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Denny A, Curtin B, Taylor-Robinson S, Chirambo GB, Cilliers L, Wu TSJ, O'Meara C, Booth R, O'Donoghue J. Evaluating the Appropriateness of Podcasts to Improve the Knowledge and Awareness of Selected Health Topics Among Undergraduate General Nursing Students: Protocol for an International Feasibility Study. JMIR Res Protoc 2024; 13:e50735. [PMID: 38319702 PMCID: PMC10879975 DOI: 10.2196/50735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Podcasts have proven to be a successful alternative source of educational material for students. Given the ability to listen to podcasts 24/7 and while on the go, this technology has the potential to provide informative and educational material to a large number of people at any given time. Podcasts are usually freely available on commonly used mobile devices, such as smartphones, laptops, and tablets. OBJECTIVE This paper describes the impact of health-related podcasts as an intervention tool to support the knowledge and awareness of nursing students on a given topic. METHODS Pre- and postpodcast questionnaires will gather data regarding the participants' knowledge and awareness of two topics-gestational diabetes and mental health. This intervention will be tested on general nursing undergraduate students. The total number of students (N=2395) from the participating universities are broken down as follows: (1) University College Cork (n=850) and the University of Galway (n=450) in Ireland, (2) Mzuzu University in Malawi (n=719), and (3) University of Fort Hare in South Africa (n=376). RESULTS The study received ethical approval from the University College Cork Ethics Committee (2022-027A1). The approval obtained from University College Cork sufficed as ethics coverage for the University of Galway in Ireland. Ethics approval was also received from the Mzuzu University Research Ethics Committee (ID MZUNIREC/DOR/23/28) and the Inter-Faculty Research Ethics Committee of the University of Fort Hare (ID CIL002-21). Data collection is currently underway and will continue until the end of February 2024. The quantitative and qualitative data are expected to be analyzed in March 2024. CONCLUSIONS Results from this study will allow for an investigation into the impact of podcasts in different settings: a high-income country (Ireland), an upper-middle-income country (South Africa), and a low-to-middle-income country (Malawi). The data gathered from this feasibility study will provide more clarity on the potential utility of podcasts as an intervention tool. We will gather data regarding listener demographics (eg, country of residence, age, gender, and year of study). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50735.
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Affiliation(s)
| | | | | | | | | | - Tsung-Shu Joseph Wu
- Research Department, Luke International, Mzuzu City, Malawi
- Overseas Services Department, Pingtung Christian Hospital, Pingtung County, Taiwan
| | - Ciara O'Meara
- School of Nursing & Midwifery, University of Galway, Galway, Ireland
| | | | - John O'Donoghue
- ASSERT Research Centre, University College Cork, Cork, Ireland
- Business Information Systems, University College Cork, Cork, Ireland
- Malawi eHealth Research Centre, Mzuzu University, Mzuzu City, Malawi
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2
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Tan YY, Woulfe F, Chirambo GB, Henn P, Cilliers L, Fadahunsi KP, Taylor-Robinson SD, O'Donoghue J. Framework to assess the quality of mHealth apps: a mixed-method international case study protocol. BMJ Open 2022; 12:e062909. [PMID: 36307160 PMCID: PMC9621190 DOI: 10.1136/bmjopen-2022-062909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Healthcare professionals (HCPs) often recommend their patients to use a specific mHealth app as part of health promotion, disease prevention and patient self-management. There has been a significant growth in the number of HCPs downloading and using mobile health (mHealth) apps. Most mHealth apps that are available in app stores employ a 'star rating' system. This is based on user feedback on an app, but is highly subjective. Thus, the identification of quality mHealth apps which are deemed fit for purpose can be a difficult task for HCPs. Currently, there is no unified, validated standard guidelines for assessment of mHealth apps for patient safety, which can be used by HCPs. The Modified Enlight Suite (MES) is a quality assessment framework designed to provide a means for HCPs to evaluate mHealth apps before they are recommended to patients. MES was adapted from the original Enlight Suite for international use through a Delphi method, followed by preliminary validation process among a population predominantly consisting of medical students. This study aims to evaluate the applicability and validity of the MES, by HCPs, in low, middle and high income country settings. METHODS AND ANALYSIS MES will be evaluated through a mixed-method study, consisting of qualitative (focus group) and quantitative (survey instruments) research, in three target countries: Malaŵi (low income), South Africa (middle income) and Ireland (high income). The focus groups will be conducted through Microsoft Teams (Microsoft, Redmond, Washington, USA) and surveys will be conducted online using Qualtrics (Qualtrics International, Seattle, Washington, USA). Participants will be recruited through the help of national representatives in Malawi (Mzuzu University), South Africa (University of Fort Hare) and Ireland (University College Cork) by email invitation. Data analysis for the focus group will be by the means of thematic analysis. Data analysis for the survey will use descriptive statistics and use Cronbach alpha as an indicator of internal consistency of the MES. The construct validity of the mHealth app will be assessed by computing the confirmatory factor analysis using Amos. ETHICS AND DISSEMINATION The study has received ethical approval from the Social Research Ethics Committee (SREC) SREC/SOM/03092021/1 at University College Cork, Ireland, Malaŵi Research Ethics Committee (MREC), Malaŵi MZUNIREC/DOR/21/59 and Inter-Faculty Research Ethics Committee (IFREC) of University of Fort Hare (REC-2 70 710-028-RA). The results of the study will be disseminated through the internet, peer-reviewed journals and conference presentations.
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Affiliation(s)
- Yong Yu Tan
- School of Medicine, University College Cork, Cork, Ireland
| | - Fionn Woulfe
- School of Medicine, University College Cork, Cork, Ireland
| | | | - Patrick Henn
- ASSERT Centre, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Liezel Cilliers
- Department of Information Systems, University of Fort Hare, Alice, South Africa
| | | | | | - John O'Donoghue
- Malawi eHealth Research Centre, University College Cork, Cork, Ireland
- Department of Primary Care and Public Health, University College Cork, Cork, Ireland
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3
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Woulfe F, Fadahunsi KP, O'Grady M, Chirambo GB, Mawkin M, Majeed A, Smith S, Henn P, O'Donoghue J. Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi Studies. JMIR Form Res 2022; 6:e36912. [PMID: 35984688 PMCID: PMC9497647 DOI: 10.2196/36912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/28/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Over 325,000 mobile health (mHealth) apps are available to download across various app stores. However, quality assurance in this field of medicine remains relatively undefined. Globally, around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in patient care worldwide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale and Enlight Suite have demonstrated potential for use in the interim. However, these frameworks require adaptation to be suitable for international use. Objective This study aims to modify the Enlight Suite, a comprehensive app quality assessment methodology, to improve its applicability internationally and to assess the preliminary validity and reliability of this modified tool in practice. Methods A two-round Delphi study involving 7 international mHealth experts with varied backgrounds in health, technology, and clinical psychology was conducted to modify the Enlight Suite for international use and to improve its content validity. The Modified Enlight Suite (MES) was then used by 800 health care professionals and health care students in Ireland to assess a COVID-19 tracker app in an online survey. The reliability of the MES was assessed using Cronbach alpha, while the construct validity was evaluated using confirmatory factor analysis. Results The final version of the MES has 7 sections with 32 evaluating items. Of these items, 5 were novel and based on consensus for inclusion by Delphi panel members. The MES has satisfactory reliability with a Cronbach alpha score of .925. The subscales also demonstrated acceptable internal consistency. Similarly, the confirmatory factor analysis demonstrated a positive and significant factor loading for all 32 items in the MES with a modestly acceptable model fit, thus indicating the construct validity of the MES. Conclusions The Enlight Suite was modified to improve its international relevance to app quality assessment by introducing new items relating to cultural appropriateness, accessibility, and readability of mHealth app content. This study indicates both the reliability and validity of the MES for assessing the quality of mHealth apps in a high-income country, with further studies being planned to extrapolate these findings to low- and middle-income countries.
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Affiliation(s)
- Fionn Woulfe
- School of Medicine, University College Cork, Cork, Ireland
| | - Kayode Philip Fadahunsi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Michael O'Grady
- School of Computer Science, University College Dublin, Dublin, Ireland
| | | | - Mala Mawkin
- School of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Simon Smith
- School of Medicine, University College Cork, Cork, Ireland
| | - Patrick Henn
- ASSERT Research Centre, School of Medicine, University College Cork, Cork, Ireland
| | - John O'Donoghue
- ASSERT Research Centre, School of Medicine, University College Cork, Cork, Ireland
- Malawi eHealth Research Centre, University College Cork, Cork, Ireland
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Chirambo GB, Thompson M, Hardy V, Ide N, Hwang PH, Dharmayat K, Mastellos N, Heavin C, O'Connor Y, Muula AS, Andersson B, Carlsson S, Tran T, Hsieh JCL, Lee HY, Fitzpatrick A, Joseph Wu TS, O'Donoghue J. Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial. J Med Internet Res 2021; 23:e25777. [PMID: 34668872 PMCID: PMC8567152 DOI: 10.2196/25777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/11/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results A total of 6965 children were recruited—49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345
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Affiliation(s)
- Griphin Baxter Chirambo
- Faculty of Health Sciences, Mzuzu University, Mzuzu, Malawi.,Malawi eHealth Research Center, University College Cork, Cork, Ireland
| | | | | | - Nicole Ide
- University of Washington, Seatle, WA, United States
| | | | | | | | | | | | | | | | | | - Tammy Tran
- Imperial College London, London, United Kingdom
| | | | | | | | | | - John O'Donoghue
- Malawi eHealth Research Center, University College Cork, Cork, Ireland.,Imperial College London, London, United Kingdom
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Woulfe F, Fadahunsi KP, Smith S, Chirambo GB, Larsson E, Henn P, Mawkin M, O' Donoghue J. Identification and Evaluation of Methodologies to Assess the Quality of Mobile Health Apps in High-, Low-, and Middle-Income Countries: Rapid Review. JMIR Mhealth Uhealth 2021; 9:e28384. [PMID: 34636737 PMCID: PMC8548973 DOI: 10.2196/28384] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, there has been rapid growth in the availability and use of mobile health (mHealth) apps around the world. A consensus regarding an accepted standard to assess the quality of such apps has yet to be reached. A factor that exacerbates the challenge of mHealth app quality assessment is variations in the interpretation of quality and its subdimensions. Consequently, it has become increasingly difficult for health care professionals worldwide to distinguish apps of high quality from those of lower quality. This exposes both patients and health care professionals to unnecessary risks. Despite progress, limited understanding of the contributions of researchers in low- and middle-income countries (LMICs) exists on this topic. Furthermore, the applicability of quality assessment methodologies in LMIC settings remains relatively unexplored. OBJECTIVE This rapid review aims to identify current methodologies in the literature to assess the quality of mHealth apps, understand what aspects of quality these methodologies address, determine what input has been made by authors from LMICs, and examine the applicability of such methodologies in LMICs. METHODS This review was registered with PROSPERO (International Prospective Register of Systematic Reviews). A search of PubMed, EMBASE, Web of Science, and Scopus was performed for papers related to mHealth app quality assessment methodologies, which were published in English between 2005 and 2020. By taking a rapid review approach, a thematic and descriptive analysis of the papers was performed. RESULTS Electronic database searches identified 841 papers. After the screening process, 52 papers remained for inclusion. Of the 52 papers, 5 (10%) proposed novel methodologies that could be used to evaluate mHealth apps of diverse medical areas of interest, 8 (15%) proposed methodologies that could be used to assess apps concerned with a specific medical focus, and 39 (75%) used methodologies developed by other published authors to evaluate the quality of various groups of mHealth apps. The authors in 6% (3/52) of papers were solely affiliated to institutes in LMICs. A further 15% (8/52) of papers had at least one coauthor affiliated to an institute in an LMIC. CONCLUSIONS Quality assessment of mHealth apps is complex in nature and at times subjective. Despite growing research on this topic, to date, an all-encompassing appropriate means for evaluating the quality of mHealth apps does not exist. There has been engagement with authors affiliated to institutes across LMICs; however, limited consideration of current generic methodologies for application in LMIC settings has been identified. TRIAL REGISTRATION PROSPERO CRD42020205149; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205149.
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Affiliation(s)
- Fionn Woulfe
- School of Medicine, University College Cork, Cork, Ireland
| | - Kayode Philip Fadahunsi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Simon Smith
- School of Medicine, University College Cork, Cork, Ireland
| | | | - Emma Larsson
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, United Kingdom
| | - Patrick Henn
- Assert Centre, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Mala Mawkin
- School of Medicine, Imperial College London, London, United Kingdom
| | - John O' Donoghue
- Malawi eHealth Research Centre, University College Cork, College Road, Cork, Ireland
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Larsson E, Mawkin M, Taylor-Robinson SD, Harrington P, Gondwe H, Watson C, Gallagher J, Ledwidge M, Chirambo GB, O'Donoghue J. Implementing Innovative Approaches to Healthcare in a Lower-Middle Income Country: Perspectives from Malawi. Int J Gen Med 2020; 13:1723-1730. [PMID: 33414644 PMCID: PMC7783193 DOI: 10.2147/ijgm.s285130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Safe, reliable, and effective healthcare systems are essential for all nations to ensure the health and wellbeing of their citizens. However, this is not always achievable with clinical therapies constantly evolving, resulting in a domino effect of structural, policy and training changes. For low- and middle-income countries (LMICs), implementing change is restricted. It is essential that innovative and realistic solutions are developed, so that effective change can be realised in LMICs. Materials and Methods In this report of a global health conference held in July 2019, six perspectives are presented which aim to generate long-term positive change in Malaŵi. Perspective 1: Pneumonia – the BIOTOPE study (BIOmarkers TO diagnose PnEumonia) sought to determine the aetiology of pneumonia in children presenting in primary care. It assessed blood-based markers of bacterial infection as part of a rapid diagnostic approach to better utilise existing resources in Malaŵi. Perspective 2: Cardiovascular – the CARDIA project (CARdiac Dysfunction in Africa) was established to assess clinical and biochemical phenotypes of diabetic patients in Malaŵi. Perspective 3: Asthma – an observational study was conducted to implement a health system strengthening initiative for asthma. The use of locally adapted formularies and protocols with ongoing online mentoring through expert partnerships provided an opportunity to sustainably build capacity. Perspective 4: Sustainable Partnerships – establishing the Malaŵi electronic Health (eHealth) Research Centre, an international hub to develop education, research and innovation for long-term collaboration. Perspective 5: Part-Time PhD Studies – undertaking a part-time PhD within a LMIC provides logistic challenges, but also a number of opportunities for observational research. Perspective 6: Medical electives – an undergraduate elective allows real exposure to global health and facilitates life-long collaborations at an early stage in a medical career. Conclusion Malaŵi is an under-doctored and resource-poor country. North-South partnerships in Malaŵi should be strengthened with particular emphasis on healthcare innovations, such as eHealth, which allow healthcare problems to be highlighted early while preventative measures are still possible.
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Affiliation(s)
- Emma Larsson
- Imperial College London, South Kensington, London SW7 2BX, UK
| | - Mala Mawkin
- Imperial College London, South Kensington, London SW7 2BX, UK
| | | | - Peter Harrington
- gHealth Research Group, University College Dublin, Dublin, Ireland
| | | | - Chris Watson
- gHealth Research Group, University College Dublin, Dublin, Ireland.,Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, Northern Ireland
| | - Joseph Gallagher
- gHealth Research Group, University College Dublin, Dublin, Ireland
| | - Mark Ledwidge
- gHealth Research Group, University College Dublin, Dublin, Ireland
| | - Griphin Baxter Chirambo
- Mzuzu University, Mzuzu, Malawi.,Malawi eHealth Research Centre, University College Cork, Cork, Ireland
| | - John O'Donoghue
- gHealth Research Group, University College Dublin, Dublin, Ireland.,Malawi eHealth Research Centre, University College Cork, Cork, Ireland.,ASSERT Research Centre, University College Cork, Cork, Ireland
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Chirambo GB, Muula AS, Thompson M, Hardy VE, Heavin C, Connor YO, Mastellos N, Andersson B, Donoghue JO. End-user perspectives of two mHealth decision support tools: Electronic Community Case Management in Northern Malawi. Int J Med Inform 2020; 145:104323. [PMID: 33232917 DOI: 10.1016/j.ijmedinf.2020.104323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The introduction of a paper-based Community Case Management (CCM) in Malawi has contributed to a reduction of child morbidity and mortality rates. In addition, the introduction of electronic Community Case Management (eCCM) (smartphones with built in CCM apps) may help to reduce the under-five mortality rates even further. PURPOSE It is not uncommon for Apps with a similar area of interest to develop different features to assist the end users. Such differences between Apps may have a significant role to play in its overall adoption and integration. The purpose of this research was to explore end users perspectives of two eCCM decision support tools developed and implemented by the Supporting LIFE project (SL eCCM App) and D-Tree International's (Mangologic eCCM App)in Northern Malawi. METHODS A mixed methods approach was applied, involving a survey of 109 users (106 Health Surveillance Assistants (HSAs), and 3 Integrated Management of Childhood Il6lnesses (IMCI) coordinators). This was followed up with semi-structured interviews with 34 respondents (31 HSAs, and 3 IMCI coordinators). Quantitative data was analyzed using SPSS version 20 where descriptive statistics and Chi-Squared tests were generated. Qualitative data were analyzed based on thematic analysis. RESULTS Participants reported that both Apps could assist the HSAs in the management of childhood illnesses. However, usability differed between the two apps where the Supporting LIFE eCCM App was found to be easier to use (61%) compared to the Mangologic eCCM App (4%). Both Apps were perceived to provide credible and accurate information. CONCLUSION It is essential that the quality of the data within Mobile Health (mHealth) Apps is high, however even Apps with excellent levels of data quality may not succeed if the overall usability of the App is low. Therefore it is essential that the Apps has high levels of data quality, usability and credibility. The results of this study will help inform mobile Health (mHealth) App designers in developing future eCCM Apps as well as researchers and policy makers when considering the adoption of mHealth solutions in the future in Malawi and other LMICs.
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Affiliation(s)
- Griphin Baxter Chirambo
- Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu, Malawi; School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi.
| | - Adamson S Muula
- School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi; Africa Centre of Excellence in Public Health and Herbal Medicine, University of Malawi, College of Medicine, Malawi
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Victoria E Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Ciara Heavin
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Yvonne O' Connor
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Bo Andersson
- Department of Informatics, Lund University, Lund, Sweden
| | - John O' Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Assert Research Centre, University College Cork, Ireland; Malawi eHealth Research Centre, University College Cork, Ireland
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Dick S, O'Connor Y, Thompson MJ, O'Donoghue J, Hardy V, Wu TSJ, O'Sullivan T, Chirambo GB, Heavin C. Considerations for Improved Mobile Health Evaluation: Retrospective Qualitative Investigation. JMIR Mhealth Uhealth 2020; 8:e12424. [PMID: 32012085 PMCID: PMC7003121 DOI: 10.2196/12424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 07/12/2019] [Accepted: 08/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile phone use and, consequently, mobile health (mHealth) interventions have seen an exponential increase in the last decade. There is an excess of 318,000 health-related apps available free of cost for consumers to download. However, many of these interventions are not evaluated and are lacking appropriate regulations. Randomized controlled trials are often considered the gold standard study design in determining the effectiveness of interventions, but recent literature has identified limitations in the methodology when used to evaluate mHealth. OBJECTIVE The objective of this study was to investigate the system developers' experiences of evaluating mHealth interventions in the context of a developing country. METHODS We employed a qualitative exploratory approach, conducting semistructured interviews with multidisciplinary members of an mHealth project consortium. A conventional content analysis approach was used to allow codes and themes to be identified directly from the data. RESULTS The findings from this study identified the system developers' perceptions of mHealth evaluation, providing an insight into the requirements of an effective mHealth evaluation. This study identified social and technical factors which should be taken into account when evaluating an mHealth intervention. CONCLUSIONS Contextual issues represented one of the most recurrent challenges of mHealth evaluation in the context of a developing country, highlighting the importance of a mixed method evaluation. There is a myriad of social, technical, and regulatory variables, which may impact the effectiveness of an mHealth intervention. Failure to account for these variables in an evaluation may limit the ability of the intervention to achieve long-term implementation and scale.
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Affiliation(s)
- Samantha Dick
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
| | - Yvonne O'Connor
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - John O'Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Victoria Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | | | - Timothy O'Sullivan
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
| | | | - Ciara Heavin
- Health Information Systems Research Centre, Cork University Business School, Cork, Ireland
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Chirambo GB, Muula AS, Thompson M. Factors affecting sustainability of mHealth decision support tools and mHealth technologies in Malawi. Informatics in Medicine Unlocked 2019. [DOI: 10.1016/j.imu.2019.100261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Chirambo GB, Hardy VE, Heavin C, O'Connor Y, O'Donoghue J, Mastellos N, Tran T, Hsieh J, Wu JTS, Carlsson S, Andersson B, Muula AS, Thompson M. Perceptions of a mobile health intervention for Community Case Management in Malawi: Opportunities and challenges for Health Surveillance Assistants in a community setting. Malawi Med J 2018; 30:6-12. [PMID: 29868152 PMCID: PMC5974379 DOI: 10.4314/mmj.v30i1.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Improved availability of mobile phones in low- and middle-income countries (LMICs) offer an opportunity to improve delivery of Community Case Management (CCM). Despite enthusiasm for introducing mHealth into healthcare across LMICs, end-user attitudes towards mHealth solutions for CCM are limited. We aimed to explore Health Surveillance Assistants' (HSAs) perceptions of the Supporting LIFE electronic CCM Application (SL eCCM App) and their experiences incorporating it as part of their clinical practice. Methods This exploratory qualitative study was part of a mixed methods feasibility study investigating whether children under-5 presenting to village clinics could be followed-up to collect patient outcome data. The convenience sample of 12 HSAs enrolled into the feasibility study participated in semi-structured interviews, which were conducted at village clinics after HSAs had field-tested the SL eCCM App over a 10-day period. Interviews explored HSAs perceptions of the SL eCCM App and their experiences in using the App in addition to paper CCM to assess and treat acutely unwell children. Open coding was used to label emerging concepts, which were iteratively defined and developed into six key themes. Results HSAs' perceived enhanced clinical decision-making, quality of CCM delivery, and work efficiency as opportunities associated with using the SL eCCM App. HSAs believed the inability to retrieve patient records,, cumbersome duplicate assessments/data entry study procedures, and inconsistencies between the SL eCCM App and paper-based CCM guidelines as challenges to implementation. Adding features to the App, such as, permitting communication between colleagues/supervisors, drug stock-out reporting, and community assessments, were identified as potentially supporting HSAs' many roles in the community. Conclusion This study identified opportunities and challenges associated with using the SL eCCM App in Malawi. This information can be used to inform future development and evaluation of the SL eCCM App, and similar mHealth solutions for CCM in Malawi and other developing countries.
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Affiliation(s)
- Griphin Baxter Chirambo
- Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu, Malawi.,School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Victoria E Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Ciara Heavin
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Yvonne O'Connor
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - John O'Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Tammy Tran
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Jenny Hsieh
- Luke International (LIN), Malawi Office, P.O. Box 1088, Mzuzu, Malawi
| | | | - Sven Carlsson
- Department of Informatics, Lund University School of Economics and Management, Lund, Sweden
| | - Bo Andersson
- Department of Informatics, Lund University School of Economics and Management, Lund, Sweden
| | - Adamson S Muula
- School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi.,Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Hardy V, O'Connor Y, Heavin C, Mastellos N, Tran T, O'Donoghue J, Fitzpatrick AL, Ide N, Wu TSJ, Chirambo GB, Muula AS, Nyirenda M, Carlsson S, Andersson B, Thompson M. The added value of a mobile application of Community Case Management on referral, re-consultation and hospitalization rates of children aged under 5 years in two districts in Northern Malawi: study protocol for a pragmatic, stepped-wedge cluster-randomized controlled trial. Trials 2017; 18:475. [PMID: 29020976 PMCID: PMC5637321 DOI: 10.1186/s13063-017-2213-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 09/25/2017] [Indexed: 11/23/2022] Open
Abstract
Background There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi. Methods/design This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017. Discussion This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries. Trial registration ClinicalTrials.gov, ID: NCT02763345. Registered on 3 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2213-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, 98195-4696, USA.
| | - Yvonne O'Connor
- Health Information Systems Research Centre, Cork University Business School, University College Cork, Cork, Ireland
| | - Ciara Heavin
- Health Information Systems Research Centre, Cork University Business School, University College Cork, Cork, Ireland
| | - Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Tammy Tran
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John O'Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, WA, 98195-4696, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nicole Ide
- Department of Family Medicine, University of Washington, Seattle, WA, 98195-4696, USA
| | - Tsung-Shu Joseph Wu
- Department of Global Health, University of Washington, Seattle, WA, USA.,Luke International (LIN), Malawi Office, Mzuzu, Malawi
| | - Griphin Baxter Chirambo
- Faculty of Health Sciences, Mzuzu University, Luwinga, Mzuzu, Malawi.,Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Cork, Malawi
| | - Adamson S Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Cork, Malawi
| | - Moffat Nyirenda
- London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Sven Carlsson
- Department of Informatics, Lund Universitet, School of Economics and Management, Lund, Sweden
| | - Bo Andersson
- Department of Informatics, Lund Universitet, School of Economics and Management, Lund, Sweden
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, 98195-4696, USA
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O'Connor S, Gallagher J, Wamba N, Moyo C, Chirambo GB, O'Donoghue J. Establishing Long-Term Nursing Informatics Capacity in Malawi, Africa. Stud Health Technol Inform 2016; 225:1013-1014. [PMID: 27332458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The capacity of developing countries to implement nursing informatics education, research and practice is limited. Therefore, an international partnership was established to provide teaching and research opportunities in the field of eHealth for nursing faculty at Mzuzu University, Malawi. This resulted in staff development and capacity building with nursing faculty undertaking mHealth research and beginning doctoral studies as well as the creation of an online repository of educational resources to teach nursing informatics to undergraduate students. Collaborative international partnerships can assist in building nursing informatics capacity in low resource settings.
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Affiliation(s)
- Siobhan O'Connor
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - Joe Gallagher
- Global Health Research Group, University College Dublin, Ireland
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