Abstract
BackgroundThe incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. This paper discusses the development and pilot testing of SMARTHealth, a mobile-based, point-of-care Clinical Decision Support (CDS) tool to assess and manage cardiovascular disease (CVD) risk in resource-constrained settings. Through pilot testing, the preliminary acceptability, utility, and efficiency of the CDS tool was obtained.MethodsThe CDS tool was part of an mHealth system comprising a mobile application that consisted of an evidence-based risk prediction and management algorithm, and a server-side electronic medical record system. Through an agile development process and user-centred design approach, key features of the mobile application that fitted the requirements of the end users and environment were obtained. A comprehensive analytics framework facilitated a data-driven approach to investigate four areas, namely, system efficiency, end-user variability, manual data entry errors, and usefulness of point-of-care management recommendations to the healthcare worker. A four-point Likert scale was used at the end of every risk assessment to gauge ease-of-use of the system.ResultsThe system was field-tested with eleven village healthcare workers and three Primary Health Centre doctors, who screened a total of 292 adults aged 40 years and above. 34% of participants screened by health workers were identified by the CDS tool to be high CVD risk and referred to a doctor. In-depth analysis of user interactions found the CDS tool feasible for use and easily integrable into the workflow of healthcare workers. Following completion of the pilot, further technical enhancements were implemented to improve uptake of the mHealth platform. It will then be evaluated for effectiveness and cost-effectiveness in a cluster randomized controlled trial involving 54 southern Indian villages and over 16000 individuals at high CVD risk.ConclusionsAn evidence-based CVD risk prediction and management tool was used to develop an mHealth platform in rural India for CVD screening and management with proper engagement of health care providers and local communities. With over a third of screened participants being high risk, there is a need to demonstrate the clinical impact of the mHealth platform so that it could contribute to improved CVD detection in high risk low resource settings.
Highlights
The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions
One of the key features in this framework was the creation of the Accredited Social Healthcare Activists (ASHAs) per 1000 population, who are female healthcare workers acting as an interface between the people in rural areas and their public health centre
Physicians used the mobile application, the results presented in this paper focuses entirely on usage by the ASHAs
Summary
The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. Diseases that may affect the heart, arteries and circulation of the blood are collectively referred to as Cardiovascular disease (CVD) This can include ailments such as stroke, coronary heart disease, atherosclerosis, or peripheral arterial disease [1] and account for the majority of deaths worldwide according to the World Health Organization (WHO) [2]. The existing physician-centric, western style care is unsustainable in these regions and there is a need for more innovative solutions One such solution is to expand the capacity of the existing healthcare workers and provide them with appropriate tools to manage CVD [7]. One of the key features in this framework was the creation of the Accredited Social Healthcare Activists (ASHAs) per 1000 population, who are female healthcare workers acting as an interface between the people in rural areas and their public health centre
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