Community-Driven Development of the Chalerm App: A Mobile Health Application for Chronic Disease Management and Elderly Care in Southern Thailand

Abstract

Background: Mobile health (mHealth) applications have the potential to improve chronic disease management and healthcare support for older adults. However, their development and contextual adaptation in rural communities remain limited. This study aimed to develop and evaluate the Chalerm App, a mobile health application designed to strengthen chronic disease management, service accessibility, and caregiver support among older adults in Southern Thailand. Methods: A participatory action research (PAR) design was conducted at a Health Promoting Hospital in Nakhon Si Thammarat Province, Southern Thailand, from March to August 2024. The Chalerm App was developed on Android- and iOS-based platforms through collaboration with software developers, health professionals, and community stakeholders. The study comprised three phases. In Phase 1 (Situation analysis), 223 participants-including 30 elderly individuals, 10 health staff, 7 community leaders, and 176 community members-were recruited using stratified random sampling and participated in interviews and focus groups to identify care gaps. In Phase 2 (Mobile Health Application Development), 30 participants-including 10 health staff, 7 community leaders, and 13 elderly individuals with their caregivers-engaged in co-designing the app. In Phase 3 (Usability and Effectiveness Assessment), 30 elderly individuals and caregivers, recruited via simple random sampling, evaluated the app using a validated researcher-developed tool. Results: In Phase 1, the main challenges identified included the high prevalence of chronic diseases (hypertension, diabetes, and degenerative joint disease), psychological issues such as loneliness and depression, limited access to healthcare due to geographical and workforce constraints, and low levels of digital literacy. In Phase 2, the Chalerm App was developed with four key functions: (1) Remote Appointment Scheduling, (2) Demographic Information Display, (3) Home Navigation Support, and (4) Health Knowledge Repository. In Phase 3, the evaluation demonstrated that the app significantly exceeded the quality benchmark (p < 0.001), showing notable improvements in elderly healthcare performance, perceptions of the innovation, and the overall quality of care services (p < 0.001). Conclusion: The Chalerm App improved chronic disease management, service accessibility, and caregiver support for older adults in a rural Thai community. Findings suggest that community-driven mHealth solutions can reduce healthcare inequities in resource-limited settings with potential applicability to similar contexts.

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