Pathways to Impact in Digital Health: Studies in Malawi and Kenya

Abstract

Health inequities remain a persistent challenge, disproportionately affecting communities in low- and middle-income countries. In response, digital health is widely promoted as a way to expand access and improve quality of care. However, many initiatives fall short of their intended impact when technological solutions are misaligned with the realities of healthcare delivery. This dissertation examines digital health interventions within health systems in Malawi and Kenya through three studies conducted in collaboration with global health partners and in-country stakeholders. The first study examines how the security and privacy of electronic medical records are experienced and managed in Malawi's HIV health system, highlighting the roles of governance, institutional capacity, and frontline practices in shaping data protection. The second study presents a contraceptive decision-support app for adolescent girls and young women in Kenyan pharmacies, demonstrating how intermediated interactions can enable person-centered care. The third study explores chatbot-based support for contraceptive decision-making in Kenyan pharmacies and proposes design guidelines for mediating stakeholder needs. This dissertation argues that impactful digital health can be enabled by contextually grounded design and an understanding of the processes that support health system goals. It contributes human-centered design of digital health, sociotechnical insights into how technologies interact with care ecosystems, and design guidelines for future technologies that can strengthen healthcare delivery and contribute to advancing health equity and improving health outcomes.