UX Research applied to digital transformation of primary care in Brazil

Background

Digital are powerful tools to improve the work and quality of information of primary care teams (PHC) in Brazil has been encouraged through the institution of the e-SUS Primary Care strategy (e-SUS AB). Digital tools were developed to optimize the PHC work process in collecting data on the health of the Brazilian population. The e-SUS AB application was one of those tools developed by the Ministry of Health. This simplified collection of population data. Despite technological updates, since 2015 there were updates regarding the usability of the application.

Objective

Aim to report on the use of UX research tools to identify changes needed in the e-SUS AB application and to propose solutions aligned with the concepts of usability.

Methods

For the UX Research, we used focus groups and field monitoring. As a result, we produced personas, empathy map, user journey, and user history documents. The Heuristic User Interface Design, proposed by Nielsen, was used for the application analysis. The World Health Organization's MEDHI (Monitoring and Evaluating Digital Health Interventions) protocol was used for designing solution proposals for UX Design.

Results

In the design process, we produced navigation sketching's flow and high-fidelity prototypes for improvement proposals. It was necessary to correlate Nielsen's 10 heuristic principles with the needs inherent to public health applications. Problems related to the freedom of control and use by the health professional and the flexibility and efficiency of use were the most significant finds. We also identified underutilization of data collected.

Conclusions

Based on the results found, an aesthetic reformulation was proposed to solve the heuristic problems. It was also proposed to include a new functionality: a checklist for specific conditions, thus optimizing the use of data collected for primary health care. The proposals are currently undergoing usability testing in a municipality in northeastern Brazil.

Key messages

We need to plan health digital tools with UX knowledge to improve analysis and decision making capabilities to pointing out strategies to face health issues in the territories. Digital tools are powerful tools to improve health care system performance.

A GDPR-compliant information system to improve community primary care in a middle income country

Background

A strong primary health care (PHC) is associated to better overall health system results. Brazil has good results in PHC in the last decades, integrating 260,000 community health workers (CHW) in 43,000 family health teams (FHT), assisting 90 million people and delivering 500 million health activities yearly, such as home visits, consultations, colposcopy, etc. We address the challenges of incorporating CHA-produced data to official electronic health records, automate its analysis and promote information use by FHT to plan activities & prioritize individuals considering social determinants of health, clinical data and treatment plans. Our study developed a general data protection regulation (GDPR) compliant information system to improve community health agents and family health teams coordination of care in order to address this challenge.

Methods

The intervention was developed using UX techniques and combines Apps and Web dashboards, issuing digital alerts to the FHT and municipal health manager, regarding individual health status and pending care for each covered individual. The research used the “Monitoring and Evaluating Digital Health Interventions” toolbox by World Health Organization (WHO), and GDPR compliance was attained by terms of use acceptance, pseudonymisation and anonymization procedures.

Results

Stage 1 and Stage 2 Maturity tests with doctors, nurses and CHA showed good feasibility, usability and user satisfaction of the solution. UX and Qualitative Assessment are reported separately.

Conclusions

Results so far point that the solution is viable and acknowledged as useful by health professionals. Stage 3 (Pilot) will run in September 2020 in two different cities to test efficacy and health system adherence in real world setting. Digital health interventions are powerful tool to improve health care system performance, particularly in Primary Health Care.

Key messages

Digital Health Intervention are viable in Primary Care as long as they reduce health profesisonal burden and increase service quality. Brazil is a promising environment for Digital Health. Careful planning, development and deployment are essential in the process.

Use of digital tools by PHC professionals as instrument for health decision-making

Background

Investments have been made in precision public health strategies, as a way to better assess needs and evaluate the health services. Experiences point out that the computerization of health systems reduces costs and improves the quality of information. Primary Health Care (PHC) workers are key elements of this transformation, which can be enhanced with the use of digital health strategies. This paper aims to know the perception of the use of digital tools provided by the Ministry of Health by PHC workers in municipalities in the state of Ceará/Brazil.

Methods

Focus groups and field monitoring were carried out with different professional profiles. The inclusion criterion was the use of digital tools in their daily work. Questionnaires were built to conduct semi-structured interviews. The analyzes were made using content analysis method.

Results

Among the 21 participants (32-49 years old, mostly female),3 reported not having digital knowledge prior to the use of digital tools in their daily work. Mostly associated the use of digital tools with greater agility and ease in the work routine and greater accuracy of information. The challenges were mainly related to the use of the equipment(tablet),such as fear of breakage, theft and problems in the synchronization of the information system. There was a consensus that the data collected are useful, however they are underutilized for the work process in PHC.

Conclusions

The use of digital tools in the health work process is able to foster the critical view of professionals for analysis and decision making, pointing out strategies to face health issues in the territories. Pointed out as a facilitator in daily work, the use of digital tools does not exclude the use of paper sheets. Despite the greater supply of data, these are not used to their full potential, mainly due to insufficient time, given the numerous tasks for professionals.

Key messages

Carefully planned, developed and deployed digital interventions are powerful tools to improve health care system performance. The use of digital tools in the health work process is able to foster the critical view for analysis and decision making, pointing out strategies to face health issues in the territories.

Reproduction of the duck catfish Ageneiosus ucayalensis in a ria river system

A total of 1006 duck catfish Ageneiosus ucayalensis were collected from a ria river system of eastern Amazonia, of which 733 were females and 273 males, a sex ratio 2·69:1. Condition factors of males were higher than those of females and size at first sexual maturity (L₅₀ ) was 12·8 cm for females and 11·8 cm for males. The relative frequency of mature specimens and gonad condition indices indicate that the breeding season is short and coincides with the rainy season.

Topographic analysis of the ganglion cell layer in the retina of the four-eyed fish Anableps anableps

Fish of the genus Anableps (Anablepidae, Cyprinodontiformes) have eyes that are adapted for simultaneous aerial and aquatic vision. In this study we investigate some of the corresponding retinal specializations of the adult Anableps anableps eye using retinal transverse sections and wholemounts. The linear dimensions of the retina were found to be asymmetric with a greater representation of the dorsal compared to the ventral visual field. The total number of neurons in the ganglion cell layer of the ventral hemiretina was on average 3.6 times greater than the values obtained in the dorsal hemiretina. Isodensity contour maps revealed a prominent horizontal visual streak in the ventral hemiretina with an average peak cell density of 18,286 cells/mm(2). A second less-well-developed horizontal visual streak was also observed in the dorsal hemiretina. A sub-population of large cells with soma areas between 74 and 188 microm(2) was identified and found to be distributed evenly across both hemiretinas. Together, these results show that the sampling gain of the ventral retina is significantly greater than the dorsal segment, that retinal specializations important for mediating acute vision are present in the parts of the visual field immediately above and below the surface of the water, and that visual functions related with the large ganglion cells require more even sampling across the visual field. The relevance of these retinal specializations to the feeding and other behavioral strategies adopted by Anableps is discussed.