i-MoMCARE: AI-enabled mobile app for maternal and child health care in Cambodia - a pilot implementation and evaluation study

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Usefulness: 5.58 (SD 1.04), Effectiveness: 5.50 (SD 0.95), Adoption barriers: 5.79 (SD 0.75)

• Primary Outcome: App usability measured by MAUQ across three domains

• Nnt Or Sensitivity: 96 MCH cases managed across 44 VHSGs (2.2 cases per VHSG on average)

• Confidence Interval: Not reported

Clinical Application

Moderate - requires significant infrastructure investment, training, and ongoing technical support Limited direct applicability due to different healthcare system structure, but principles of digital health integration for community health workers may inform rural and remote care initiatives Community health workers and primary care staff in resource-limited settings with maternal and child health responsibilities

Abstract

OBJECTIVES: In Cambodia, village health support groups (VHSGs) are central to maternal and child health (MCH) service delivery, yet maternal mortality remains high with regional disparities. Although digital health solutions show promise, their real-world use is underexplored. This study therefore aims to evaluate the i-MoMCARE app in supporting VHSGs and health centre staff for delivering MCH services. METHODS: A mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used. Reach was assessed using programme records (number of users trained and MCH cases managed). Effectiveness and adoption were evaluated using the mHealth App Usability Questionnaire (MAUQ) and qualitative data on user experience and intention to use. Implementation was examined through system usage monitoring and feedback on workflow integration. Maintenance was explored using qualitative insights on long-term use, barriers and recommendations. RESULTS: 44 VHSGs and 10 health centre staff were trained, and 96 MCH cases were managed with the app. Usefulness was rated highly (MAUQ 5.58, SD 1.04), with users appreciating the user-centric design that improved usability and integration into daily workflows. Effectiveness was similarly high (MAUQ 5.50, SD 0.95); the clinical decision support system and point-of-care alerts were valued as reliable decision-support tools, and the electronic medical record (EMR) was seen as a secure data repository. However, adoption was hindered by hardware and software limitations (MAUQ 5.79, SD 0.75), including device availability and low digital literacy. DISCUSSION: Our findings highlight the value of the i-MoMCARE app in supporting VHSGs, particularly those with limited training, by enhancing their decision-making. The study also lays the groundwork for a unified EMR in primary care. However, concerns around hardware and software limitations hinder adoption and sustained use. CONCLUSION: To enable scale-up, we recommend reducing access barriers and supporting sustained use through diversifying the platform's design and implementing phased incentivisation strategies.