like gardening, especially old people, who don’t have good places at their house. Some people don’t like gardening they just like drinking tea. You could have different groups for those who like gardening and those who like drinking tea. I think you would get more people involved that way, off their couch and away from the tv. We have a problem here. Old people think that when you retire you stop being active. It’s hard to change their thinking. It would be good to provide activities for them and I think more would come if you could remind them. Geohealth could be programmed to help us understand the demands of the health center. How many visits, how many medications…it would make predictions based on the data. We could type in how much insulin patients are using, and if they are getting it but not using it at home. We could also use it to motivate community members by showing them how they are improving. For example, if a community member was taking good care of a wound but didn’t think it was healing, we could show them a photo from last week and say “look here! It is better.” It is a way of incentivizing community members to take care of their wound because we are documenting it. I’d use a camera to take photos—to motivate community members. For example, we have groups of hypertensives, diabetics, and we do activities with them. We have workshops and things. It is important to take pictures of these events. To document our work, and it is a way of motivating them to come. People love photos, the community members love photos. We observe the entire house. We’d like to take a photo, sometimes we use our own phone to take photos. I take pictures of trash pile. Sometimes I put pictures of trash on social networks to show the government how things are here. I take pictures of things that call my attention.
Improved device	How can the system be improved? A tablet with a stylus would be great, because they we could write with the stylus... it is more natural than typing. I think the community members would be more comfortable with that too because it doesn’t look like we are typing on WhatsApp. It is also faster than typing. Tablets would be better perceived by community members because the community member could see what I am doing on the screen and the keyboard would be bigger. I would only change the device - it deletes the visit. Also, having more computers to enter the visits who help. We have to make a summary for the nurse and this is a lot of work. It takes a lot of time to enter all of the visits in the computer.