Effectiveness and Implementation of the DINKNESH Digital Palliative Care Tool in Ethiopia

Effectiveness and Implementation Determinants of the DINKNESH App Compared to Paper-Based Assessment Tools for Palliative Care: A Mixed-Methods Cluster Randomized Trial in Addis Ababa, Ethiopia

The goal of this clinical trial is to learn if a digital health app called DINKNESH is effective for palliative care identification compared to traditional paper-based assessment tools. It will also look at the factors that help or hinder the use of this app in primary care settings.

The main questions it aims to answer are:

Does the DINKNESH app improve palliative care assessments compared to paper forms?

What are the main barriers and facilitators for Health Extension Workers when using the app in their daily work?

We will compare the DINKNESH app to standard paper-based tools to see if digital tools improve clinical assessment and implementation.

Participants will:

Be assessed for palliative care needs using either the DINKNESH mobile app or standard paper forms.

Receive routine follow-up care as determined by their health provider.

(For health workers): Participate in interviews or surveys to discuss their experience using the assigned assessment tool.

Inclusion Criteria

• For patients(Quantitative Part):

  • Adults aged 18 years or older
  • Currently diagnosed with one or more chronic conditions and receiving home-based follow-up care from a participating Family Health Team within the catchment area of a selected study cluster
  • Willing to provide verbal informed consent, or has a primary caregiver willing to provide proxy consent

• For healthcare workers:

  • Staff members of the Family Health Team at the selected clusters
  • Involved in delivering or supervising palliative care services during the study period
  • For the qualitative part: Participated in the DINKNESH App implementation process and is willing to participate in a Focus Group Discussion (FGD)

Exclusion Criteria

• For patients

  • Patients whose clinical condition prevents both self-participation and proxy participation in the assessment process
  • Patients already formally identified and referred for palliative care prior to the study period

• For healthcare workers:

  • Staff members planning to be absent for more than 1 day during the six-week active study period
  • Healthworkers not present during the training session