Opportunities for Integrating Indigenous Health

Systems into Mobile

Health Solutions for Elderly People in Africa
Hlumisa Pinyana
G19P6404
Rhodes University, Makhanda, Africa
[email protected]

1. Introduction
1.1 Background

Mobile health is defined as the ongoing integration and utilisation of mobile

communication and network technologies for healthcare (Ogundaini et al.,
2021). It is aimed at improving health outcomes and increasing access to
healthcare services. Mobile health encompasses various portable, wireless
technologies, such as mobile phones, patient monitoring systems, personal
digital assistants, and other wireless gadgets that facilitate remote access to
healthcare information and services (Istepainan, 2022). Mobile health
addresses issues such as healthcare accessibility, cost reduction by making
sure healthcare is accessible without having to travel, chronic disease
management and patient engagement by using mobile technologies to provide
convenient, efficient and remote health services (Changizi and Kaveh, 2017).

Mobile health platforms offer benefits to elderly people which include managing
chronic diseases, tracking health conditions, and accessing emergency
assistance in remote areas where healthcare resources are scarce. As such,
the use of mobile technology has provided elderly people in remote areas an
opportunity to access healthcare in the comfort of their own homes without
having to travel long distances and wait in long lines to receive healthcare
(Cilliers and Fotoyi, 2022). As much as the use of mobile health solutions are
beneficial to elderly people, various challenges prevent them from accessing
these technologies such as the cost of purchasing them being too high. Elderly
people may face sensory, motor or economic challenges in accessing mobile
health technologies or lack the digital literacy that is required to utilise them in
their homes (Mulinde, 2014).

Statistics from Statista (2024) indicate that the number of mobile phone users
in Africa has increased significantly over the years with the recent estimation
being 13,41 million to date (Statista, 2024). The escalating adoption of mobile
phones has attracted significant attention from governments, international
organisations such as the United Nations, WHO, and World Bank, as well as
researchers, regarding its potential to enhance healthcare delivery systems. ()
This growing number of phone users shows a significant opportunity to enhance
how healthcare is made available to elderly people through digital platforms.

African indigenous practices and medicines are fundamental elements of the

life and culture of Africans, profoundly shaping their views on human well-being
and holistic health (Ajima et al., 2018). Despite the appeal of Western
developments in health, Africans continue to embrace these core beliefs and
practices, deeply rooted in their cultural identity (Ajima and Ubana, 2018). It has
been estimated that 84% of Africans are dependent on public healthcare for
health-related services (Abrahams et al., 2022). Public healthcare is a
government-funded healthcare service that fosters physical and mental health
well-being, ensuring personal hygiene, monitoring of contagious diseases, and
structuring healthcare services (Bryant and Rhodes, 2024). As populations age,
healthcare systems need to evolve and create strategies that address the
requirements of elderly patients dealing with a rising number of chronic
illnesses. It's crucial to grasp elderly people’s views on the quality of care to
devise methods that encourage the use of mobile health solutions (Ojo, 2018).

Onongha (2015) stated that Africans have a strong belief in the influence of the
supernatural realm on human life, considering it the primary source of illness.
They have strong beliefs in the use of traditional herbal medicine which is a
holistic health system within indigenous health systems that has three pillars
which are divination, herbalism, and spiritualism (Ozioma and Chinwe, 2019).
These perspectives, ingrained since childhood, shape their understanding of
healthcare and ailments. Acknowledging and comprehending this viewpoint is
crucial in identifying effective solutions to contemporary healthcare delivery
challenges for elderly people.

Mokgobi (2014) states that indigenous health systems include four fundamental
African traditional practices which are diagnostic, curative, preventative, and
causative. These fundamental aspects of indigenous health system practices
are achieved by the use of divination which involves the consumption of herbal
remedies, application of portions, dealing with natural and supernatural forces,
and influencing outcomes in favour of the individual (Mokgobi, 2014).
Integrating these fundamental aspects into mobile healthcare solutions would
ensure that the services provided by mobile healthcare platforms align with the
healthcare assistance that elderly people need. Integrating indigenous systems
into mobile health applications may present an opportunity to enhance the
healthcare of elderly people in Africa. By combining indigenous wisdom with
mobile healthcare technologies, healthcare needs of elderly people can be
addressed (Naidoo and Van Wyk, 2019).

1.2 Problem Statement

Despite the growing interest in digital health solutions for elderly populations in
Africa, there remains a significant gap in understanding how to effectively
integrate indigenous health systems into these technologies. This research gap
highlights the need for further investigation into strategies for blending
indigenous health systems and mobile health solutions approaches to improve
health outcomes and promote holistic well-being among elderly individuals in
Africa. Despite the potential advantages of integrating indigenous health
systems into mobile digital solutions for enhancing elderly care in Africa, there
is a lack of identifying opportunities on how to implement this integration.

1.3 Research Objectives

 This study’s primary research objective is: “To explore what opportunities are
present in the integration of indigenous health systems into mobile health
solutions for elderly people in Africa”.

The sub-research objectives are:

● To explore relevant indigenous health systems practices and beliefs
among elderly people in South Africa.
● To identify the opportunities for integrating indigenous health systems
into mobile health solutions currently available to elderly people in Africa.
● Examine how cultural sensitivity and accessibility influence the
integration indigenous health systems into mobile health solutions.

1.4 Research question

The study’s primary research question is:
“What opportunities are present in the integration of indigenous health systems
into mobile solutions for elderly people in Africa?”

1.4.1 Sub-Research Questions

The sub-research questions are:
● What indigenous health systems, practices, and beliefs are relevant to
elderly people in Africa?
● What are the opportunities for integrating indigenous health systems into
mobile health solutions that are currently available to elderly people in
Africa?
● How can cultural sensitivity and accessibility affect the integration of
indigenous health systems into mobile health solutions

2. Method
This section highlights what methods will be used in conducting this research. This
research will follow the JBI’s Population, Concept, Context (PCC) framework which
is a structured approach used for conducting scoping reviews (Peters, Godfrey,
Khalil, et al 2015). ‘Population’ narrows the scope of the research by limiting it to
certain demographic factors such as age, gender or cultural factors. ‘Concept’
defines the set of ideas that the research is investigating. ‘Context’ considers the
geographical or locational factors the research is aiming to focus on.

2.1 Search String Formulation

The search string consists of keywords used to retrieve articles across various
databases. Two PCC tables were used to identify literature, since insufficient
literature directly integrates both indigenous health systems and mobile health
solutions for the elderly population.

PCC Table 1 focuses on integrating indigenous health systems and elderly

populations into mobile health solutions. Keywords in this table aim to identify
studies and evidence specifically related to incorporating indigenous health
systems, medicine or healing practices within mobile health intervention.

PCC Table 2 focuses on mobile health solutions for elderly people in Africa,
considering factors such as mobile apps, telemedicine, remote monitoring, and
other related technologies. Keywords in this table aim to identify studies about
mobile health solutions and mobile health interventions targeted at the elderly
population.

Table 1: PCC for Indigenous health systems

Population Concept Context

Primary “elderly people” “indigenous health “Africa”

systems”
 Synonyms “senior citizens”, “indigenous
“older adults”, medicine”, “cultural
“aged”, “elderly health practices”,
populations” “indigenous
healing methods”

Table 2: PCC for Mobile health

Population Concept Context

Primary “elderly people” “mobile health” “Africa”

Synonyms “senior citizens”, “m-health”,

“older adults”, “telemedicine”,
“aged”, “elderly “mobile
populations” applications”,
“health monitoring
technologies”

2.2 Inclusion and exclusion criteria

The inclusion and exclusion criteria provide guidelines for selecting relevant
articles. They clearly define the characteristics that the articles must have in order
to be considered for the review. This section will show the guidelines to select
papers which will be used in the discussion chapter in tabular format.

Table 3: Inclusion and Exclusion Criteria

Inclusion Criteria Exclusion Criteria

Studies that are published in English. Studies published in languages other

 than English.

Studies that explore or evaluate the use Studies that do not explore or evaluate
of mobile health technologies for the use of mobile health solutions for
improving health care of elderly elderly populations.
populations.

Studies about indigenous health Studies that are not about indigenous
systems, practices and knowledge. health systems, practices and
knowledge.

Studies focusing on older people (age 60 Studies not focusing on older people
and above). (age less than 60).

Studies that are peer-reviewed, Studies that are not peer-reviewed,

conference papers and literature thesis/research papers.
produced outside from academic
publishing channels.

Articles that are within African contexts. Studies that are not within African
contexts.

Papers published from 2014. Papers published before 2014.

2.3 Information Sources

This section explains in depth the databases and search engine used to select
papers to be used for the discussion chapter. Four databases were chosen.
Scopus is a large abstract and citation database of peer-reviewed literature
supported by the academic publisher Elsevier and containing 80 million
documents. ACM digital library claims to be the most comprehensive database of
full-text articles and bibliographic literature covering computing and information
technology. PubMed is an academic database known for its extensive collection of
high-quality, peer-reviewed biomedical and life sciences literature., Google Scholar
is a widely-used academic search engine that provides access to a broad range of
scholarly literature across multiple disciplines. This search engine was chosen as
there is a lack of literature on academic databases that focus on indigenous health
systems and its integration with mobile health solutions for elderly people The
search string, formulated from the keywords on Tables 1 and 2 will be entered to
each database to ensure that the breadth and depth of existing research about this
research is thoroughly explored. The following section will explain how the search
string was formulated then at the end show the search strings.

2.3.1 Conducting the search on the chosen databases

The search was done in three steps:
An initial search on the ACM digital library used keywords such as was done by
searching keywords such as “elderly people'', “indigenous health systems”, “mobile
health ","Africa " to determine whether or not the literature existed. A second search
of five databases, Scopus, ACM digital library, Google Scholar, Scopus and
PubMed identified keywords and their synonyms to formulate search strings.
Lastly, the identified keywords and synonyms and the appropriate Boolean
operators were used to conduct the final searches.

Search strings:
For mobile health:

"mobile Health" OR "m-Health" OR "telemedicine" OR "mobile applications" OR

"health monitoring technologies" AND "elderly people" OR "senior citizens" OR
“older adults” OR “aged” OR “elderly populations” AND "Africa"

For indigenous health systems:

"indigenous health systems" OR "indigenous medicine" OR "cultural health
practices" OR "indigenous healing methods" AND "elderly people" OR "senior
citizens" OR “older adults” OR “aged” OR “elderly populations” AND "Africa" .
2.4 Data Mapping and Analysis
This section outlines the elements that will be used for data analysis. These
elements will ensure that the data collected is relevant to the study conducted and
is within the scope of the research.

Table 4: Data Mapping and analysis table

Author(s) Knowing the author(s) helps us understand the expertise

and background of the individuals contributing to the
research.

Year of Publication The year of publication provides important temporal context,

allowing researchers to understand when the research was
conducted and how recent or outdated the findings may be.
This helps in assessing the relevance of the study to current
trends, practices, and knowledge in the field.

Publisher It is important to know the author because it helps assess

the credibility, reliability, and potential biases of the sources
being reviewed.

Source/ Country of Knowing the source or country of origin for literature in a

origin review is important to understand the context, cultural
perspectives, and potential biases that may influence the
research findings.

Purpose/Aim Knowing the purpose of the study conducted helps in

understanding if the scope and focus of the research in line
with my research objectives
 Author(s) Knowing the author(s) helps us understand the expertise
and background of the individuals contributing to the
research.

Type of study Knowing the type of study conducted helps in analysing the
characteristics of the research data to the scope of the
research conducted.

Key findings Determining the key findings helps in providing a

comprehensive overview in existing research and identify
research gaps.

Recommendations Recommendations provide an overview of what has been

done in literature and what other authors think should be
done.

2.5 Thematic Analysis

Thematic analysis will be employed in this research to systematically explore and
interpret the complex interplay between indigenous health systems and mobile health
solutions for elderly people in Africa. Thematic analysis is a qualitative research
method that involves identifying, analysing, and reporting patterns (themes) within
data, providing a rich and detailed account of participants' experiences and
perspectives (Braun & Clarke, 2006). Thematic Analysis has six steps which are:

● Familiarisation: Researchers immerse themselves in the data by reading and

re-reading it to gain a deep understanding.

● Coding: Data is systematically coded to identify and label key features and
patterns.

● Theme Development: Codes are organised into broader themes that capture
significant patterns and concepts within the data.
 ● Reviewing Themes: Themes are reviewed and refined to ensure they
accurately represent the data and are relevant to the research questions.

● Defining and Naming Themes: Clear definitions and names are assigned to
each theme, providing a coherent narrative of the findings.

● Writing Up: The final analysis is compiled into a comprehensive report that
interprets the themes and discusses their implications in relation to the research
objectives.

These steps collectively enable a structured and insightful exploration of qualitative

data, hence their application in Section 4.1.

3. Search Results
3.1 PRISMA Diagram
This section focuses on displaying the number of articles that were assessed using a
PRISMA diagram (Figure 1) below. A total of 2853 articles were retrieved from online
databases. 213 duplicates were removed, then 2640 articles were left. 2483 articles
were then excluded using the inclusion criteria in Section 2 based on their titles and
the abstract. 157 articles were then assessed, then 131 articles were excluded as they
were not relevant to the research to be conducted. 11 articles were included from
backward search, which then made the total of the final articles that will be used to be
37.

Figure 1: PRISMA Diagram

3.2 Data Mapping with Data Mapping table extract

Table 3: Data Mapping Table Extract

This section presents the papers that will be used in the discussion chapter in an excel table format. The table above is an extraction
of the data mapping table, the rest of the table will be found in Appendix A.
4. Findings
This chapter presents the findings of the study, directly addressing the research
objectives outlined in Chapter 1 which is to explore what opportunities are present in
the integration of indigenous health systems into mobile health solutions for elderly
people in Africa. Detailed insights from the results of data charting will be provided and
explained using different graphs and tables which illustriated below.

Figure 4.1: Number of Studies vs Country

The bar graph in Figure 4.1 indicates that South Africa has the highest number of
studies on the integration of indigenous health systems into mobile health solutions
for elderly people, followed by Nigeria, and then an equal number between Ethiopia,
France, and Ghana. This finding aligns with the research objectives, particularly the
aim to explore and analyse the extent of research focused on indigenous health
practices within African contexts. The prominence of South Africa and Nigeria
suggests a concentrated academic interest in these regions, possibly due to their rich
indigenous knowledge systems and ongoing efforts to integrate these practices into
modern healthcare solutions. This distribution of studies underscores the importance
of focusing on these regions to understand the potential for integrating traditional
health systems into digital platforms.
 Figure 4.2: Number of Studies vs Year of Publication

Figure 4.2 is a line graph that shows the years of publications of the studies that will
be used in this research. The rising trend in studies from 2014 to 2022 reflects a
growing interest in the potential of mobile health technologies, driven by rapid
advancements and increased accessibility that make these platforms attractive for
delivering healthcare services. There is also a growing recognition of the value of
indigenous knowledge, particularly in addressing the needs of underserved elderly
populations who often rely on traditional healthcare practices. The global health
agenda has increasingly focused on non-communicable diseases, ageing populations,
and primary healthcare, creating a conducive environment for research in this area.
Additionally, there has been a significant increase in the availability of research grants
and funding specifically targeting global health and digital health initiatives, further
fuelling research activities (WHO, 2021). Changes in government policies and
regulations that support the integration of traditional medicine into healthcare systems
have also played a critical role in driving research (Musariwa et al., 2022).

However, the downturn in studies observed in 2023 and 2024 can be attributed to
several factors. Shifting research priorities, possibly towards emerging infectious
diseases or mental health, could also explain the decline. Global economic challenges
may have impacted research funding and slowed down the publication process.
Additionally, the COVID-19 pandemic likely disrupted research activities, causing
delays in study completion and publication.() The complexities involved in data
analysis and the integration of indigenous health systems into mobile health solutions
may require more time, further contributing to the observed decrease in studies during
this period.

Figure 4.3: Number of Studies vs Type of Study

The categorisation of studies in Figure 4.3 illustrates a diverse methodological

approach that aligns with the research objectives of exploring indigenous health
practices, evaluating mobile health solutions, and identifying integration opportunities
for elderly care in Africa. The predominance of qualitative studies (25%) emphasises
the importance of understanding the lived experiences and cultural contexts of elderly
individuals, while narrative reviews (15%) synthesise existing literature to highlight
current gaps. The inclusion of systematic reviews, scoping reviews, mixed-methods,
and ethnobotanical surveys (each at 10%) further supports a comprehensive analysis
of both empirical data and traditional healing practices. Additionally, the presence of
conceptual papers, descriptive cross-sectional studies, and a research proposal (all at
5%) indicates a balanced focus on theoretical frameworks and practical applications,
ensuring that the research effectively addresses the complexities of integrating
indigenous health systems into mobile health solutions for the elderly.

4.1 Thematic Analysis

This section highlights areas of focus for integrating indigenous health systems into
mobile health solutions for elderly individuals in Africa in the table below. By
addressing traditional practices, identifying integration opportunities, and ensuring
cultural sensitivity, the research aims to improve health outcomes and accessibility for
this demographic. As guided by Brain and Clarke detailed in section 2.5, the
references to the themes underscore the importance of a comprehensive approach to
this integration process, aligning with the research objectives to explore, evaluate, and
identify opportunities for effective healthcare delivery.
Table 3: Thematic Analysis Table

Theme Sub-theme Reference

Mobile health solutions

● Health Monitoring ● Istepainan (2022)
apps
● Changizi & Kaveh,
● Telemedicine (2017)

● Telehealth ● Shamsabadi,
technologies Mehraeen and
Pashaei (2022)

Indigenous practices
● Herbalism ● Onongha, (2015)

● Spirituality ● Ajima and Ubana,

(2018)
● Divination
● Anderson and Adu-
gyamfi (2019)

● Ozioma & Chinwe,

(2019)

● Thobakgale,
Ngunyulu and
Mulaudzi (2024)

● Mabvurira (2016)
 ● Mokgobi, (2014).

Integration Opportunities
● Culturally relevant ● Naidoo & Van Wyk,
apps (2019)

● User-centric design ● Changizi & Kaveh,

(2017)

Barriers
● Digital Literacy ● Cilliers & Fotoyi,
(2022)
● Cost
● Ajima and Ubana,
● Accessibility
(2018)
5. Discussion
The integration of indigenous health systems into mobile health solutions for elderly
people presents a multifaceted opportunity to enhance healthcare of elderly people in
Africa. This section aims to address the sub-research questions identified in Chapter
1 by exploring the current indigenous health systems and mobile health solutions
available to elderly people, identifying the integration opportunities and the barriers
that potentially hinder the integration.

5.1 Sub-research Question 1: What indigenous health systems practices and

beliefs are relevant to elderly people in Africa? Indigenous practices underscore
the significance of traditional health approaches, such as herbalism, spirituality, and
divination. These practices are integral to the cultural identities of various communities
and significantly influence the health-seeking behaviours of elderly individuals in Africa
(Onongha, 2015).

5.1.1 Herbalism

Ozioma (2019) defines herbalism as a significant and prominent form of traditional

medicine that involves the use of herbs to treat various ailments. It is characterised by
the knowledge and practices of traditional healers, known as herbalists, who specialise
in the therapeutic use of plants. Herbalism encompasses the selection, compounding,
dosage, efficacy, and toxicity of herbal remedies, which are derived from indigenous
plants. Many elderly people view the use of traditional herbal medicines effective for
managing health conditions such as diabetes, high blood pressure and ulcers, making
them a primary source of treatment in certain parts of Africa which is used to treat
these ailments (Mudaua, Olowoyob and Amooa, 2021).

5.1.2 Spirituality

Indigenous health systems view health as a state of harmony between the physical,
mental, and spiritual realms (Anderson and Adu-gyamfi, 2019). Spirituality
encompasses beliefs in the influence of ancestors, spirits, and supernatural forces on
an individual’s health. Spirituality is a fundamental component of African traditional
medicine that recognizes the influence of spiritual forces on health and well-being
(Mabvurira, 2016). It encompasses beliefs in supernatural causes of illness, which
may include the actions of spirits, ancestors, or other metaphysical entities. Common
spiritual practices include rituals, prayers, divination, and the use of symbolic objects
or herbs to restore spiritual balance. Spirituality uses a holistic approach to healing,
which integrates both the physical and spiritual aspect which reflect the ancient belief
of African elders that health is a balance of body, mind and spirit (Mokgobi, 2014).
There are certain spiritual ailments that affect old people such as spirit possession and
curses/witchcraft which then manifest themselves as physical and mental ailments
such as psychosis, hallucinations, seizures and gastrointestinal issues to name a few
(Thobakgale, Ngunyulu and Mulaudzi, 2024). Spirituality recognizes that ailments are
not merely physical but often stem from or are exacerbated by spiritual imbalances,
beliefs, and fears. Integrating spiritual practices into healthcare can provide a culturally
relevant and effective way to heal ailments in elderly people, enhancing their overall
well-being (Mabvurira, 2016).

5.1.3 Divination

Divination is a spiritual practice used to understand the causes of and individual's

ailments, which are often believed to be rooted in spiritual or supernatural factors
(Anderson and Adu-gyamfi, 2019). Divination involves seeking insight or guidance
from the spiritual realm, ancestors, or deities to identify the underlying issues affecting
a person's health. This practice can include the use of rituals, symbols, and sacred
objects, such as bones, shells, or other items believed to carry spiritual significance.

Divination serves as a diagnostic tool that goes beyond the physical symptoms,
exploring the spiritual or emotional imbalances that may be contributing to the ailment
(Ozioma and Chinwe, 2019). For elderly individuals, divination can address concerns
such as curses, spirit possession, displeasure from ancestors, or disruptions in
spiritual harmony. By revealing these hidden spiritual causes, divination guides the
healer and the patient towards appropriate healing actions, such as specific rituals,
herbal remedies, or other spiritual interventions that aim to restore balance and well-
being. In essence, divination is a critical element of indigenous healing practices that
connects the physical and spiritual aspects of health, offering a comprehensive
approach to treating ailments in elderly people.

By incorporating divination together with herbalism and spiritualism into mobile health
solutions, there is a significant opportunity to blend indigenous practices with modern
healthcare for elderly people. This integration can enhance elderly patient trust in the
healthcare system, encourage adherence to treatment regimens, and provide a
holistic approach to healthcare that acknowledges the spiritual, mental, and physical
dimensions of well-being. The following section will discuss the opportunities for
integrating indigenous health systems into mobile health solutions that are currently
available to elderly people in Africa.

5.2 Sub-Research Question 2: What are the opportunities for integrating

indigenous health systems into mobile health solutions that are currently
available to elderly people in Africa?

This section will discuss the opportunities for the integration of indigenous health
systems into mobile health solutions that are currently available to elderly people in
Africa.

5.2.1 Telehealth

Telehealth is the use of information and communication technologies to provide

healthcare services and information remotely (Foguem and Foguem, 2014). It offers a
broad range of services such as enabling real-time monitoring of disease management
through various digital tools such as mobile monitoring apps and wearable devices to
name a few. Telehealth is not limited to clinical services only, it also offers non-clinical
services such as health education and health promotion activities ( Silva et al., 2024).

Telehealth has emerged as an important aspect of home-based primary care for older
adults, offering innovative solutions to the challenges posed by traditional healthcare
delivery model. It allows elderly people to receive medical consultations, diagnosis and
treatment from the comfort of their homes (Agwuna et al., 2016). Telehealth improves
the continuity of care by facilitating ongoing communication between healthcare
providers and patients. This is particularly valuable for managing chronic conditions
like diabetes and hypertension, enabling real-time adjustments to treatment based on
a patient’s current health status(Stachteas et al.,2022).

Integrating indigenous health systems into telehealth provides a culturally relevant and
accessible healthcare solution for elderly populations in Africa (Mulinde, 2024). By
incorporating traditional practices like herbalism, spiritual healing, and divination,
telehealth platforms can offer holistic care that aligns with the beliefs of elderly patients
(Shamsabadi et al., 2022). This integration allows access to traditional healers through
remote consultations, improving healthcare accessibility for those in rural areas or with
limited mobility. It also supports the management of chronic diseases by combining
indigenous remedies with modern treatments, fostering trust in healthcare systems
(Mulinde,2014). Ultimately, this approach enhances patient engagement, health
outcomes, and empowers elderly individuals to take an active role in their health.

The availability of indigenous health systems on telehealth, particularly divination,

offers a unique opportunity to blend culturally rooted practices with modern healthcare
technologies, especially for elderly populations in Africa. Divination, as a diagnostic
tool within indigenous health systems, allows for the spiritual understanding of illness,
which is deeply important to many communities (Cillers and Fototyi, 2022). Integrating
this practice into telehealth platforms can create a holistic approach to care by
addressing both physical and spiritual aspects of health.

For elderly people, this means accessing traditional healers and receiving divination
consultations without having to travel long distances, which is often a challenge
(Kindie, 2023). By incorporating these systems into Telehealth, healthcare can be
more culturally sensitive and personalised, enhancing the patient experience.
Additionally, divination via telehealth can provide real-time spiritual guidance, which
may complement conventional treatment, especially for chronic conditions that elderly
people face.

This approach shows the opportunity of combining indigenous knowledge with

telehealth as a mobile health solution to increase access to healthcare, something that
can deeply resonate with African elderly people relying on traditional healing practices.
Ultimately, offering divination, spiritualism and herbalism through telehealth could
enhance trust in modern healthcare systems, improving health outcomes and
encouraging more frequent engagement with health services.

5.2.2 Mobile monitoring applications

Mobile monitoring applications(apps) are software applications that are designed to

track, collect and analyser health-related data by using mobile devices such as
smartphones, watches and tablets (Cilliers and Fotoyi, 2022). These apps monitor
various things such as heart rate and blood pressure, physical activity and symptoms
of chronic diseases. By providing real-time data to both patients and healthcare
providers, mobile monitoring apps enable continuous health monitoring, early
detection of potential health issues, and remote management of diseases, ultimately
improving healthcare accessibility and outcomes, especially for individuals with
chronic conditions or limited mobility (Ngenzi, Nyesheja and Uwizeyimana, 2022).

Integrating indigenous health systems into monitoring apps involves a thoughtful and
collaborative approach. This process begins with engaging indigenous communities
to understand their health practices, beliefs, and needs. By incorporating traditional
knowledge, such as herbal remedies or community-specific wellness practices, the
app can offer a more holistic view of health that resonates with elderly people
(Shamsabadi et al., 2022). The app’s design presents key integration opportunities by
prioritising cultural sensitivity and user-friendliness, ensuring accessibility for elderly
people with diverse levels of technological proficiency. The app can seamlessly
incorporate existing indigenous health resources such as allowing for a cohesive
experience that respects traditional practices. By offering user feedback mechanisms
and educational resources informed by divination, spiritualism and herbalism, the app
can empower elderly people to navigate and utilise its features effectively, creating a
balanced integration of modern healthcare and traditional wellness approaches. The
following section will discuss how cultural sensitivity and accessibility affect the
integration of indigenous health systems into mobile health solutions.

5.3 Sub-Research Question 3: How can cultural sensitivity and accessibility

affect the integration of indigenous health systems into mobile health
solutions?

Cultural sensitivity and accessibility are crucial in integrating indigenous health

systems into mobile health solutions, particularly regarding digital literacy, cultural
relevance, and accessibility (Kruse, Mileski, Moreno, 2019). It is therefore crucial that
mobile health solutions be tailored to the cultural contexts of indigenous populations
to enhance engagement and effectiveness. The following section discusses how
digital literacy affects accessibility and in turn, the opportunity for indigenous health
systems integration into mobile health solutions for elderly people.
5.3.1 Digital Literacy

Digital literacy is a critical factor in the integration of indigenous health systems into
mobile health solutions (Mulinde, 2024). Many indigenous communities in Africa may
have varying levels of experience with digital technology, so it's essential for mobile
health apps to be designed with simplicity and ease of use in mind. This involves
creating intuitive interfaces, straightforward navigation, and clear instructions that can
accommodate elderly people who might not be familiar with advanced technological
features. Training and educational resources tailored to the community’s needs can
further bridge the gap, offering hands-on guidance to help users become comfortable
with the indigenous health systems and mobile health solutions integration and its
functionalities(Wang et al., 2022).

Ongoing support and feedback mechanisms are crucial for fostering digital literacy.
Providing user support through help desks, community workshops, or online tutorials
can assist elderly people in troubleshooting issues and learning how to use the
integrated mobile health solutions effectively. By prioritising these aspects, developers
can enhance digital literacy within indigenous communities, ensuring that mobile
health solutions are accessible and beneficial to elderly people, regardless of their
initial level of technological proficiency.

5.2.3 Accessibility

Accessibility in mobile health solutions involves ensuring that the mobile health
solution is usable by elderly people, including those with disabilities or limited physical
abilities (Wang et al., 2022). This includes features such as adjustable text sizes, voice
commands, and screen readers to accommodate elderly people with visual or motor
impairments. Designing the mobile health solution to be compatible with various
devices, including those with lower specifications or older models, is also essential to
reach elderly people who may not have access to the latest technology. By addressing
these physical accessibility needs, developers can ensure that the mobile health
solution is inclusive and usable by elderly people in African communities.

In addition to physical accessibility, ensuring that the integrated mobile health solution
functions effectively in areas with limited internet connectivity is vital. This can be
achieved by incorporating offline functionalities, minimising data usage, and designing
the app to work well under varying network conditions. By considering both physical
and digital accessibility factors, mobile health solutions can be made more universally
available and functional, supporting a wider range of elderly people in different parts
of Africa.

5.3.2 Cultural Relevance

Cultural relevance is fundamental for ensuring that mobile health solutions resonate
with indigenous communities (Shamsabadi et al., 2022). This involves integrating
traditional health practices and knowledge into the mobile health solutions, which
means collaborating with community members to accurately represent their health
beliefs and practices. The integrated mobile solutions should reflect local customs,
values, and terminology to create an experience that feels authentic and respectful.
This cultural alignment will not only makes the integrated mobile health solution more
meaningful but also helps in building trust and acceptance among elderly people
(Cilliers and Fotoyi, 2022).

Additionally, providing content in native African languages and incorporating culturally

appropriate symbols and imagery can enhance the mobile health solution’s relevance.
Engaging with local health practitioners and community leaders during the
development process can help ensure that the app aligns with cultural norms and
practices. By prioritising cultural relevance, mobile health solutions can offer a more
personalised and supportive experience, fostering greater engagement and utilisation
for elderly people within indigenous communities. The following section discusses how
accessibility could possibly affect the integration of indigenous health systems into
mobile health solutions for elderly people in Africa.

5.3.3 Accessibility

Accessibility in mobile health solutions involves ensuring that the app is usable by
everyone, including those with disabilities or limited physical abilities (Wang et al.,
2022). This includes features such as adjustable text sizes, voice commands, and
screen readers to accommodate users with visual or motor impairments. Designing
the app to be compatible with various devices, including those with lower specifications
or older models, is also essential to reach users who may not have access to the latest
technology. By addressing these physical accessibility needs, developers can ensure
that the app is inclusive and usable by a broader audience.
In addition to physical accessibility, ensuring that the app functions effectively in areas
with limited internet connectivity is vital. This can be achieved by incorporating offline
functionalities, minimising data usage, and designing the app to work well under
varying network conditions. By considering both physical and digital accessibility
factors, mobile health solutions can be made more universally available and functional,
supporting a wider range of users in different environments.

6. Conclusion

The integration of indigenous health systems into mobile health solutions for elderly
people in Africa presents a significant opportunity to improve healthcare outcomes
and accessibility. This study has explored the intersection of traditional health
practices, such as herbalism, spirituality, and divination, with modern mobile health
technologies like telehealth and mobile health monitoring applications. The findings
demonstrate that cultural relevance, digital literacy and accessibility are critical to
the successful adoption of these solutions, ensuring that healthcare is both
accessible and aligned with the beliefs and needs of elderly populations.

6.1 Implications
The integration of indigenous health practices into mobile health solutions can
enhance trust in healthcare systems, especially among elderly people who rely on
traditional healing methods. By offering a culturally sensitive approach, mobile
health solutions can foster elderly patient engagement, improve the management
of chronic diseases, and provide remote access to healthcare in underserved
areas. This approach also promotes holistic healthcare by addressing not only
physical ailments but also spiritual and emotional well-being.

6.2 Limitations

This research is limited by the availability of literature directly addressing the

integration of indigenous health systems into mobile health solutions. Most studies
focus on either indigenous practices or mobile health technologies in isolation,
leaving a gap in comprehensive research that combines both. Additionally, the
diversity of indigenous health systems across different regions in Africa means that
findings may not be universally applicable.

6.3 Future Research

Further studies should focus on developing and testing specific mobile health
solutions that integrate indigenous health systems in diverse African contexts.
Additionally, research should explore the long-term impacts of these solutions on
health outcomes, user satisfaction, and the sustainability of integrating traditional
practices into digital health platforms. Expanding the research to include more
empirical studies on user experiences and health improvements will provide
deeper insights into the effectiveness of these integrated solutions.

In conclusion, this study highlights the potential opportunities of integrating

indigenous health systems into mobile health solutions, particularly for elderly
populations in Africa. The research underscores the importance of cultural
sensitivity, digital literacy, and accessibility in ensuring the successful adoption of
these technologies. By addressing the healthcare needs of elderly people through
a combination of traditional and modern approaches, mobile health solutions can
improve health outcomes and access to care.
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