Adherence to treatment regimes is a crucial factor in ensuring that anti-retroviral medications and tuberculosis therapy are effective. Unfortunately, insuffient adherence or non-compliance - that is irregular taking of medications, or none at all when symptoms disappear - is common in HIV/AIDS and TB patients. This leads to treatment failure, morbidity and the development of drug resistance.
To address this very problem, there are countless pilot projects and exploratory studies that are testing the role of text message-based reminder systems to improve drug-taking compliance amongst HIV/AIDS and TB patients. The hope is to push for large scale behavior change - a daunting and challenging task in and of itself, with or without technology. One of the key prerequisites for success is to understand cultural promoters and barriers of behavior change.
This research slidecast is a brief look at participatory research involving HIV/AIDs patients in Peru and their preferences for such a text message reminder system. Dr. Curioso and colleagues from the University of Washington and Universidad Peruana Cayetano Heredia presented the study at the American Medical Informatics Association Symposium in 2009.
Curioso WH, Quistberg DA, Cabello R, Gozzer E, Garcia PJ, Holmes KK, Kurth AE. "It´s time for your life": How should we remind patients to take medicines using short text messages? AMIA Annu Symp Proc 2009; pgs 129-133. Full text available here (PDF)
SMART Diaphragm: Changing the Way Doctors Detect High-Risk Pregnancies data sheet 3783 Views
Pre-term births can result in dangerous deliveries for mothers and life-long medical problems for children. Currently, one in ten babies are born prematurely, but a new project called SMART Diaphragm is working to change this through an early detection system.
SMART Diaphragm is an early warning system for high-risk pregnancies. Pregnant women insert a sensor-enabled diaphragm that monitors changing collagen levels in the woman's cervix. The results are wirelessly transmitted via bluetooth-enabled phones to a cloud data storage system.
Innovative Use of Cellphone Technology for HIV/AIDS Behaviour Change Communications: Three Pilot Projects data sheet 2145 Views
Author:
de Tolly, Katherine and Helen Alexander
Publication Date:
Jan 2009
Publication Type:
Report/White paper
Abstract:
The opportunities in South Africa for using mobile technologies to support initiatives in the HIV/AIDS sector are enormous. A huge number of people have cellphone access, and there are a range of innovative ways in which cellphones can be used to support treatment, disseminate information, provide anonymous counselling, gather data and link patients to services. Cell-Life is an NGO based in Cape Town, South Africa, that seeks to improve the lives of people infected and affected by HIV through the appropriate use of technology. This paper describes three pilot interventions that use cellphones for behaviour change communication, ie that are experimenting with different cellphone technologies to disseminate information, undertaken as part of Cell-Life’s Cellphones4HIV project: ARV adherence SMSs, USSD content delivery and content delivery via MXit. Challenges around measuring impact in behaviour change communications are briefly discussed, and some of Cell-Life’s upcoming initiatives are outlined.
Mobile Technology for Community Health (MOTECH) Ghana data sheet 4572 Views
MOTECH in Ghana has developed two interrelated mobile health services:
“Mobile Midwife” application: This service enables pregnant women and their families to receive SMS or voice messages that provide time-specific information about their pregnancy each week in their own language. This information is a mixture of: Alerts and reminders for care seeking (e.g., reminders to go for specific treatments, such as prenatal care or a tetanus vaccination). Actionable information and advice to help deal with challenges during pregnancy (e.g., tips for saving money for transportation to deliver at a health facility, what is needed for a birthing kit, nutrition information). Educational information, including milestones in fetal development, promotion of good health practices, and songs about breastfeeding. Voice messages are delivered in English or local languages. Two languages of the Upper East Region, Kasem and Nakam, were supported for MOTECH’s first implementation, and two languages of central region, Senya and Fante, will be supported in Awutu Senya. SMS messages are all delivered in English.
Mobile Africa Report 2011: Regional Hubs of Excellence and Innovation data sheet 2791 Views
Author:
Rao, Madanmohan
Publication Date:
Mar 2011
Publication Type:
Report/White paper
Abstract:
According to industry estimates, there are more than 500 million mobile phone subscribers in Africa now, up from 246 million in 2008. In 2000, the number of mobile phones first exceeded that of fixed telephones. Africans can accelerate development by skipping less efficient technologies and moving directly to more advanced ones.
The telecommunications sector continues to attract a flurry of public and private investment from foreign sources and local banks, but the investment should be in software and services, not just cabling infrastructure.
Using mobiles for data collection is increasingly common, particularly in the area of mobile health and with a focus on community health workers. eMOCHA is a program using a smartphone Android application for storing and transmitting data easily.
Developed by the Johns Hopkins Center for Clinical Global Health Education, eMOCHA (which stands for “Electronic Mobile Open-source Comprehensive Health Application”) uses video, audio, touchscreen quizzes, GPS and SMS to collect and analyze large amounts of data. Larry William Chang, director of field evaluations for eMOCHA, explains in an interview with MobileActive.org that the inspiration for developing the tool came out of researchers’ experiences in the field and their desire to build solutions to gaps in health care data collection systems.
Fellow team members include Miquel Sitjar, lead developer for eMOCHA, and Robert Bollinger, director of the Johns Hopkins Center for Clinical Global Health Education. Chang says, “We all had these public health problems and these education and training problems that we were looking to solve, and we wanted to build a mobile-based platform that could address all the different challenges we were facing. So we designed eMOCHA to address some of the public health and patient care problems that we were seeing with our other work.” eMOCHA’s first deployment began in October of 2010, and new pilots have been announced for 2011.
Mobile Phones for Health Education in the Developing World: SMS as a User Interface data sheet 4002 Views
Author:
Catalina M. Danis, Jason B. Ellis, Wendy A. Kellogg, Hajo van Beijma, Bas Hoefman, Steven D. Daniels, Jan-Willem Loggers
ISSN/ISBN Number:
2147483647
Publication Date:
Jan 2011
Publication Type:
Journal article
Abstract:
Uganda suffers from a severe shortage of professional healthcare workers. Thus, programs aimed at prevention of disease are an important complement to the limited healthcare delivery system.
We analyze two deployments of an SMS-based HIV/AIDS education system that uses a quiz format to assess people’s knowledge of the disease, including its causes and methods of prevention. The deployments were to two groups in Uganda, one a sample of mobile phone users who live in a town in northwest Uganda; the other, workers at three factories in central and southeastern Uganda. The two samples had accuracy rates above chance levels and workers at the three factories had higher rates of participation (more individuals and more questions) than the sample selected from the cell tower service area. An analysis of incorrect answers suggested that while participants had some difficulty in matching the formatting required by the quiz, literacy did not appear to be a significant problem.
We discuss the results in terms of implications for using SMS as a user interface mechanism and explore the possibility of using social ties among participants as a way to promote the scalability and sustainability of this quiz-based education method.
Up Close and Personal with TulaSalud's m-Health work in Guatemala data sheet 3998 Views
Mohini Bhavsar was a summer 2010 research intern at MobileActive.org. Shortly after, she volunteered with TulaSalud in Guatemala to observe what it takes to implement and scale a mobile health program.
Innovation in mobile health is not quite as widespread in Latin America as it is in Africa and Asia. Of the m-health programs in Latin America, little sharing of region-specific strategies has taken place.
TulaSalud is an organization based in Guatemala that is leveraging ICT -- specifically mobile phones -- to improve the delivery of health care services for indigenous communities. Through this case study, we hope to share some of what TulaSalud has learned over the years.
TulaSalud partners with the Ministry of Health and the Cobán School of Nursing and receives support from the Tula Foundation based in Canada. The organization's vision is to use ICT and mobile technology to reduce maternal and infant mortality and to monitor disease outbreaks in the remote highlands of Alta Verapaz. Using mobile phones, TulaSalud has been able to improve the flow of information between health professionals based in hospitals and community health workers (CHWs) in remote villages.
Alta Verapaz has the largest rural and poor indigenous population in the region with limited access to health care services. In an area with one million inhabitants, 93% are indigenous and share the highest burden of maternal mortality.
TulaSalud's community health workers, known as tele-facilitadores, use mobile phones to:
Adherence reminders, patient data transmission via community health workers, HIV/AIDs info services – mobile phones can be used in a variety of health settings. As mobiles have become cheaper and more easily available around the world, mobile health projects have followed, taking advantage of the devices’ data storage capabilities, information transferring potential, and social networking features.
MobileActive has covered the m-health area extensively as NGOs, aid organizations, and governments continue to launch new projects incorporating ICTs into their work. Organizations like the Praekelt Foundation, which runs multiple mobile health projects, Pesinet, a micro-insurance and community health worker data collection tool, Dimagi, which developed CommCare (a project that helps community health workers promote healthy behaviors in patients), and MoTeCH, a Grameen Foundation project that uses mobiles to send medical advice to pregnant women and young parents along with creating a data managing resource for community health workers, are exploring the potential that mobile technology offers for delivering health care.
Looking at some of these organizations’ experiences, we put together a list of key lessons organizations are learning as they develop m-health projects:
Amplifying the Impact: Examining the Intersection of Mobile Health and Mobile Finance data sheet 2042 Views
Author:
Gencer, Menekse
Publication Date:
Jan 2011
Publication Type:
Report/White paper
Abstract:
Both mHealth and MFS (Mobile Financial Services) are nascent industries and fragmented along multiple dimensions. The aim of this paper is to help reduce some of these uncertainties and reinforce dialogue on how the mobile communications platform can be leveraged to strengthen mutually positive outcomes related to both financial inclusion and health. With user-centric solutions that leverage common technologies, new efficiencies and capabilities can be created that serve to accelerate global scale.
Unlocking this potential will require the following questions to be addressed: 1. What will be the best method to drive awareness and adoption of the self-reinforcing dynamics of “wealth and health”? Who will lead these efforts? 2. How will the integration and interoperability of disparate technologies across multiple industry and public sector domains occur? 3. Who will build and manage the common infrastructure and distribution networks? 4. How will the various points of policy coordination work across sector domains?
In Jordan, a new program called SOHITCOM (Social Health and IT for Rural Communities) uses mobile phones and web-based technology to improve access to maternal and early childhood healthcare information.
Developed by the Royal Scientific Society of Jordan in a partnership with Canadian funder IDRC, SOHITCOM is part of a larger program promoting and developing ICT4D in the Middle East. A two-part project, SOHITCOM is both a vaccination adherence service and a health information portal for rural Jordanians.
What can we expect to see on the technical front in m-health and m-for-development in 2011? Unleashing the inner geek in all of us, guest contributor Matt Berg has some predictions. This post originally appeared on his blog BuildAfrica.org. It is reposted here with permission.
Mobile phones are being tried and tested in myriad ways in health care. They are used for data collection and disease surveillance, for ensuring treatment compliance, for managing health information systems and point-of-care support, for health promotion and disease prevention, and for delivering emergency medical services. Clearly, m-health, as this growing field is dubbed, is here to stay.
At the same time, achieving scale and sustainability in most m-health projects has been a challenge. One of the key aspects of beginning to think about ways to integrate m-health into health systems in a sustainable way is to establish financial systems to pay for health services and to ensure financial accountability within programs.
The Vodafone Americas Foundation and the mHealth Alliance are announcing a call for entries for the annual Vodafone Americas Foundation Wireless Innovation Project mHealth Alliance Award, a competition to identify and support promising wireless-related technologies to address critical social issues around the globe. Proposals will be accepted from September 27, 2010 through December 15, 2010, with the final winners announced in April 2011.
Tanzania MOH and donors introduced reporting requirements for PMTCT (preventing mother-to-child transmission of HIV/AIDS) facilities to submit monthly reports to the district and regional levels for progam monitoring and decision making. Futures Group is responsible for collecting reports from PMTCT facilities across four regions. Sites are remote and there is no Internet, and no computers.
To meet the technical and budgetary challenges we developed IQSMS, an open source, freely available SMS reporting tool monitoring and evaluation data collection, to enable facilites to report on PMTCT indicators. IQSMS is used to track program activities at PMTCT sites in rural Tanzania using basic SMS mobile phone technology.
IQSMS is a freely available, software using SMS data in a predetermined format. Information is sent to a dedicated central laptop connected to Motorola mobile phones. The IQSMS software aggregates incoming SMS reports into an SQL database. Automated data quality checks, business rules and immediate notifications are sent to users ensuring that only validated data is added to the database. Aggregated PMTCT data is instantly available to district, regional and national managers based on role views.
FINALIST AND HONORABLE MENTION IN STOCKHOM CHALLENGE AWARD 2010
International Quality Short Message Services focus on development and implementation of a software technology that uses mobile phone to report data to a dedicated centralized computer. This will help coordinating medical care in various part of Tanzania. It is a project with great impact and potential for transferability particularly as the costs of telecom tend to decline with volume. It is a case of e-health, more clearly mobile e-health. International Quality Short Message Services makes health services available. a service which must be recognized. Congratulations.
Tool Category:
Resides and runs on a computer with tethered modem or mobile phone
Key Features :
The software uses SMS data in a predetermined format, sent to a dedicated central laptop connected to a Motorola mobile phone. The IQSMS software records incoming SMS reports into an SQL database. Automated data quality checks, business rules and immediate notifications are sent to users ensuring that only validated data is added to database. Aggregated PMTCT data is instantly available to district, regional and national managers based on role views.
IQSMS has reduced the time and costs associate with traveling to 535 facilities for data reporting, eliminated need to aggregate paper reports, reduced the need for expensive equipment, improved compliance in monthly reporting and has inspired confidence by rural healthcare workers that their results were accurately reported.
For the period from Jan –Dec 2009, 9867 total reports were submitted and 9400 reports were successfully validated. As the project takes advantage of mobile phones already owned by health workers, the training requirements are relatively low.
Main Services:
Information Resources/Information Databases
Tool Maturity:
Currently deployed
Release Date:
2009-12
Platforms:
All phones -- SMS
Current Version:
1.3
Program/Code Language:
C/C++
Organizations Using the Tool:
PMTCT facilities providing services to all mothers, fathers and children to infected or affected by HIV/AIDS. The plan is to scale up to include more PMTCT sites supported by AIDSRelief, the NGO we work with. The IQSMs has been demonstrated to the Ministry of Health and Social Welfare and we are thinking of introducing the system to other regions not supported by AIDSRelief.
Mobile Direct Observation Treatment for Tuberculosis Patients data sheet 2918 Views
Author:
Jeffrey A. Hoffman, Janice R. Cunningham, Andrew J.Suleh, Aaron Sundsmo, Debra Dekker, Fred Vago, Kelly Munly, Emmy Kageha Igonya, Jonathan Hunt-Glassman
Publication Date:
Jul 2010
Publication Type:
Journal article
Abstract:
Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.
This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.
Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009
All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.
MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.
Mobile Phone Interventions for Reproductive Health (m4RH): Testing the Feasibility of Text Messaging to Improve Family Planning data sheet 3086 Views
Author:
Kelly L’Engle and Heather Vadhat
Publication Date:
Jul 2009
Publication Type:
Report/White paper
Abstract:
Mobile phones are currently used by millions of people around the world. In Africa, mobile phone ownership and use has dispersed at a surprisingly rapid rate across the continent. Recently, there have been multiple and diverse efforts to exploit mobile technologies for purposes of health communication, including collection of health data and provision of health information. Using mobile phones to provide family planning information, however, is a new area that has received almost no attention from health workers.
Recognizing this as a gap and an opportunity, the Mobile for Reproductive Health (m4RH) project was born. The m4RH project is conceptualized as an automated, text-based system that is compatible with any and every mobile phone to maximize reach and access to family planning information via mobile phone. Since this is a new project and mobile phones are a novel method of delivering family planning information, formative research to obtain feedback on the project was carried out in countries where the m4RH project will be piloted in 2010.
The Mobile Minute is back with the latest mobile news. McKesson Foundation's president is interviewed about its $1.5 million grant for m-health research, Zimbabwe begins to roll out per-second mobile billing, NTEN shows non-profits in the United States seven ways to incorporate mobile donations, Apple publishes its guidelines for submissions to the app store, and Twitter releases new figures about their mobile access numbers.
Sana Mobile: Connecting Big-City Care to Patients in Remote Villages data sheet 6810 Views
Decision making support for nurses and health workers, even when connectivity is poor or low, is possible with Sana Mobile, an Android-based mobile health application. Formerly known as Moca Mobile, the Sana technology facilitates remote consultations between health care specialists and community health workers in remote areas.
Sana Mobile started at MIT's NextLab, where developers, faculty and students collaborate to tackle a problem using mobile technology. The Sana technology was developed by Sidhant Jena, Sana team lead and Harvard Business School student and Russell Ryan, lead engineer and MIT student.
When general practitioners lack the expertise to diagnose a case, they refer patients to specialists, who may not be easily accessible. The Sana technology addresses the lack of accessibility to specialty care in places, where specialist doctors and tertiary care centers are sparse.
The MHIF System Supporting the Health Impact Fund with Mobile Technology data sheet 884 Views
Author:
Juggs Ravalia and Lennart Stern
Publication Date:
Jan 2010
Publication Type:
Other
Abstract:
The Health Impact Fund (HIF) is a proposal designed to incentivize pharmaceutical innovation by rewarding the development of new medicines in proportion to their health impact. The health care sector is plagued by wastage and poor governance, especially in developing countries. The MHIF system is a mobile payment and data collection system designed to enhance transparency and accountability, whilst improving the quality of data available for impact assessment. It also provides a platform for reporting misuse and abuse. The system is designed to mitigate some of the deployment challenges of the HIF and to act as a springboard for further expansion into broader mobile health (MHealth) solutions.
Responding to the Human Resource Crisis: Peer Health Workers, Mobile Phones, and HIV Care in Rakai, Uganda data sheet 2201 Views
Author:
Chang, L.W. et al.
Publication Date:
Jan 2008
Publication Type:
Journal article
Abstract:
Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations.
We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.
The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.
Building an SMS Network into a Rural Healthcare System data sheet 2529 Views
Author:
Joshua Nesbit
Publication Date:
Jan 2010
Publication Type:
Other
Abstract:
This guide provides an inexpensive way to create an SMS communications network to enable healthcare field workers as they serve communities and their patients. The steps are purposefully simple – the system is easy to set up, use and maintain.
Answers to Frequently Asked Questions:
1. Who might benefit from a text-based communications network? 2. What are the benefits for my hospital, clinic or organization and the people it serves? 3. What technology do I need? 4. Do I need an internet connection? 5. How expensive is an SMS network? 6. How do I distribute communication credit? 7. How much staff training is required? 8. How much time does it take, per day, to manage the SMS network? 9. How do I conduct SMS training? 10. What is the best power source for the cell phones? 11. Do the CHWs communicate with each other? 12. Where can I find more information on FrontlineSMS?
Today's Mobile Minute brings you news on the state of the mobile web, California's plan to be the first state with a mass mobile alert system, Cisco's (rumored) move to buy Skype, a guide to installing PercentMobile on different platforms, and results from a study on the effects of SMS reminders for taking birth control pills.
Participant and Interviewer Attitudes toward Handheld Computers in the Context of HIV/AIDS Programs in Sub- Saharan Africa data sheet 2119 Views
Author:
Karen G. Cheng, Francisco Ernesto and Khai N. Truong
Publication Date:
Apr 2008
Publication Type:
Journal article
Abstract:
Handheld computers have untapped potential to improve HIV/AIDS programs in sub-Saharan Africa, particularly in the collection of survey data. We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior.
Participants were asked about their HIV/AIDSrelated knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition. These results suggest that using handheld computers in data collection in sub-Saharan Africa may lead to biased reports of HIV/AIDS-related risk behaviors.
