Background:Digital health interventions for cancer care in low- and middle-income countries often do not work well due to inadequate assessment of stakeholders’ readiness and poor alignment between technology design and health system capacity. In Ghana, breast cancer survival remains challenging, with limited services to support survivors and patients. The GLOCASSA digital patient navigator is designed to provide peer support, educational resources, and symptom reporting, designed to address these gaps; however, implementation barriers across patients, survivors, healthcare workers, and health-system leadership remain poorly understood and mis-characterized.

Objectives: To quantify multi-stakeholder implementation readiness for a mobile peer-support platform for breast cancer care in Ghana by assessing digital access, eHealth literacy, platform acceptability, trust in digital health, and perceived barriers to implementation across key stakeholder groups.
Methods: We conducted a cross-sectional baseline implementation readiness assessment for the App in Ghana, with a specific focus on the “My Community” feature. Structured surveys assessed 45 stakeholders: breast cancer survivors (n=18), current patients (n=15), healthcare workers (n=7), administrative staff and patient advocates (n=5) in a tertiary cancer treatment facility. Measures included smartphone ownership and internet access patterns, eHealth Literacy Scale (eHEALS; range 8–40), platform feature acceptability (5-point Likert scales), trust in digital health entities (5-point scales), and implementation barriers. Statistical analyses included descriptive statistics and Wilcoxon rank-sum test for group comparison. This US-Ghana collaborative study was co-led on-site with the Ghanaian team, with implementation support from oncology health workers and patient advocates who culturally adapted instruments, recruited participants, and led all data collection activities.

Results: Participants included survivors (40.0%), current patients (33.3%), healthcare workers (15.6%), and administrative staff/advocates (11.1%). Smartphone ownership was 97.0%, primarily Android devices (81.8%), with universal internet access among patients/survivors, though 87.9% relied on mobile data. Mean eHealth literacy was 26.4/40 (SD=7.4) with variation: 33.3% low literacy (<24), 42.4% moderate (24-32), and 24.2% high literacy (>32). Survivors demonstrated significantly higher eHealth literacy than current patients (28.8 vs. 23.5; Wilcoxon p=0.027). Among patients and survivors, 42.4% expressed strong interest in peer support and 54.5% in symptom tracking. The predominant patient/survivor barrier was mobile data cost (44% survivors, 47% current patients), while an equal proportion reported no barriers. Healthcare workers identified patient language/literacy barriers (71%), concerns about patient technology capability (57%), and inadequate training on digital health tools (43%) as primary barriers. Patients and survivors expressed high trust in clinicians (mean=4.7/5) and hospitals (mean=4.8/5) but lower trust in mobile health applications (mean=3.2/5) and technology companies (mean=2.5/5).

Conclusion/Implications:This assessment reveals strong patient motivation and near-universal smartphone access (97%) alongside critical structural, literacy, trust, and health-system barriers. Evidence-based implementation strategies include data subsidies or offline functionality to address affordability barriers, multilingual audio-visual interfaces for heterogeneous eHealth literacy, transparent data governance frameworks to build trust, healthcare worker training on digital health integration. This baseline provides an implementation blueprint for the ongoing six-month pilot and offers a transferable assessment framework for digital cancer care implementation across sub-Saharan Africa.