Feasibility and Acceptability of mPallCare, a Digital Health Intervention for People Living With Advanced Cancer in a Refugee Settlement in Uganda: Mixed Methods Study.

BACKGROUND

Palliative care is a key component of comprehensive humanitarian health; yet, access and service capacity remain limited in displacement settings, where fragile health systems struggle to meet the complex needs of people living with advanced illness. Digital health technologies have the potential to enhance the reach and delivery of palliative care; yet, their feasibility and acceptability in humanitarian settings remain underexplored.

OBJECTIVE

We evaluated the feasibility and acceptability of mPallCare, a mobile health intervention integrating patient-reported symptom and outcome monitoring with a clinician dashboard, to support palliative care delivery in the Bidibidi Refugee Settlement, Uganda.

METHODS

A 6-week, uncontrolled, exploratory concurrent mixed methods feasibility study was conducted, involving 32 participants with advanced cancer. Community health workers (ie, village health teams) used the mobile app to document patient-reported symptoms and multidimensional outcomes, which were accessible to clinical teams via a dashboard. Following the use of mPallCare, patient and clinical team participants participated in face-to-face interviews. Data collected via mPallCare were analyzed using descriptive statistics to assess feasibility (ie, compliance with reporting, with a feasibility threshold of ≥65% of scheduled reports), and interview data from a subsample of patient and clinical team participants were analyzed using framework analysis to assess acceptability.

RESULTS

Participants completed 84.9% (163/192) of symptom reports and 59.4% (266/448) of outcome reports, with a combined 67% (429/640) of all scheduled reports completed. A modest decline in engagement with report submissions occurred across the 6-week study period. Commonly reported symptoms included headache (27/32, 84.4%), muscle pain (27/32, 84.4%), and dizziness (26/32, 81.3%). Interview findings indicated strong acceptability among patients and clinicians, who described improved communication, enhanced symptom management, and greater continuity of care. Reported challenges included initial navigation difficulties, limited translation accuracy, and technical synchronization issues. Participants and clinical leaders identified the potential for integrating mPallCare within Uganda's district health information system to strengthen data use and visibility of palliative care within health reporting structures.

CONCLUSIONS

mPallCare is a feasible and acceptable digital health intervention for palliative care in a humanitarian setting. While initial uptake was high, sustaining engagement over time may require simplified reporting processes, enhanced language accessibility, and optimizing the mobile app's connectivity and usability. This feasibility phase highlights key priorities for scale-up, including integration with existing health information systems and adaptation for sustained, equitable use across low-resource and displaced populations.