Use of Indigenous-based methodologies to enhance the understanding of local context in Ugandan communities: Protocol for a community-based adaptation of a digital health program (Preprint)

Abstract

Background With many socially disadvantaged populations experiencing a higher level of illness than the general population, health research has begun to recognize the impact of social determinants on health outcomes. Community-based research has increasingly been used to understand the complexities of the local context. However, given the number of interdependent factors influencing individual well-being, no single methodology can explore this level of complexity alone. To put context into perspective, research processes need to shift from the sole use of Western methodologies and, instead, incorporate collaborative methods from nontraditional research. Specifically, Indigenous methodologies have been developed to better understand the complexity of context within multiple worldviews, but current studies have failed to apply these approaches within other cultural settings. Objective This mixed methods study will use Western and Indigenous methodologies to adapt a digital health program for remote communities in Uganda. Methods Using the principles of community-based research and user-centered design, a 4-phase mixed methods study will be conducted. The Indigenous method of 2-eyed seeing will be used to promote a reflexive engagement strategy throughout all study phases. Phase 1 will focus on partnership building to codevelop the project priorities and study design. Phase 2 will involve a needs assessment to elicit a context-focused understanding of the local clinic and community environment. Phase 3 will involve a series of system adaptations to co-design the program. Phase 4 will consist of a community-based field study to evaluate the usability and cultural relevance of the adapted program. Results This study was approved by the Makerere University School of Medicine Research and Ethics Committee (Mak-SOMREC-2021-63) and the University Health Network Research Ethics Board (20-6022). This protocol provides a novel strategy leveraging a range of community-based methods to ensure that the contextual significance of each community's challenges is reflected in the design of the Medly Uganda program. Partnership building was initiated in June 2019, and the first stage of data collection in phase 2 began in January 2021. At the time of manuscript submission, phases 1 to 3 have been completed. Phase 4 data analysis is ongoing and expected to be completed in October 2025. Conclusions Integrating the community's local knowledge into the design of the Medly Uganda program will lead to the development of meaningful interventions that improve health outcomes. International registered report identifier (irrid) DERR1-10.2196/75136.