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

Sujarwoto Sujarwoto; Holipah Holipah; Sri Andarini; Ismiarta Aknuranda; Eduwin Pakpahan; Delvac Oceandy; Gindo Tampubolon; Asri Maharani

doi:10.1136/bmjhci-2025-101511

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

BMJ Health Care Inform. 2025 Nov 17;32(1):e101511. doi: 10.1136/bmjhci-2025-101511.

Authors

Sujarwoto Sujarwoto¹, Holipah Holipah², Sri Andarini², Ismiarta Aknuranda³, Eduwin Pakpahan⁴, Delvac Oceandy⁵, Gindo Tampubolon⁶, Asri Maharani⁷

Affiliations

¹ Public Administration, Universitas Brawijaya, Malang, Indonesia sujarwoto@ub.ac.id.
² Department of Public Health, Universitas Brawijaya, Malang, Indonesia.
³ Department of Information Science, Universitas Brawijaya, Malang, Indonesia.
⁴ Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Newcastle upon Tyne, UK.
⁵ Division of Cardiovascular Sciences, School of Health Sciences, The University of Manchester, Manchester, UK.
⁶ Global Development Institute, The University of Manchester, Manchester, UK.
⁷ Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.

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.

Keywords: COVID-19; Community Health Workers; Public Health; Public health informatics.

MeSH terms

Adult
COVID-19* / diagnosis
COVID-19* / epidemiology
COVID-19* / prevention & control
COVID-19* / therapy
Community Health Workers*
Digital Health
Female
Health Knowledge, Attitudes, Practice*
Health Services Accessibility
Humans
Indonesia / epidemiology
Male
Middle Aged
Mobile Applications
Rural Population
SARS-CoV-2
Telemedicine*