Table 2.

The hexagon exploration tool assessment of the CHEST App.

Program indicators
Evidence	Multiple studies have shown that mHealth tools can improve CHA performance in similar low-resource community settings, including health education with videos and digital surveillance tools (47–49, 51–55)
Usability	Previous studies and stake-holder interviews suggested that the technology could be used in the local context. Additionally, the acceptability and usability of the CHEST App was confirmed through informal interviews with the local populations. The CHAs and local supervisors expressed their preferences for how the tool should be designed to fit the needs of their program.
Supports	Elementos had the resources to design and implement the CHEST App thanks to funding from Grand Challenges Canada, Saving Brains grant (60). Elementos created the capacity to conduct the project by hiring a multidisciplinary team of specialists; an implementation scientist, nutritionist, anthropologist, community psychologist, epidemiologist, nurse, communicator, and software engineer. Together they developed the material (a guidebook of health messages and animated videos), the App, and the implementation protocol. The CHEST App was developed from open source code from OpenSRP, (61) which includes code and forums for support. Technical assistance and development was also provided by the UNC CHAI Core team (62)
Implementing site indicators
Capacity to implement	The communities have established CHA programs that have the capacity and interest to receive and integrate the CHEST App into their normal activities. The CHA programs are supported by funding from their Municipality, which includes pay for a program supervisor. Additional implementation support was provided by Elementos by providing an implementation team that visits the communities for continuous training and support for 1 year.
Fit with current initiatives	The tool was created to integrate within the established CHA programs with minimal interruption of their current activities. The tool was expected to improve the ease and effectiveness of their current initiatives.
Need	Multiple studies by the research team identified the need; reflected by the high rates of malnutrition, misunderstanding of health topics by caregivers, and poor performance of CHAs.