Development and Evaluation of a Mobile Application Trauma Registry for Use in Low- and Middle-Income Countries
Why This Research Matters
With 90% of trauma deaths occurring in low- and middle-income countries and mobile phone subscriptions reaching 103.8 per 100 people in LMICs, mobile health technologies represent a promising solution for sustainable trauma data collection. In Uganda, there are 25 million mobile subscriptions for 37.7 million people, making mobile applications more accessible than traditional computer-based systems. This study demonstrates how mobile technology can address the critical gap between trauma registry need and implementation sustainability.
Key Findings
- High user acceptance: Healthcare workers rated the mobile trauma registry highly across all acceptance measures, with 92.7% rating performance benefits as "agree" or higher
- Strong intention to use: 86.7% of participants indicated they would use the application within 6 months if available
- Infrastructure support was the key factor: "Facilitating Conditions" (infrastructure, time, and platform availability) was the only significant predictor of intention to use
- Efficiency and research potential highlighted: Users praised the application's speed, ease of use, and potential for building valuable trauma databases
Study Overview
Researchers developed an open-source Android mobile application for trauma registry data collection at Mbarara Regional Referral Hospital in Uganda, incorporating feedback from local stakeholders. The application included offline functionality to address connectivity issues and password protection for data security. Seventeen healthcare workers—including resident physicians, interns, and trauma nurses—evaluated the application using the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire plus qualitative feedback.
Key Findings in Detail
User Acceptance Scores: The UTAUT evaluation showed consistently high scores across major constructs: Performance Expectancy (mean 6.4/7), Effort Expectancy (mean 6.3/7), Social Influence (mean 5.4/7), and Facilitating Conditions (mean 5.3/7). These scores indicate strong perceived benefits and ease of use.
Infrastructure as the Limiting Factor: While all acceptance measures scored highly, only Facilitating Conditions significantly predicted actual intention to use. This reflects real challenges with device compatibility, time constraints, and technical support that must be addressed for successful implementation.
User Experience Strengths: Qualitative feedback emphasized the application's ease of use, efficiency for bedside data collection, and potential for creating comprehensive databases for future research and clinical improvement. Users appreciated the speed compared to paper-based systems.
Implementation Considerations: Users identified important areas for improvement including expanding platform availability beyond Android, addressing privacy concerns when phones are lost or stolen, and ensuring adequate time and training for implementation.
Implications for Practice
This research provides a validated methodology for developing and evaluating mobile health technologies in LMIC settings. The high user acceptance scores combined with infrastructure concerns highlight the importance of addressing practical implementation barriers rather than focusing solely on application design.
The study demonstrates that mobile trauma registries can be successfully adapted to low-resource environments through features like offline data storage, open-source development for cost-effectiveness, and local stakeholder involvement in design and evaluation.
The finding that infrastructure support predicts usage more than perceived benefits emphasizes the need for comprehensive implementation planning including device procurement, technical support, and workflow integration rather than simply developing technically sound applications.
Abstract
Introduction
Trauma registries are a means for improving trauma care in low- and middle-income countries, though a number of challenges for the sustainability of these trauma registries exist. Mobile health applications represent a promising technology for low- and middle-income country trauma registries. The development, implementation and evaluation of a mobile application trauma registry for use at the Mbarara Regional Referral Hospital, Uganda is demonstrated.
Methods
A paper-based trauma registry was implemented at the Mbarara Regional Referral Hospital. Based on feedback from local stakeholders, this was developed into an open-source mobile application version of the trauma registry. The mobile application was evaluated by 17 healthcare workers using a modified Unified Theory of Acceptance and Use of Technology questionnaire and qualitative analysis.
Results
Unified Theory of Acceptance and Use of Technology scores showed the majority of participants responding positively to the major constructs of Performance Expectancy, Effort Expectancy, Social Influence and Facilitating Conditions, with mean Likert scores (out of 7) of 6.41 (±1.43), 6.25 (±1.41), 5.44 (±1.43) and 5.32 (±1.99), respectively. There was also a young average user age (29.1 years). Qualitative analysis identified response themes of ease of use, efficiency and potential for future research and clinical use; users also suggested expansion of the type of platforms the application was available on.
Conclusions
Though a number of challenges exist for sustaining trauma registries in low- and middle-income countries, substantial involvement of local stakeholders and responsiveness to feedback should be used to facilitate the use of these technologies in developing countries. This study demonstrates a potential methodology for developing and evaluating trauma registry technologies for use in low- and middle-income countries.