Transforming Delivery : Learning the Fundamentals ...
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The use of this real-time data is important in many of Medic Mobile ’ s projects . “ You will see community health workers using an app for the case management of childhood illnesses and from this you are able to see for example the number of clients they had in a given time period and how that stacks up relative to peer health workers .” explains Holeman . “ One important indicator is the number of children followed up within 24 , 48 or 72 hours of a particular health event . For conditions like malaria , that timeliness is deeply important in averting child mortality . In this case and many others , the opportunities with real-time data are less about the tools themselves and more about drawing attention to health workers and the quality of care they provide . That is to say , when real-time data projects are going well , the digital technology often fades into the background , it is the infrastructural and human features of the health system as a whole that become more visible . One of the interesting opportunities and challenges for these projects is to use that data to feed back into the design process . Ideally you are reshaping the delivery of care and making changes to the technology at the same time . In my mind , this all underscores a point that we return to repeatedly throughout the course : that successful mHealth initiatives typically involve the integration of new digital tools with routine health worker activities and the re-organization of local health systems .”
Says Pagliari , “ As more and more of these real world sources of mHealth evidence become available our challenge is to make best use of the data and render it into forms that are easily interpretable ”.
“ Trying to differentiate the stages of research within the life cycles of innovation is also something that we ’ ve been looking at over the years ,” says Pagliari . “ For example , at the innovation stage , when we are not quite sure how things are going to work , our research question and methods will be more exploratory and may use participative design methods or softer forms of evaluation that are much quicker , later moving into more traditional qualitative and quantitative research methods .”
Despite the raft of new technologies that we see in digital health , when it comes to scaling mHealth projects there is always a need to understand accessibility . If a technology is only accessible by a few owing to infrastructure , device availability or socio-economic limitations then it is unlikely to have a significant impact when introduced to a wider audience .
“ With Medic Mobile it has been interesting to watch the rise and fall and rise again in popularity of text messaging ” says Holeman . “ When we were getting started in 2008 people were already telling us then that text messaging was basically dead and that before long smartphones would be almost as cheap as water and everybody would have them . The popular wisdom was that if you want to blast large regions with educational messages then text messaging is fine but if you want to equip health care workers with coordination tools so that they can keep track of actual data then working with text messaging was a quickly dying project . However , we chose to do it anyway because our approach starts with people ! So we observe what tools people already have in their hands . In the challenging places where we like to work , they had basic phones .”
“ We had some very successful early projects using SMS [ 6 , 7 ] and when you understand how and why it is that these coordinating tools work it is not that shocking .” explains Holeman . “ Most of what community health care workers do is walk . They are travelling from home to home , so anything that enables them to know that they need to visit this house today or that they don ’ t need to visit a particular house today - basic coordinating tools - can save them hours . In the last year Medic Mobile has started using more smartphones and tablets to great effect , but not just anywhere . In many of the places we work less than a third of the population has electricity at home ; that level of electricity access still presents striking challenges for smartphone projects . There are workarounds like giving people solar panels but that requires additional work on their part and it means that they can ’ t do their technology-enabled work while the phone is charging . So if we introduce electricity workarounds , these are not only another burden on the health workers , they also become another design consideration . We have to be humble in our reflection on these difficulties , because it ’ s far too easy to fall into a trap of pursuing innovation for its own sake without actually understanding what problems we are trying to solve .”
“ Understanding what new eHealth approaches will be truly transformational , or are truly innovative is the critical challenge ” agrees Pagliari . “ In mHealth , simple but sensitively-designed interventions may be far more effective than simply having the latest technology , and may also be considerably cheaper in some cases . I think this disentangling of the truth from the hype , is really important for the area , which is why it ’ s so valuable to be working with someone like Isaac . With all his work in the lower income countries it makes you catch yourself when you are talking about all the high tech [ digital health ] stuff and makes you think about what is fundamentally important .” April / May 2016
References
1 . Pagliari C . ( 2007 ) Design and Evaluation in eHealth : Challenges and Implications for an Interdisciplinary Field . Journal of Medical Internet Research 9 ( 2 )
2 . Pagliari C , Sloan D , Gregor P , Sullivan F , Kahan J , Detmer D , Oortwijn W , MacGillivray S . ( 2005 ) What is eHealth ( 4 ): a scoping exercise to map the field . Journal of Medical Internet Research 7 ( 1 ): e9
3 . Franklin V , Greene A , Waller A , Greene S , Pagliari C . Patients ’ Engagement With “ Sweet Talk ” – A Text Messaging Support System for Young People With Diabetes . J Med Internet Res 2008 ; 10 ( 2 ): e20
4 . Ryan D , Pinnock H , Lee AJ , Tarassenko L , Pagliari C , Sheikh A , Price D . ( 2009 ) The CYMPLA trial . Mobile phone-based structured intervention to achieve asthma control in patients with uncontrolled persistent asthma : a pragmatic randomised controlled trial . Prim Care Respir J . 2009 Dec ; 18 ( 4 ): 343-5
5 . Lee S , Nurmatov U , Nwaru B , Mukherjee M , Grant E , Pagliari C . ( 2016 ) Effectiveness of mHealth for Maternal , Newborn and Child Health in Low and Middle Income Countries : Systematic Review . Journal of Global Health 2016 ; 6 ; 010401 .
6 . Holeman I , Pagliari C , Weller D , Grant L , Evans J ( 2014 ) Mobile health for cancer in low to middle income countries . priorities for research and development . European Journal of Cancer Care . Doi : 10.1111 / ecc . 12250 e15 )
7 . Mahmud N , Rodriguez J , Nesbit J . A text message-based intervention to bridge the healthcare communication gap in the rural developing world . Technology and Health Care . 2010 Jan 1 ; 18 ( 2 ): 137-44 . •