{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Public Administration, Universitas Brawijaya, Malang, Indonesia"
      ],
      "name": "Sujarwoto Sujarwoto"
    },
    {
      "affiliations": [
        "Department of Public Health, Universitas Brawijaya, Malang, Indonesia"
      ],
      "name": "Holipah Holipah"
    },
    {
      "affiliations": [
        "Department of Public Health, Universitas Brawijaya, Malang, Indonesia"
      ],
      "name": "Sri Andarini"
    },
    {
      "affiliations": [
        "Department of Information Science, Universitas Brawijaya, Malang, Indonesia"
      ],
      "name": "Ismiarta Aknuranda"
    },
    {
      "affiliations": [
        "Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Newcastle upon Tyne, UK"
      ],
      "name": "Eduwin Pakpahan"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Sciences, School of Health Sciences, The University of Manchester, Manchester, UK"
      ],
      "name": "Delvac Oceandy"
    },
    {
      "affiliations": [
        "Global Development Institute, The University of Manchester, Manchester, UK"
      ],
      "name": "Gindo Tampubolon"
    },
    {
      "affiliations": [
        "Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK"
      ],
      "name": "Asri Maharani"
    }
  ],
  "title": "Evaluating community-based digital health interventions to improve COVID-19 outcomes in rural Indonesia: a quasi-experimental study",
  "uid": "058741ef-89ab-515c-9856-fb25b1f88191"
}