Reliability of the COntext Assessment for Community Health (COACH) tool when administered on mobile phones versus pen-paper: A comparative study among healthcare staff in Nairobi, Kenya.

Abstract: Aim: To investigate the reliability of the COntext Assessment for Community Health (COACH) tool on mobile phone versus pen-paper in Nairobi, Kenya. Background: One of the barriers to the progress of the MDGs has been the failure of health systems in many LMICs to effectively implement evidence-based interventions As a result of the “know-do” gap, patients do not benefit from advances in healthcare and are exposed to unnecessary risks. Better mapping of context improves implementation by allowing tailoring of strategies and interpretation of knowledge translation. COACH investigates healthcare contexts for LMICs and has only been used on pen-paper. With 5 billion mobile phone users globally, mobile technologies is being recognized as able to play a formal role in health services. Methods: Comparative study with 140 nurses/midwives and doctors in four hospitals in Nairobi. 70 were randomly assigned to mobile phone and pen-paper each. The tool was administered twice with a two week interval and test-retest reliability, internal consistency and interrater reliability were assessed. Findings: Excellent test-retest reliability for both pen-paper and mobile phone (ICC >0.81). 45% (pen-paper) and 34% (mobile phone) moderate agreement between individual questions in round 1 and 2. Acceptable average Cronbach’s alpha (>0.70). Conclusion: Both mobile phone and pen-paper were reliable and feasible for data collection. The findings are a good first step towards using COACH in Kenya. Additional research is needed for individual settings. Using mobile phones could increase healthcare facilities’ accessibility in implementation research, helping to close the “know-do” gap and reach the SDGs.