CANMI APP: Development, implementation, and usability evaluation of a digital tool to monitor the quality of maternal and child nutrition care in primary health units in Mexico (Preprint)

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BACKGROUND In Mexico, the maternal and child population continues to face a high burden of malnutrition, posing a persisted public health challenge. The healthcare system plays a crucial role, not only in addressing existing cases but also in preventing and detecting malnutrition early. Mobile health (mHealth) technologies have the potential to strengthen maternal and child health services by improving the quality, accessibility, and timeliness of nutritional care. OBJECTIVE The aim was to develop and validate the design and content of a mobile application—CANMI (Calidad de la Atención Nutricional Materno Infantil, by its Spanish acronym) — to monitor the quality of maternal and child nutritional care in primary health care units in Mexico. METHODS The framework of the CANMI app was based on the 16 validated indicators designed to assess the quality of nutritional care during the preconception, pregnancy, postpartum, early childhood, and preschool stages. The application was developed for both iOS and Android systems using a user-centered design approach. Following development, a pilot usability study was conducted in a randomized sample of 18 primary health care units in Guanajuato, Mexico. Trained nutritionists implemented the app and collected usability data at the end of the initial usage period and again six weeks later. To further explore user experience, semi-structured online interviews were conducted to identify barriers, facilitators, and overall satisfaction with the app. RESULTS The CANMI app allows the systematic registration of key indicators to assess the quality of nutritional care in primary health care settings. Users described the app as simple, intuitive, and visually appealing. Overall usability was rated positively, with a mean score of 71.13 on the System Usability Scale (SUS) indicating good acceptability. The app’s offline functionality, streamlined interface, and efficiency in data collection were identified as key facilitators of use. Reported benefits included reduced time for data entry and perceived improvements in the quality of nutritional care. Identified barriers to integration included the need to use personal devices, user fatigue due to prolonged screen time, inconsistent clinical records, and limited time to incorporate the app into routine workflows. Importantly, the app encouraged promoted improvements in documentation practices and heightened awareness among health personnel regarding the precision and clarity of their nutritional recommendations. CONCLUSIONS The CANMI app provides a feasible and effective solution for monitoring the quality of maternal and child nutritional care in primary health settings. Its high usability and offline capabilities make it particularly suitable for low-connectivity environments. Beyond facilitating data collection, the app contributed to improved clinical documentation practices and enhanced provider awareness of care quality. As such, the application can represent a promising digital tool to support the implementation evidence-based, user-centered strategies aimed at strengthening maternal and child health services in resource- limited contexts. CLINICALTRIAL The study protocol was reviewed and approved by the Research Ethics Committee of the Universidad Iberoamericana in Mexico City (172/2022).