Development of an mHealth tool to prevent chronic childhood malnutrition in Ecuador: A user-centered design approach in developing contexts.

BACKGROUND: Chronic malnutrition in children (CMC) remains a pressing public health issue in Ecuador, especially in the rural Sierra communities. Support from community health workers (CHWs) to families during the first 1000 days of life is crucial for prevention. However, CHWs face operational challenges that reduce intervention effectiveness, emphasising the need to develop mobile health (mHealth) tools that are contextually appropriate, culturally relevant, and technically reliable. OBJECTIVE: To design an mHealth tool (called Mikuy) that enables CHWs to implement a family support strategy to prevent CMC in rural Ecuador. METHODS: A user-centered design tailored to the local context was employed, using a mixed participatory methodology involving 99 participants (84 pregnant women or mothers and 15 CHWs). The process unfolded in three iterative stages: (1) analysis of context and needs, (2) design of content and interface, and (3) usability and acceptability assessment. Qualitative techniques included focus groups, a co-design workshop, one-to-one think-aloud sessions, and observations during simulated use. Quantitative methods involved administering usability (SUS) and acceptability (TAM) questionnaires. RESULTS: Participants identified critical needs relating to connectivity and cultural appropriateness. Key features for effectiveness included offline accessibility, language switching (Spanish/Kichwa), household georeferencing, and a system for monitoring home visits. Qualitative observations led to improvements in interface, navigation, and language. The final tool scored highly in usability tests (SUS = 83.75) and acceptability (TAM-PU ≥ 4.60). CONCLUSIONS: Mikuy is a culturally adapted and operationally viable mHealth solution that supports CHWs and other community agents in educational and monitoring efforts to prevent CMC in rural areas of the Ecuadorian Sierra.