Participants appreciated the comprehensive and accessible care and highlighted the perceived high quality of care, comparable to private facilities, but without the cost.
“We are getting treatment better, when the ASHA came to my house, and with the mobile tablet, I felt that I was getting treatment better than at a private hospital…even though I do not have the money to go to a private hospital, I am being taken care of…I also shared this with my brother who lives in Oman” (Participant, Interview, Female, 54, Rohtak, Haryana).
The integration of technology, such as ASHAs utilizing mobile tablets and blood glucose monitors during home visits, was received well by the participants.
“It was very helpful that all my blood tests were being done at home. ASHAs who were only taking care of small babies and pregnant ladies were also helping us maintain our health.” (Participant, FGD, Male, 55, Guntur, Andhra Pradesh).
Participants valued the continuity of care facilitated by the CDSS, which ensured physicians were well-informed about their health status before consultations. One participant shared:
“When I was sent to the doctor, the doctor already knew about me and had my reports. This was a great experience.” (Participant, FGD, Female, 60, Rohtak, Haryana).
Provision of long-term medications and comprehensive lifestyle advice also contributed to patient satisfaction and empowerment.
ASHA and physician experiences with the intervention
ASHAs and physicians shared positive experiences and perceived the intervention as beneficial. ASHAs expressed a sense of empowerment and enhanced professional development. While initially apprehensive about using the mobile tablets and new diagnostic tools, they quickly gained confidence with the support of the training provided.
“We were already doing a lot of work in communicable diseases and maternal and child health…but we did gain some visibility and recognition from carrying this mobile tablet…We learned to not only use this mobile tablet but also the BP instrument and the blood glucose testing instrument.” (ASHA, Interview, Female, Rohtak, Haryana).
The intervention equipped ASHAs with new skills and knowledge, expanding their capacity to address a wider range of health concerns and enhancing their professional standing.
“When I first told my friend who is a lab technician at one of the PHCs that I would be doing blood glucose testing, they were surprised, and it made me feel proud that I am able to do more than height and weight measurement in the community…” (ASHA, Interview, Female, Guntur, Andhra Pradesh).
Physicians valued the system’s ability to provide readily accessible patient information, treatment recommendations, and lifestyle modification suggestions through the CDSS.
“The mobile app is very well developed…It’s good to have a reminder of the options of the drug that could be given to the participants based on their condition…just by a scan of a code I get to see the patient history, and also I am suggested options for the treatment and lifestyle modification options as well.” (Physician, Interview, Female, Guntur, Andhra Pradesh).
Satisfaction with training and capacity building
An important component of the IMPACT Diabetes intervention was the training and capacity building of the ASHAs and physicians.
“The initial training was quite a new concept for us because we were not managing non-communicable diseases or diabetes in the past… It was good to hear and get trained from the study team. Now many of our misconceptions that the villagers or our community members have were clarified.” (ASHA, FGD, Female, Guntur, Andhra Pradesh).
The hands-on training component, which included demonstrations of blood glucose and BP measurement using the CDSS, was particularly valued. Demonstration of these skills to dignitaries and district officials fostered a sense of empowerment and recognition for their expanded role in healthcare delivery.
“Traveling to Delhi to showcase my training to dignitaries from Australia and the UK was a truly rewarding experience.” (ASHA, Interview, Female, Rohtak, Haryana).
They recognized the value of their contribution to diabetes care and felt motivated to continue their efforts.
“15–18 of the diabetics in my area had no idea that they had diabetes, and I feel good that they have started taking their medicines now because I found out first that they have diabetes.” (ASHA, Interview, Female, Rohtak, Haryana).
Physicians also expressed satisfaction with the training, particularly the app-based format, which accommodated their busy schedules. An experienced physician acknowledged the value of the system for younger doctors:
“I also like the functionality of the CDSS where I was being advised what medications to give… while I have more than 20 years of experience, for a young PHC doctor, this would be quite helpful.” (Physician, Interview, Male, Guntur, Andhra Pradesh).
Usefulness of the intervention
The participants appreciated the usefulness and benefits of both the CDSS and the overall intervention strategy. Physicians emphasized the potential for scalability and impact of this CDSS and recommended wider adoption.
“The mobile-based CDSS was really effective, and I encourage this to be scaled up to other PHCs… it is important that… other doctors are also able to use it.” (Physician, Interview, Male, Guntur, Andhra Pradesh).
The comprehensive nature of the intervention, which included lifestyle advice and patient education resources, was also commended.
“Even the lifestyle advice is quite useful. I saw that the ASHA module contains videos and other personal risk factor-specific information and some resources on quitting some risky behaviours… I found it effective and useful for them.” (Physician, Interview, Male, Rohtak, Haryana).
ASHAs also emphasized the usefulness of the CDSS in enhancing their ability to collect, track, and utilize patient data.
“This tool was very useful. We would not have been able to do this work on paper or collect this information effectively. Now this information is available with us, and we can use it for the benefit of these patients.” (ASHA, FGD, Female, Guntur, Andhra Pradesh).
The ability to access and compare previous visit information facilitated more informed patient interactions and personalized advice. Furthermore, one of the ASHAs mentioned.
“The interactive ‘what if’ module, which visually demonstrated the potential health benefits of lifestyle changes, proved to be a powerful tool for patient motivation.” (ASHA, Interview, Female, Rohtak, Haryana).