End-user perceptions and stakeholder experiences of implementing a mobile health application in Ekurhuleni Health District, South Africa

Aim This study assesses the perceived usefulness, end-user satisfaction, and stakeholder experiences with the CommCare mobile health application during its five-year implementation in Ekurhuleni Health District, to identify key factors for scaling and sustainability. Method A mixed-methods cross-sectional descriptive study was conducted. Data were collected via semi-structured interviews with seven key stakeholders and an online questionnaire distributed to 1 197 community health workers and outreach team leaders. Quantitative data were analysed descriptively, and qualitative data underwent thematic analysis. Results The questionnaire response rate was 39% (n = 464). Most end-users (83%) reported that CommCare met their expectations, 85% expressed overall satisfaction, and 95% recommended its adoption elsewhere. Challenges, reported by 35%, included connectivity issues, data management difficulties, and device malfunctions. Stakeholders highlighted logistical training hurdles and device theft, mitigated through a cascade training model and a formal asset management policy. Key recommendations from stakeholders included dedicated technical teams, improved infrastructure, and sustained multi-stakeholder engagement. Conclusion The CommCare implementation was successful, demonstrating high end-user satisfaction and a strong potential to enhance primary health care. For successful scale-up, key recommendations are to invest in robust digital infrastructure, build internal technical capacity within government, and formalise governance through long-term planning and proactive stakeholder management.