Perceived usability and usefulness of a clinical decision-support application among newly graduated physicians in rural areas: a mixed-methods study
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Mobile clinical-support applications can facilitate access to evidence-based information at the point of care, but evidence on their usability and perceived usefulness among newly graduated physicians working in health facilities with limited capacity is scarce. We assessed physicians’ experiences with BMJ Best Practice using a convergent mixed-methods study. All 81 eligible physicians assigned to rural facilities were invited; 32 enrolled and received application access and training. After three months, participants completed an online survey, and 23 reported using the application. Ten physicians reporting the highest consultation frequency were purposively selected for semi-structured interviews. Survey findings showed a predominantly favorable perception of usability: for most items, 70%–90% of participants agreed or strongly agreed with the statements assessed. Among users, 14 of 23 (60.9%) used the mobile application and 9 (39.1%) used the web version. Interviews indicated that participants valued rapid searches, organized and evidence-based information, and support for diagnostic reasoning, referral decisions, learning, and clinical confidence. Barriers included limited connectivity, difficulties searching in Spanish, automatic updates, challenges locating or using some calculators, and treatment information that was sometimes insufficiently specific. Most importantly, participants could not always implement recommendations because suggested medicines, diagnostic tests, or other resources were unavailable in their facilities. Mobile clinical-support applications may complement decision-making and learning among early-career physicians in rural primary care. However, their practical value depends not only on usability and evidence quality, but also on adaptation to users’ language, workflow, connectivity, and local service capacity.
AUTHOR SUMMARY
We evaluated whether BMJ Best Practice, a mobile application that provides evidence-based clinical information, was useful to newly graduated physicians completing SERUMS in rural Peru. Thirty-two physicians had access to the application for three months; 23 reported using it and 10 participated in interviews. Users valued its speed, information organization, and support for diagnostic reasoning, referral decisions, and greater confidence during patient care. However, access to a global tool did not resolve constraints in the practice environment. Connectivity, searches in Spanish, automatic updates, and the performance of some calculators hindered use. Moreover, several recommendations required medicines, diagnostic tests, or other resources that were unavailable in rural primary-care facilities. Our findings suggest that these applications may support learning and decision-making among early-career physicians, but their usefulness depends on adaptation to local language, workflow, and service capacity. Studies using objective usage metrics and clinical outcomes are also needed.
