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Thomas V, Kalidindi B, Waghmare A, Bhatia A, Raj T, Balsari S. The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems. JMIR Form Res 2023; 7:e45250. [PMID: 37607881 PMCID: PMC10580130 DOI: 10.2196/45250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users' perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. OBJECTIVE To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. METHODS We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. RESULTS We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system's users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system-the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. CONCLUSIONS The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption.
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Affiliation(s)
- Verghese Thomas
- Division of Medical Informatics, St John's Research Institute, Bangalore, India
| | - Bharat Kalidindi
- Division of Medical Informatics, St John's Research Institute, Bangalore, India
| | - Abijeet Waghmare
- Division of Medical Informatics, St John's Research Institute, Bangalore, India
| | - Abhishek Bhatia
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tony Raj
- Division of Medical Informatics, St John's Research Institute, Bangalore, India
- Department of Physiology, St John's Medical College, Bangalore, India
| | - Satchit Balsari
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Barbosa GL, Gomes AHA, de Camargo-Neves VLF. The SisaMob Information System: Implementation of Digital Data Collection as a Tool for Surveillance and Vector Control in the State of São Paulo. INSECTS 2023; 14:380. [PMID: 37103195 PMCID: PMC10145243 DOI: 10.3390/insects14040380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
Information systems are essential instruments in managing resources, in the evaluation of the epidemiological situation, and for decision-making at all hierarchical levels. Technological advances have allowed the development of systems that meet these premises. Therefore, it is recommended to consider the optimization of data entry and its immediate georeferencing in order to obtain information in real time. To meet this objective, we describe the application introduction process for the implementation of the digital collection of primary data and its integration with the database through synchronization with the SisaWeb platform (Information System for surveillance and control of Aedes aegypti), developed to meet the needs of the Arbovirus Surveillance and Control Program in the state of São Paulo, Brazil. For this purpose, the application-SisaMob-was conceived in the Android Studio development environment, Google®, following the same guidelines as the traditional collection method. Tablets equipped with the Android® operating system were used. To evaluate the implementation of the application, a semi-structured test was applied. The results highlighted that 774.9% (27) of the interviewees evaluated its use positively and, replacing the standard bulletin, 61.1% (22) of the users considered it regular to excellent. The automatic collection of geographic coordinates represented the greatest innovation in the use of the portable device, with reductions in errors and in the time taken to complete the report in the field. The integration to SisaWeb allowed obtaining information in real-time, being easily presented in tabular and graphic modes and spatially arranged through maps, making it possible to monitor the work at a distance, and allowing preliminary analyses during the data collection process. For the future, we must improve the mechanisms for assessing the effectiveness of information, increase the potential of the tool to produce more accurate analyses, which can direct actions more efficiently.
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Addotey-Delove M, Scott RE, Mars M. Healthcare Workers' Perspectives of mHealth Adoption Factors in the Developing World: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1244. [PMID: 36673995 PMCID: PMC9858911 DOI: 10.3390/ijerph20021244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND mHealth applications provide health practitioners with platforms that enable disease management, facilitate drug adherence, facilitate drug adherence, speed up diagnosis, monitor outbreaks, take and transfer medical images, and provide advice. Many developing economies are investing more in mobile telecommunication infrastructure than in road transport and electric power generation. Despite this, mHealth has not seen widespread adoption by healthcare workers in the developing world. This study reports a scoping review of factors that impact the adoption of mHealth by healthcare workers in the developing world, and based on these findings, a framework is developed for enhancing mHealth adoption by healthcare workers in the developing world. METHODS A structured literature search was performed using PubMed and Scopus, supplemented by hand searching. The searches were restricted to articles in English during the period January 2009 to December 2019 and relevant to the developing world that addressed: mobile phone use by healthcare workers and identified factors impacting the adoption of mHealth implementations. All authors reviewed selected papers, with final inclusion by consensus. Data abstraction was performed by all authors. The results were used to develop the conceptual framework using inductive iterative content analysis. RESULTS AND DISCUSSION Of 919 articles, 181 met the inclusion criteria and, following a review of full papers, 85 reported factors that impact (promote or impede) healthcare worker adoption of mHealth applications. These factors were categorised into 18 themes and, after continued iterative review and discussion were reduced to 7 primary categories (engagement/funding, infrastructure, training/technical support, healthcare workers' mobile-cost/ownership, system utility, motivation/staffing, patients' mobile-cost/ownership), with 17 sub-categories. These were used to design the proposed framework. CONCLUSIONS Successful adoption of mHealth by healthcare workers in the developing world will depend on addressing the factors identified in the proposed framework. They must be assessed in each specific setting prior to mHealth implementation. Application of the proposed framework will help shape future policy and practice of mHealth implementation in the developing world and increase adoption by health workers.
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Affiliation(s)
- Michael Addotey-Delove
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
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Elson WH, Kawiecki AB, Donnelly MAP, Noriega AO, Simpson JK, Syafruddin D, Rozi IE, Lobo NF, Barker CM, Scott TW, Achee NL, Morrison AC. Use of mobile data collection systems within large-scale epidemiological field trials: findings and lessons-learned from a vector control trial in Iquitos, Peru. BMC Public Health 2022; 22:1924. [PMID: 36243698 PMCID: PMC9571464 DOI: 10.1186/s12889-022-14301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 10/05/2022] [Indexed: 11/25/2022] Open
Abstract
Vector-borne diseases are among the most burdensome infectious diseases worldwide with high burden to health systems in developing regions in the tropics. For many of these diseases, vector control to reduce human biting rates or arthropod populations remains the primary strategy for prevention. New vector control interventions intended to be marketed through public health channels must be assessed by the World Health Organization for public health value using data generated from large-scale trials integrating epidemiological endpoints of human health impact. Such phase III trials typically follow large numbers of study subjects to meet necessary power requirements for detecting significant differences between treatment arms, thereby generating substantive and complex datasets. Data is often gathered directly in the field, in resource-poor settings, leading to challenges in efficient data reporting and/or quality assurance. With advancing technology, mobile data collection (MDC) systems have been implemented in many studies to overcome these challenges. Here we describe the development and implementation of a MDC system during a randomized-cluster, placebo-controlled clinical trial evaluating the protective efficacy of a spatial repellent intervention in reducing human infection with Aedes-borne viruses (ABV) in the urban setting of Iquitos, Peru, as well as the data management system that supported it. We discuss the benefits, remaining capacity gaps and the key lessons learned from using a MDC system in this context in detail.
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Affiliation(s)
| | | | | | | | | | - Din Syafruddin
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | - Neil F Lobo
- Department of Biological Sciences, Eck Institute for Global Health, Notre Dame, IND, USA
| | | | | | - Nicole L Achee
- Department of Biological Sciences, Eck Institute for Global Health, Notre Dame, IND, USA
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Lukkanalikitkul E, Kongpetch S, Chotmongkol W, Morley MG, Anutrakulchai S, Srichan C, Thinkhamrop B, Chunghom T, Wiangnon P, Thinkhamrop W, Morley KE. Optimization of the Chronic Kidney Disease-Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study. JMIR Form Res 2022; 6:e37291. [PMID: 35793137 PMCID: PMC9301552 DOI: 10.2196/37291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 02/06/2023] Open
Abstract
Background The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding.
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Affiliation(s)
- Eakalak Lukkanalikitkul
- Center of Excellence in Kidney Diseases, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawinee Kongpetch
- Center of Excellence in Kidney Diseases, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wijittra Chotmongkol
- Center of Excellence in Kidney Diseases, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Michael G Morley
- Ophthalmic Consultants of Boston, Harvard Medical School, Boston, MA, United States
| | - Sirirat Anutrakulchai
- Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chavis Srichan
- Department of Computer Engineering, Faculty of Engineering, Khon Kaen University, Khon Kaen, Thailand
| | - Bandit Thinkhamrop
- Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Theenatchar Chunghom
- Kidney Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pongsai Wiangnon
- Kidney Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wilaiphorn Thinkhamrop
- Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Katharine E Morley
- Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, United States
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The Influence of Situational Involvement on Employees’ Intrinsic Involvement During IS Development. BUSINESS & INFORMATION SYSTEMS ENGINEERING 2022. [DOI: 10.1007/s12599-021-00719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zakerabasali S, Ayyoubzadeh SM, Baniasadi T, Yazdani A, Abhari S. Mobile Health Technology and Healthcare Providers: Systemic Barriers to Adoption. Healthc Inform Res 2021; 27:267-278. [PMID: 34788907 PMCID: PMC8654335 DOI: 10.4258/hir.2021.27.4.267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Despite the growing use of mobile health (mHealth), certain barriers seem to be hindering the use of mHealth applications in healthcare. This article presents a systematic review of the literature on barriers associated with mHealth reported by healthcare professionals. Methods This systematic review was carried out to identify studies published from January 2015 to December 2019 by searching four electronic databases (PubMed/MEDLINE, Web of Science, Embase, and Google Scholar). Studies were included if they reported perceived barriers to the adoption of mHealth from healthcare providers’ perspectives. Content analysis and categorization of barriers were performed based on a focus group discussion that explored researchers’ knowledge and experiences. Results Among the 273 papers retrieved through the search strategy, 18 works were selected and 18 barriers were identified. The relevant barriers were categorized into three main groups: technical, individual, and healthcare system. Security and privacy concerns from the category of technical barriers, knowledge and limited literacy from the category of individual barriers, and economic and financial factors from the category of healthcare system barriers were chosen as three of the most important challenges related to the adoption of mHealth described in the included publications. Conclusions mHealth adoption is a complex and multi-dimensional process that is widely implemented to increase access to healthcare services. However, it is influenced by various factors and barriers. Understanding the barriers to adoption of mHealth applications among providers, and engaging them in the adoption process will be important for the successful deployment of these applications.
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Affiliation(s)
- Somayyeh Zakerabasali
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azita Yazdani
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahabeddin Abhari
- Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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Bhatia A, Matthan R, Khanna T, Balsari S. Regulatory Sandboxes: A Cure for mHealth Pilotitis? J Med Internet Res 2020; 22:e21276. [PMID: 32763889 PMCID: PMC7525408 DOI: 10.2196/21276] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 01/17/2023] Open
Abstract
Mobile health (mHealth) and related digital health interventions in the past decade have not always scaled globally as anticipated earlier despite large investments by governments and philanthropic foundations. The implementation of digital health tools has suffered from 2 limitations: (1) the interventions commonly ignore the “law of amplification” that states that technology is most likely to succeed when it seeks to augment and not alter human behavior; and (2) end-user needs and clinical gaps are often poorly understood while designing solutions, contributing to a substantial decrease in usage, referred to as the “law of attrition” in eHealth. The COVID-19 pandemic has addressed the first of the 2 problems—technology solutions, such as telemedicine, that were struggling to find traction are now closely aligned with health-seeking behavior. The second problem (poorly designed solutions) persists, as demonstrated by a plethora of poorly designed epidemic prediction tools and digital contact-tracing apps, which were deployed at scale, around the world, with little validation. The pandemic has accelerated the Indian state’s desire to build the nation’s digital health ecosystem. We call for the inclusion of regulatory sandboxes, as successfully done in the fintech sector, to provide a real-world testing environment for mHealth solutions before deploying them at scale.
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Affiliation(s)
- Abhishek Bhatia
- The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States.,FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Rahul Matthan
- The Takshashila Institution, Bengaluru, India.,Trilegal, Bengaluru, India
| | - Tarun Khanna
- The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States.,Harvard Business School, Boston, MA, United States
| | - Satchit Balsari
- The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, United States.,FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, MA, United States.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Ashfaq A, Esmaili S, Najjar M, Batool F, Mukatash T, Al-Ani HA, Koga PM. Utilization of Mobile Mental Health Services among Syrian Refugees and Other Vulnerable Arab Populations-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1295. [PMID: 32085422 PMCID: PMC7068284 DOI: 10.3390/ijerph17041295] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022]
Abstract
The global refugee crisis is at its most critical state in history; Syria alone has produced 12 million internally displaced persons, with another 5 million refugees seeking protection across the globe. Faced with the heavy burden of mental distress carried by a massive refugee influx, many host nations lack the service capacity to respond adequately. While mobile mental health (mMHealth) applications and platforms have the potential to augment screenings and interventions for vulnerable populations, an insufficient gender and cultural adaptation of technology may drastically hamper its uptake in Arab refugees. Reporting only papers originating from Middle Eastern and/or Arab nations or refugee host nations, this systematic review evaluates the available literature published between 2000 and 2019 on the usage acceptability of mMHealth in Syrian refugees and other vulnerable Arab populations. We conducted a systematic review in PubMed, PsychInfo, Association of Computing Machinery (ACM) and the Directory of Open Access Journals (DOAJ) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies that addressed mMHealth implementation in these populations; of a total of 607 articles identified, only 10 (1.6%) available, unique articles met our search criteria. These studies discussed the feasibility and efficacy of mMHealth applications and the barriers to their uptake. The few existing studies show positive impacts of mMHealth on the access to services and on treatment outcomes but also reveal a paucity of literature on mMHealth for vulnerable Arab populations. These findings indicate a critical need for research on the barriers to mMHealth uptake, to bolster service capacity in the Arab Region and in the refugee diaspora of other, non-Arab host countries.
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Affiliation(s)
- Adeel Ashfaq
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
| | - Shawn Esmaili
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
| | - Mona Najjar
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
| | - Farva Batool
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
| | - Tariq Mukatash
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
| | - Hadeer Akram Al-Ani
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Patrick Marius Koga
- ULYSSES Project University of California, Davis, Davis, CA 95616, USA; (S.E.); (M.N.); (F.B.); (T.M.); (H.A.A.-A.)
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA 95616, USA
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Kruse C, Betancourt J, Ortiz S, Valdes Luna SM, Bamrah IK, Segovia N. Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review. J Med Internet Res 2019; 21:e13263. [PMID: 31593543 PMCID: PMC6811771 DOI: 10.2196/13263] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/15/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background The use of mobile health (mHealth) technologies to improve population-level health outcomes around the world has surged in the last decade. Research supports the use of mHealth apps to improve health outcomes such as maternal and infant mortality, treatment adherence, immunization rates, and prevention of communicable diseases. However, developing countries face significant barriers to successfully implement, sustain, and expand mHealth initiatives to improve the health of vulnerable populations. Objective We aimed to identify and synthesize barriers to the use of mHealth technologies such as text messaging (short message service [SMS]), calls, and apps to change and, where possible, improve the health behaviors and health outcomes of populations in developing countries. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Deriving search criteria from the review’s primary objective, we searched PubMed and CINAHL using an exhaustive terms search (eg, mHealth, text messaging, and developing countries, with their respective Medical Subject Headings) limited by publication date, English language, and full text. At least two authors thoroughly reviewed each article’s abstract to verify the articles were germane to our objective. We then applied filters and conducted consensus meetings to confirm that the articles met the study criteria. Results Review of 2224 studies resulted in a final group of 30 articles for analysis. mHealth initiatives were used extensively worldwide for applications such as maternal health, prenatal care, infant care, HIV/AIDS prevention, treatment adherence, cardiovascular disease, diabetes, and health education. Studies were conducted in several developing countries in Africa, Asia, and Latin America. From each article, we recorded the specific health outcome that was improved, mHealth technology used, and barriers to the successful implementation of the intervention in a developing country. The most prominent health outcomes improved with mHealth were infectious diseases and maternal health, accounting for a combined 20/30 (67%) of the total studies in the analysis. The most frequent mHealth technology used was SMS, accounting for 18/30 (60%) of the studies. We identified 73 individual barriers and grouped them into 14 main categories. The top 3 barrier categories were infrastructure, lack of equipment, and technology gap, which together accounted for 28 individual barriers. Conclusions This systematic review shed light on the most prominent health outcomes that can be improved using mHealth technology interventions in developing countries. The barriers identified will provide leaders of future intervention projects a solid foundation for their design, thus increasing the chances for long-term success. We suggest that, to overcome the top three barriers, project leaders who wish to implement mHealth interventions must establish partnerships with local governments and nongovernmental organizations to secure funding, leadership, and the required infrastructure.
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Affiliation(s)
- Clemens Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Jose Betancourt
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Stephanie Ortiz
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | | | - Inderdeep Kaur Bamrah
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Narce Segovia
- School of Health Administration, Texas State University, San Marcos, TX, United States
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Costa Stutzel M, Filippo MP, Sztajnberg A, da Costa RMEM, Brites ADS, da Motta LB, Caldas CP. Multi-part quality evaluation of a customized mobile application for monitoring elderly patients with functional loss and helping caregivers. BMC Med Inform Decis Mak 2019; 19:140. [PMID: 31331309 PMCID: PMC6647294 DOI: 10.1186/s12911-019-0839-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background The challenges faced by caregivers of the elderly with chronic diseases are always complex. In this context, mobile technologies have been used with promising results, but often have restricted functionality, or are either difficult to use or do not provide the necessary support to the caregiver - which leads to declining usage over time. Therefore, we developed the Mobile System for Elderly Monitoring, SMAI. The purpose of SMAI is to monitor patients with functional loss and to improve the support to caregivers’ communication with the health team professionals, informing them the data related to the patients’ daily lives, while providing the health team better tools. Method SMAI is composed of mobile applications developed for the caregivers and health team, and a web portal that supports management activities. Caregivers use an Android application to send information and receive care advice and feedback from the health team. The system was constructed using a refinement stage approach. Each stage involved caregivers and the health team in prototype release-test-assessment-refinement cycles. SMAI was evaluated during 18 months. We studied which features were being used the most, and their use pattern throughout the week. We also studied the users’ qualitative perceptions. Finally, the caregiver application was also evaluated for usability. Results SMAI functionalities showed to be very useful or useful to caregivers and health professionals. The Focus Group interviews reveled that among caregivers the use of the application gave them the sensation of being connected to the health team. The usability evaluation identified that the interface design and associated tasks were easy to use and the System Usability Scale, SUS, presented very good results. Conclusions In general, the use of SMAI represented a positive change for the family caregivers and for the NAI health team. The overall qualitative results indicate that the approach used to construct the system was appropriate to achieve the objectives.
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Affiliation(s)
- Matheus Costa Stutzel
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Bacharelado em Ciência da Computação (BCC/IME) and Laboratório de Ciência da Computação (LCC), Rio de Janeiro, Brazil
| | - Michel Pedro Filippo
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Bacharelado em Ciência da Computação (BCC/IME) and Laboratório de Ciência da Computação (LCC), Rio de Janeiro, Brazil
| | - Alexandre Sztajnberg
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Bacharelado em Ciência da Computação (BCC/IME) and Laboratório de Ciência da Computação (LCC), Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Ciências Computacionais (CComp/IME), Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Engenharia Eletrônica (PEL/FEN), Rio de Janeiro, Brazil
| | - Rosa Maria E M da Costa
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Bacharelado em Ciência da Computação (BCC/IME) and Laboratório de Ciência da Computação (LCC), Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Ciências Computacionais (CComp/IME), Rio de Janeiro, Brazil
| | - André da Silva Brites
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Programa de Pós-Graduação em Ciências Médicas (PGCM/FCM), Rio de Janeiro, Brazil.,Núcleo de Atenção ao Idoso (NAI), Universidade Aberta da Terceira Idade (UnATI), Rio de Janeiro, Brazil
| | - Luciana Branco da Motta
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Programa de Pós-Graduação em Ciências Médicas (PGCM/FCM), Rio de Janeiro, Brazil.,Núcleo de Atenção ao Idoso (NAI), Universidade Aberta da Terceira Idade (UnATI), Rio de Janeiro, Brazil
| | - Célia Pereira Caldas
- Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier, 524 - Maracanã, Rio de Janeiro, 20550-900, Brazil.,Programa de Pós-Graduação em Ciências Médicas (PGCM/FCM), Rio de Janeiro, Brazil
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Early J, Gonzalez C, Gordon-Dseagu V, Robles-Calderon L. Use of Mobile Health (mHealth) Technologies and Interventions Among Community Health Workers Globally: A Scoping Review. Health Promot Pract 2019; 20:805-817. [PMID: 31179777 DOI: 10.1177/1524839919855391] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is mounting evidence to show that community health workers (CHWs) play a positive role in improving population health by connecting people to information, resources, and services. However, barriers faced by CHWs include not being able to access information quickly and in a language tailored to the communities they serve. Mobile health (mHealth) shows promise of bridging this gap. Although there are a number of studies published on mHealth interventions, there is a need to synthesize the literature specific to mHealth and CHWs globally. Therefore, the primary goals of this review are to identify and describe over ten years of studies on the use, effectiveness, and potential of mHealth involving CHWs. Findings provide evidence-based strategies for designing and implementing mHealth tools for and with CHWs. We used criteria and methodology for scoping reviews established by the Joanna Briggs Institute as well as PRISMA protocols. We searched scholarly databases for peer-reviewed articles published between 2007 and 2018. The initial search yielded 207 published articles; after applying inclusion criteria, the sample totaled 64. While research about mHealth use among CHWs is still emerging, we found out that large-scale, longitudinal, and clinical studies are lacking. The existing evidence indicates that interventions, which include both CHWs and mHealth tools, are effective. Challenges include the scarcity of culturally relevant mHealth interventions, lack of a consistent methodology to assess mHealth outcomes, the need for effective training for CHWs to adopt mHealth tools, and improved communication within health care teams working with CHWs.
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Affiliation(s)
- Jody Early
- University of Washington Bothell, Bothell, WA, USA
| | | | - Vanessa Gordon-Dseagu
- University of Washington, Seattle, WA, USA.,National Cancer Institute, Bethesda, MD, USA
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Pfisterer KJ, Boger J, Wong A. Prototyping the Automated Food Imaging and Nutrient Intake Tracking System: Modified Participatory Iterative Design Sprint. JMIR Hum Factors 2019; 6:e13017. [PMID: 31094336 PMCID: PMC6532336 DOI: 10.2196/13017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/27/2019] [Accepted: 04/06/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A total of 45% of older adults living in long-term care (LTC) have some form of malnutrition. Several methods of tracking food and fluid intake exist, but they are limited in terms of their accuracy and ease of application. An easy-to-use, objective, accurate, and comprehensive food intake system designed with LTC in mind may provide additional insights regarding nutritional support systems and nutritional interventions. OBJECTIVE The aim of this study was to conduct a multistage participatory iterative design sprint of a Goldilocks quality horizontal prototype for the Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) system. Specific design objectives included the following: (1) identify practice-relevant problems and solutions through user-centered participatory design, (2) mitigate feasibility-related barriers to uptake, and (3) employ user-centered technology development. METHODS A 6-stage iterative participatory design sprint was developed and executed. A total of 38 participants and advisors representing 15 distinct roles (eg, personal support worker, nurse, and dietitian) were engaged in the design sprint. Subjective workload (Raw Task Load Index), subjective usability scales, and a modified Ravden checklist were used to assess project advisors' perceptions of the AFINI-T system prototype compared with the current method of food and fluid intake charting. RESULTS The top priorities for this system were identified as the following: ease of use, high accuracy, system reliability, ease of maintenance, and requirement of integrating with the current PointClickCare system. Data from project advisors informed design decisions leading to a Goldilocks quality horizontal prototype of the AFINI-T system. Compared with the current food and fluid intake charting system, AFINI-T was perceived to have the following: less time demands (t10.8=4.89; P<.001), less effort (t13.5=5.55; P<.001), and less frustration (t13.0=3.80; P=.002). Usability ratings of the AFINI-T prototype were high, with a subjective usability score mean of 89.2 and the highest ratings on a modified Ravden usability checklist of "very satisfactory" for 7 out of 8 sections. CONCLUSIONS The AFINI-T concept system appears to have good practice relevance as a tool for an intelligent food and fluid intake tracking system in LTC. The AFINI-T concept system may provide improvement over the current system, and advisors are keen to try the AFINI-T system. This research gives tangible examples of how the sprint method can be adapted and applied to the development of novel needs-based application-driven technology.
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Affiliation(s)
- Kaylen J Pfisterer
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - Alexander Wong
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Nagel DA, Keeping-Burke L, Pyrke RJL, Pyrke CLB, Goudreau A, Luke A, Wilbur KA, Waycott L, Hamilton C. Frameworks for evaluation of community health centers' services and outcomes: a scoping review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:451-460. [PMID: 30451712 DOI: 10.11124/jbisrir-2017-003843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this scoping review is to identify and map the frameworks used to evaluate services and outcomes of community health centers within the broader context of primary health care.The primary question for this scoping review is: what are the frameworks used to evaluate services and outcomes of community health centers?Secondary questions for this review are.
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Affiliation(s)
- Daniel A Nagel
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Lisa Keeping-Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Ryan J L Pyrke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | - Courtney L B Pyrke
- Saint John Free Public Library, New Brunswick Public Library Service, Saint John, Canada
| | - Alex Goudreau
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
- University of New Brunswick Libraries, University of New Brunswick, Saint John, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Kimberly A Wilbur
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Loretta Waycott
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
| | - Catherine Hamilton
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: a Joanna Briggs Institute Affiliated Group
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Andrikopoulou E, Scott PJ, Herrera H. Important Design Features of Personal Health Records to Improve Medication Adherence for Patients with Long-Term Conditions: Protocol for a Systematic Literature Review. JMIR Res Protoc 2018; 7:e159. [PMID: 29954729 PMCID: PMC6116916 DOI: 10.2196/resprot.9778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/29/2018] [Accepted: 04/22/2018] [Indexed: 12/25/2022] Open
Abstract
Background The National Health Service (NHS) England spent £15.5 billion on medication in 2015. More than a third of patients affected by at least one long-term condition do not adhere to their drug regime. Many interventions have been trialed to improve medication adherence. One promising innovation is the electronic personal health record. Objective This systematic literature review aims to identify the important design features of personal health records to improve medication adherence for patients with long-term conditions. Methods This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P 2015) statement. The following databases will be searched for relevant articles: PubMed, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Studies published in the last fifteen years, in English, will be included if the participants are adults who were treated outside the hospital, have the ability to self-administer their medication, and have at least one long-term condition. The review will exclude commercial or political sources and papers without references. Papers that research pediatrics, pregnant, or terminally ill patients will also be excluded, since their medication management is typically more complex. Results One reviewer will screen the included studies, extract the relevant data, and assess the quality of evidence utilizing the Grading of Recommendations Assessment, Development, and Evaluation system and the risk of bias using the Cochrane RevMan tool. The second reviewer will assess the quality of 25% of the included studies to assess interrater agreement. Any disagreement will be solved by a third reviewer. Only studies of high and moderate quality will be included for narrative synthesis. Conclusions NHS policy assumes that increasing usage of personal health records by citizens will reduce demand on health care services. There is limited evidence, however, that the use of health apps can improve patient outcomes, and, to our knowledge, this is the first systematic literature review aiming to identify important design features of the personal health record which may improve medication adherence in the adult population with long-term conditions. Trial Registration PROSPERO CRD42017060542; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60542 (Archived by WebCite at http://www.webcitation.org/6zeuWXxVh) Registered Report Identifier RR1-10.2196/9778
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Affiliation(s)
- Elisavet Andrikopoulou
- School of Computing, Faculty of Technology, University of Portmouth, Portsmouth, United Kingdom
| | - Philip James Scott
- School of Computing, Faculty of Technology, University of Portmouth, Portsmouth, United Kingdom
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portmouth, Portsmouth, United Kingdom
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Shen LQ, Zang XY, Cong JY. Nurses' satisfaction with use of a personal digital assistants with a mobile nursing information system in China. Int J Nurs Pract 2018; 24:e12619. [PMID: 29356202 DOI: 10.1111/ijn.12619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/31/2017] [Accepted: 11/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Personal digital assistants, technology with various functions, have been applied in international clinical practice. Great benefits in reducing medical errors and enhancing the efficiency of clinical work have been achieved, but little research has investigated nurses' satisfaction with the use of personal digital assistants. AIM To investigate nurses' satisfaction with use of personal digital assistants, and to explore the predictors of this. DESIGN This is a cross-sectional descriptive study. METHODS We conducted a cross-sectional survey targeting nurses who used personal digital assistants in a comprehensive tertiary hospital in Beijing. RESULTS A total of 383 nurses were recruited in this survey in 2015. The total score of nurses' satisfaction with use of personal digital assistants was 238.91 (SD 39.25). Nurses were less satisfied with the function of documentation, compared with the function of administering medical orders. The time length of using personal digital assistants, academic degree, and different departments predicted nurses' satisfaction towards personal digital assistant use (all P < 0.05). CONCLUSION Nurses were satisfied with the accuracy of administering medical orders and the safety of recording data. The stability of the wireless network and efficiency related to nursing work were less promising. To some extent, nurses with higher education and longer working time with personal digital assistants were more satisfied with them.
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Affiliation(s)
| | - Xiao-Ying Zang
- Nursing School of Tian Jin Medical University, Tianjin, China
| | - Ji-Yan Cong
- Nursing School of Tian Jin Medical University, Tianjin, China
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Drummond JL, Were MC, Arrossi S, Wools-Kaloustian K. Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities. Int J Gynaecol Obstet 2017; 138 Suppl 1:33-40. [DOI: 10.1002/ijgo.12192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer L. Drummond
- National Foundation for the Centers for Disease Control and Prevention; Atlanta GA USA
| | - Martin C. Were
- Department of Biomedical Informatics; Vanderbilt University; Nashville TN USA
- Department of Medicine; Vanderbilt University; Nashville TN USA
- Vanderbilt Institute for Global Health; Nashville TN USA
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y técnicas; Buenos Aires Argentina
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