Co-designing eCap-CoDe: A mobile health application for primary health care-based dementia care in rural Uganda

Abstract

Dementia is an emerging public health challenge in low- and middle-income countries (LMICs), yet it remains underdiagnosed in rural Uganda, where primary health care (PHC) providers often lack tools, training, and data systems for early detection and management. Mobile health (mHealth) applications can enhance provider capacity, improve data capture, and strengthen feedback systems. This study explored the perspectives of PHC providers and District Health Teams (DHTs) to inform the co-design of eCap-CoDe, a mobile application for community-based dementia care in rural Uganda. We conducted in-depth interviews with 31 participants from two rural districts: 23 PHC providers (medical/clinical officers and nurses) and 8 DHT members. Participants were purposively sampled for diversity in cadre, experience, and facility type. Data were thematically analyzed using the Consolidated Frame work for Implementation Research (CFIR), with four a priori domains, i.e., content, user experience, organizational, and service delivery, guiding coding and analysis. Content requirements - included dementia-specific screening and management tools, modular in-app training aligned with the WHO mhGAP Intervention Guide, and structured data capture integrated with Uganda’s Health Management Information System (HMIS). User experience needs: emphasized simple, intuitive interfaces with dropdown menus, checkboxes, audio-visual decision support, and offline functionality to address connectivity gaps. Organizational requirements: prioritized interoperability with District Health Information System 2 (DHIS2), integration with supervisory work flows, and dementia-specific performance indicators. Service delivery needs: focused on real-time feedback loops, reducing duplicate documentation, and potential expansion to other common conditions to enhance utility and uptake. Co-designing mHealth tools with end-users ensures alignment with the realities of workflows, systems, and infrastructure. eCap-CoDe addresses capacity, data, and feedback gaps in rural dementia care and offers a scalable model for integrating digital tools into PHC in Uganda and similar LMICs. Pilot testing will assess the feasibility, usability, and impact before scaling up.