Designing a user-centered mHealth screening system for children in low-resource settings: A multi-stakeholder implementation study.

OBJECTIVE: To identify user requirements, usability expectations, and contextual constraints relevant to designing and implementing a scalable mobile health (mHealth) hearing-screening system for children in low-resource settings. DESIGN: Cross-sectional, implementation-oriented survey. PARTICIPANTS: A total of 1,055 stakeholders: teachers (n = 364), Anganwadi workers (n = 350), and parents/caregivers (n = 341) of children aged 3-10 years. METHODS: A structured questionnaire assessed seven implementation-relevant domains: digital infrastructure and system readiness; awareness and screening context; operational workflow; usability and interaction readiness; feasibility constraints; acceptability, trust, and workload; and system-design requirements. Group differences were analyzed using chi-square tests and Cramer's V. Multivariable logistic regression identified factors associated with willingness to use the system. RESULTS: Smartphone use was reported by 96.7 % and daily use by 76.5 %, whereas only 19.6 % had access to earphones/headphones. Awareness of childhood hearing loss was high (91.6 %), but 81.0 % had no previous screening-tool experience, indicating an awareness-practice gap. Significant group differences occurred across awareness, workflow, usability, feasibility, and system-design domains. Willingness to use the system was 68.3 %, and 78.9 % expressed trust in AI-assisted outputs when explained. Time constraints (77.4 %) and anticipated increased workload (80.9 %) were prominent barriers. Respondents preferred 6-10-minute screening, 1-3-step workflows, multimodal guidance, and offline functionality. Teachers had higher odds of willingness than Anganwadi workers (OR = 2.10, 95 % CI 1.40-3.10, p < 0.001), and prior screening exposure was independently associated with willingness (OR = 1.90, 95 % CI 1.30-2.80, p = 0.002). Infrastructure variables were not independently associated after adjustment. CONCLUSIONS: Implementation readiness extends beyond digital infrastructure. Scalable mHealth hearing-screening systems should prioritize simple, multimodal workflows, offline functionality, role-specific preparation, transparent decision support, and structured referral pathways. These stakeholder-informed requirements provide a basis for subsequent usability and field evaluation.