Evaluating community-based digital health interventions to improve COVID-19 outcomes in rural Indonesia: A quasi-experimental study

Abstract

Objectives COVID-19 has challenged health systems in low-income and middle-income countries, particularly in rural areas where communities face barriers to information, prevention and timely care. Digital health interventions delivered through community health workers (CHWs) offer a promising approach to closing these gaps. This study evaluated whether a CHW-led digital intervention improved knowledge, attitudes and practices (KAP), vaccination uptake, COVID-19 outcomes and access to hospital care in rural Indonesia. Methods A quasi-experimental study was conducted from June 2022 to June 2023 with 10 023 individuals across four intervention and four control villages in Malang Regency. In intervention villages, CHWs used a mobile application (AREEMA Skrining Mandiri) to conduct contact tracing, symptom screening, vaccination outreach and referrals, while control villages received standard care. Outcomes included KAP, vaccine uptake, COVID-19 diagnoses and related hospitalisations. Results Intervention participants demonstrated greater improvements in attitudes (mean change=3.5, SD=2.1) and practices (0.02, SD=2.2) compared with controls (attitudes: -2.2, SD=4.6; practices: -2.0, SD=2.1). Vaccine uptake was higher in intervention villages (50.6% vs 40.9%), while COVID-19 diagnoses were lower (1.5% vs 2.4%). Among diagnosed cases, hospitalisation was more frequent in intervention villages (21.3% vs 14.5%). Discussion The intervention enhanced CHWs' effectiveness in promoting protective behaviours, facilitating early detection and improving referrals. These findings highlight the potential scalability of CHW-led digital health strategies in low-resource settings. Conclusion Integrating digital tools into CHW-led care can strengthen COVID-19 prevention, vaccination and access to hospital care in rural populations.