mHealth Initiative Research Articles

Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study.

BackgroundThe effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings.ObjectiveTo better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program.MethodsA mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior.ResultsAmong the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors.ConclusionsOur study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change.

Development and validation of a mobile health communication framework for postnatal care in rural Kenya

BackgroundA need exists for a theory-based framework that is useful to strengthen postnatal care. Though mHealth communication is proposed to support health care, there is no framework for postnatal care. This paper describes development and validation of an mHealth communication framework for postnatal care in rural Kenya. MethodsThe framework was developed through a multi-methods research design, underpinned by the theory of change logic model. Prior to framework development, two separate studies, were carried out, in addition to a literature review. The framework was developed in two stages. In the first stage, theory of change logic model was used to integrate the results of the first two studies and the literature review, to develop a draft framework. In the second stage, stakeholders’ input was integrated into the draft framework, thereby validating the final mHealth communication framework. ResultsAn mHealth communication framework was developed articulating the elements needed for planning and designing an mHealth communication initiative in rural areas, to strengthen postnatal care. The elements consisted of the problem to be addressed, community needs, desired results, influential factors, strategies, and assumptions. ConclusionBy using the theory of change logic model, various elements were linked to demonstrate how an mHealth communication framework can work to strengthen postnatal care in rural Kenya. The framework incorporated the best available evidence, the community’s needs, and stakeholders’ input, therefore, the authors recommend implementing the framework to support the desired outcomes and contribute to lowering maternal and neonatal mortalities, especially in rural areas.

Knowledge, Attitudes, Behaviors of Women Related to Pregnancy, and Early Childhood Caries Prevention: A Cross-Sectional Pilot Study.

ObjectiveHealth education interventions during pregnancy can influence maternal oral health (OH), maternal OH-behaviors and children’s OH. Interventions that can be delivered at anytime and anywhere, for example mobile-health (mHealth) provides an opportunity to address challenges of health education and support activation of women in underserved and rural communities to modify their health behavior. This pilot study was undertaken as a part of a mHealth initiative to determine knowledge, attitudes, and behaviors related to pregnancy and ECC prevention among women attending obstetrics/gynecology (OB/GYN) practices at a large rurally-based clinic.MethodsA cross-sectional survey study was voluntarily engaged by women (n = 191) aged 18 to 59 years attending OB/GYN visits, over a 3-week period from 12/2019 to 1/2020. Survey results were analyzed applying descriptive statistics, X2 and Fisher’s Exact tests. The significance level was set at P < .0001 for all analyses.ResultsApproximately half of respondents were between 18 and 29 years (53%), had a college degree (55%), and 100% reported cell phone use. Whereas 53% and 31%, respectively, indicated that they were “somewhat” or “very” sure of how to prevent ECC in their children, only 9% recognized evidence of early decay and 30% did not know the purpose of fluoride. Overall, only 27% of participants correctly answered the knowledge-based questions. Further, only 57% reported their provider explained things in a way that was easy to understand. Only 24% reported seeing a dentist during their current pregnancy.ConclusionsStudy results suggested potential gaps in knowledge and behaviors related to ECC prevention and provided baseline data to inform future interventions to improve ECC prevention practices. Notably, majority of participants used their cell phones for making medical/dental appointments and reported using their phones to look up health-related information. This demographic represents a potentially receptive target for mHealth approaches to improve understanding of oral health maintenance during pregnancy and ECC prevention.

EFFECTIVENESS OF HEALTH EDUCATION MODULE DELIVERED THROUGH WHATSAPP TO ENHANCE TREATMENT ADHERENCE AND SUCCESSFUL OUTCOME OF TUBERCULOSIS IN SEREMBAN DISTRICT, NEGERI SEMBILAN, MALAYSIA

Introduction: Health education and awareness program have shown to be the factor that promote adherence behaviour and successful outcome of tuberculosis (TB). Mobile health (mHealth) initiative that utilize WhatsApp may help in achieving health objectives. Aims: This study aimed to determine the effectiveness of Health Education Module named TB@Clicks delivered through WhatsApp to enhance treatment adherence and successful outcome among pulmonary tuberculosis (PTB) patients. Methodology: A randomized controlled trial was done among all newly diagnosed TB cases registered in Seremban District between 1st of July 2017 until 9th of April 2018. The patients who fulfils the eligibility criteria were systematically selected and randomly assigned to receive TB@Clicks module through WhatsApp or continue with the existing conventional health education. The respondents were followed-up until treatment was completed. The estimated total sample size was 110. Adherence rate and treatment outcome were gathered from the record book in Health Clinics. Multivariate statistical analysis was conducted to determine the effectiveness of intervention on both outcomes. Result: A total of 110 PTB patients were recruited and 93 patients retained in the study (84.5%). Among them, 50 (90.9%) was from intervention group and 43 (78.2%) was from control group. There were 81.8% of respondents who received intervention adhered to TB treatment and 85.5% has the successful treatment outcome as compared to only 69.1% adherence and 70.9% with treatment success in control group but both were not statistically significant (p=0.121 & p=0.065). In multivariate analyses performed using generalized linear mixed models, PTB patients who had received intervention was 4.1 (95% CI = 1.16-14.87) times as likely to had successful treatment outcome as patients who had not received intervention. Conclusion: The TB@Clicks intervention module delivered through WhatsApp was effectively enhanced the treatment success rate but no significant effects on the adherence rate among PTB patients. Keywords: Pulmonary tuberculosis, mHealth, medication adherence

Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol

IntroductionTimely antenatal care (ANC) and postnatal care (PNC) attendance decrease maternal and child mortality by improving maternal and child health (MCH) outcomes. Mobile health or mHealth has been identified as...

Harnessing mHealth to improve the diabetes screening and diagnosis rate in rural Indian settings: a learning from health systems initiative

Background: Diabetes forms huge burden of non-communicable diseases that is affecting health care systems in India. India has large number undiagnosed and undetected cases. mHealth initiatives are cost effective, quick and less resource intensive technology assisted initiatives which help to strengthen the health system. High mobile penetration and availability of cheap and high-speed data network across India has been conducive to implement mHealth initiatives in Indian health system. We present our experience in using mHealth initiative to improve the diabetes screening and diagnosis in rural Indian settings.Methods: The study is a descriptive analysis of all the tasks undertaken as part of “Disease free Village” Initiative of our organization. The study data is operational data from our organizational health information management systems. The study is divided into three phase. Phase 1, was dedicated to enrolling entire village population using android smartphone and ODK collect application; phase 2 used clinical decision support system for screening of high risk individuals and phase 3 used traditional door to door campaign to motivating the high risk individuals to get their fast and post prandial blood glucose levels checked at health care facility.Results: Phase 1 was to set a baseline, with 3624 base population, 2651 was target adult population. Rapid screening in phase 2, screened 2204 (83.14%). Out of 2204 screened cases 1307 were high risk cases. 1307 high risk cases were followed in Phase 3, and blood glucose screening was carried out 1156 (88.44%) high and moderate risk individuals out of 1307 (100%).Conclusions: We concluded that the mHealth initiatives for screening and diagnosis of diabetes in rural India, combined with traditional techniques could help to improve screening and diagnosis rate and help to reduce the hidden burden of disease.

Mobile Technology for Community Health in Ghana: Is Maternal Messaging and Provider Use of Technology Cost-Effective in Improving Maternal and Child Health Outcomes at Scale?

BackgroundMobile technologies are emerging as tools to enhance health service delivery systems and empower clients to improve maternal, newborn, and child health. Limited evidence exists on the value for money of mobile health (mHealth) programs in low- and middle-income countries.ObjectiveThis study aims to forecast the incremental cost-effectiveness of the Mobile Technology for Community Health (MOTECH) initiative at scale across 170 districts in Ghana.MethodsMOTECH’s “Client Data Application” allows frontline health workers to digitize service delivery information and track the care of patients. MOTECH’s other main component, the “Mobile Midwife,” sends automated educational voice messages to mobile phones of pregnant and postpartum women. We measured program costs and consequences of scaling up MOTECH over a 10-year analytic time horizon. Economic costs were estimated from informant interviews and financial records. Health effects were modeled using the Lives Saved Tool with data from an independent evaluation of changes in key services coverage observed in Gomoa West District. Incremental cost-effectiveness ratios were presented overall and for each year of implementation. Uncertainty analyses assessed the robustness of results to changes in key parameters.ResultsMOTECH was scaled in clusters over a 3-year period to reach 78.7% (170/216) of Ghana’s districts. Sustaining the program would cost US $17,618 on average annually per district. Over 10 years, MOTECH could potentially save an estimated 59,906 lives at a total cost of US $32 million. The incremental cost per disability-adjusted life year averted ranged from US $174 in the first year to US $6.54 in the tenth year of implementation and US $20.94 (95% CI US $20.34-$21.55) over 10 years. Uncertainty analyses suggested that the incremental cost-effectiveness ratio was most sensitive to changes in health effects, followed by personnel time. Probabilistic sensitivity analyses suggested that MOTECH had a 100% probability of being cost-effective above a willingness-to-pay threshold of US $50.ConclusionsThis is the first study to estimate the value for money of the supply- and demand-side of an mHealth initiative. The adoption of MOTECH to improve MNCH service delivery and uptake represents good value for money in Ghana and should be considered for expansion. Integration with other mHealth solutions, including e-Tracker, may provide opportunities to continue or combine beneficial components of MOTECH to achieve a greater impact on health.

Exploring the functional dynamics of innovation for inclusive development innovation systems: a case study of a large scale maternal mHealth project in South Africa

ABSTRACTIn the developing country healthcare context, inequalities often exist due to systematic exclusions through poverty, unemployment, poor infrastructure and lack of access. This article reflects on the use of an Innovation for Inclusive Development Systems approach within a healthcare context to systematically (i) evaluate the dynamic factors that drive inclusion and exclusion in healthcare innovation systems; and (ii) support policymakers to arrive at interventions that may lead to more inclusively orientated healthcare projects. The study inductively develops a set of exploratory questions for considering the functions of Innovation for Inclusive Development Systems. The framework is inductively developed from the MomConnect project in South Africa (a maternal mHealth initiative). The authors conclude that the developed exploratory questions provide guidance for similar projects in the future to be more inclusive, particularly so in the complex field of healthcare where a systems perspective towards inclusive healthcare is required.

The potential scope of m-health initiative into Grameen renewable energy in Bangladesh

Sustainability or sustainable development is possible only if health issues of mother and their child and the employment or involvement of women can be ensured in society by promoting social business using the easiest technological system like mobile technology. In this paper, we demonstrate how Grameen Shakti (GS) a not-for-profit organization aiming at sustainable development by ensuring environment and technological friendly social business model. Household energy usage, air pollution, and carbon emission can be controlled by Grameen Shakti (GS) which energy saving, convenient, user friendly and cheap. The paper presents an illustration of how carbon emission, air pollution, and ensuring safe and healthy environment for mother and children are all possible through integrating mobile health (m-Health) management which is a part of sustainable development.

Mapping mHealth (mobile health) and mobile penetrations in sub-Saharan Africa for strategic regional collaboration in mHealth scale-up: an application of exploratory spatial data analysis

BackgroundMobile health (mHealth), a term used for healthcare delivery via mobile devices, has gained attention as an innovative technology for better access to healthcare and support for performance of health workers in the global health context. Despite large expansion of mHealth across sub-Saharan Africa, regional collaboration for scale-up has not made progress since last decade.MethodsAs a groundwork for strategic planning for regional collaboration, the study attempted to identify spatial patterns of mHealth implementation in sub-Saharan Africa using an exploratory spatial data analysis. In order to obtain comprehensive data on the total number of mHelath programs implemented between 2006 and 2016 in each of the 48 sub-Saharan Africa countries, we performed a systematic data collection from various sources, including: the WHO eHealth Database, the World Bank Projects & Operations Database, and the USAID mHealth Database. Additional spatial analysis was performed for mobile cellular subscriptions per 100 people to suggest strategic regional collaboration for improving mobile penetration rates along with the mHealth initiative. Global Moran’s I and Local Indicator of Spatial Association (LISA) were calculated for mHealth programs and mobile subscriptions per 100 population to investigate spatial autocorrelation, which indicates the presence of local clustering and spatial disparities.ResultsFrom our systematic data collection, the total number of mHealth programs implemented in sub-Saharan Africa between 2006 and 2016 was 487 (same programs implemented in multiple countries were counted separately). Of these, the eastern region with 17 countries and the western region with 16 countries had 287 and 145 mHealth programs, respectively. Despite low levels of global autocorrelation, LISA enabled us to detect meaningful local clusters. Overall, the eastern part of sub-Saharan Africa shows high-high association for mHealth programs. As for mobile subscription rates per 100 population, the northern area shows extensive low-low association.ConclusionsThis study aimed to shed some light on the potential for strategic regional collaboration for scale-up of mHealth and mobile penetration. Firstly, countries in the eastern area with much experience can take the lead role in pursuing regional collaboration for mHealth programs in sub-Saharan Africa. Secondly, collective effort in improving mobile penetration rates for the northern area is recommended.

Health information system strengthening and malaria elimination in Papua New Guinea

BackgroundThe objective of the study was to describe an m-health initiative to strengthen malaria surveillance in a 184-health facility, multi-province, project aimed at strengthening the National Health Information System (NHIS) in a country with fragmented malaria surveillance, striving towards enhanced control, pre-elimination.MethodsA remote-loading mobile application and secure online platform for health professionals was created to interface with the new system (eNHIS). A case-based malaria testing register was developed and integrated geo-coded households, villages and health facilities. A malaria programme management dashboard was created, with village-level malaria mapping tools, and statistical algorithms to identify malaria outbreaks.ResultsSince its inception in 2015, 160,750 malaria testing records, including village of residence, have been reported to the eNHIS. These case-based, geo-coded malaria data are 100% complete, with a median data entry delay of 9 days from the date of testing. The system maps malaria to the village level in near real-time as well as the availability of treatment and diagnostics to health facility level. Data aggregation, analysis, outbreak detection, and reporting are automated.ConclusionsThe study demonstrates that using mobile technologies and GIS in the capture and reporting of NHIS data in Papua New Guinea provides timely, high quality, geo-coded, case-based malaria data required for malaria elimination. The health systems strengthening approach of integrating malaria information management into the eNHIS optimizes sustainability and provides enormous flexibility to cater for future malaria programme needs.

The MomConnect mHealth initiative in South Africa: Early impact on the supply side of MCH services.

MomConnect is an mHealth initiative giving pregnant women information via SMS. We report on an analysis of the compliments and especially complaints component of the feedback. We scrutinised the electronic databases containing information on the first seventeen months of operation of MomConnect. During this time, 583,929 pregnant women were registered on MomConnect, representing approximately 46per cent of pregnant women booking their pregnancy in the public sector in South Africa. These women gave feedback on services received: 4173 compliments and 690 complaints. Nearly three quarters (74per cent) of all complaints were resolved. The complaints were classified into those related to health services (29per cent), staff (22per cent), health systems (42per cent) and other (6per cent). These complaints were fed back to managers in the health facilities. This has resulted in improvements in the quality of services, e.g. decreased drug stock-outs and change of behaviour of some health workers.

The Top Chinese Mobile Health Apps: A Systematic Investigation.

BackgroundChina’s mHealth market is on track to become a global leader by industry size. The Chinese mobile app market and health care system have peculiarities that distinguish them from other app markets. To date, Chinese mHealth apps have not been systematically investigated.ObjectiveThe objective of this study was to provide an overview of Chinese mHealth apps as of December 2015.MethodsWe identified and investigated the most downloaded apps from the iOS and Android platforms. For each app, we analyzed and recorded its main service offered, mHealth initiative, disease and specialty focus, app cost, target user, Web app availability, and emphasis on information security. Standard descriptive statistics were used.ResultsA total of 234 apps met the inclusion criteria and were investigated. The apps targeting nonhealth care professionals focused on providing telemedicine and appointment-making services. The apps targeting health care professionals focused on education and peer reviewed articles. The most common disease-specific apps focused primarily on diabetes, hypertension, and hepatitis management. Most apps were free and available on both iOS and Android platforms.ConclusionsThe primary mHealth initiatives targeted by the apps reflect Chinese patients’ demand for access to medical care. Disease-specific apps are also representative of disease prevalence in China. Government press releases suggest that new policies on the horizon may shift the industry.

Mobile-based effective vaccine management tool: An m-health initiative implemented by UNICEF in Bihar.

UNICEF launched the mobile-based Effective Vaccine Management (EVM) system in Bihar in 2014 along with the state government to electronically capture information and identify gaps in the existing vaccine management system for appropriate action. This study accessed the implementation process of this initiative. Quantitative data related to vaccine supply chain management indicators were collected in November-December 2015 using factsheets and dashboards, representing the situation of the vaccine supply and cold chain management system at regular intervals since the launch. In-depth interviews were conducted with the program specialists to understand the initiative's genesis, its challenges and strengths. This initiative resulted in an increased cold chain space from 49% (July 2014) to 87% (September 2015), deployment of sufficient human resource; 38 cold chain technicians for regular maintenance of the machines and equipment, installation of necessary equipment, and upgradation of state and regional vaccine stores. In health facilities, district vaccine stores, and regional vaccine stores, marked improvements were observed in the overall EVM criteria indicators (82%, 84%, and 80% in September 2015, respectively, as against 51%, 46%, and 43% in July 2014, respectively) as well as EVM category indicators (83%, 84%, and 76% in September 2015, respectively, as compared to 54%, 53%, and 54% in July 2014, respectively). The EVM mobile initiative was successfully implemented and it complies with its objective of providing experienced guidance to the human resource responsible for vaccine cold chain management. The initiative is scalable and its sustainability depends on its thoughtful merger with the existing immunization ecosystem.

TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala

Summary The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q’eqchí and/or Poqomchi’ languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas).

Stakeholder Management in a Community mHealth Initiative in Malawi

Background and Purpose: Varying interests and expectations of different stakeholders have implications on successful implementation of Information and Communication Technologies for Health (ICT4H) interventions. Research has shown that proper management of stakeholders’ interests has a positive bearing on the effectiveness and sustainability of Information and Communication Technologies for Development (ICT4D) initiatives. However, there is a dearth of studies on stakeholder management in ICT4H research, especially the mobile for health (mHealth) domain. This could be due to the mHealth field still being in its infancy and many projects being implemented for a short period without being evaluated. This paper reports on management of stakeholders in an mHealth intervention from the community perspective. The study examined how management of stakeholders from the community affected the effectiveness and sustainability of the mHealth intervention. Methods: The case of a Mobile System for Safe Motherhood intervention in maternal health in a developing country context was analysed. The study employed an interpretive approach using qualitative methods. Documentary review and semi-structured interviews were used to collect data, and the data was analysed using content analysis. Results: Different expectations of mothers and other community agents were not given adequate voice and attention in reaching the common good towards achieving the main objectives of the intervention. Stakeholder management from the community perspective was inadequate due to: 1) less consultation of key community stakeholders in some stages of the project; 2) poor communication; 3) lack of formal procedures in operations; and 4) exclusion of tradition information systems. Conclusions : Management procedures such as face to face meetings, training, effective communication using formal channels, and community empowerment would help in building winning coalitions that improve performance of interventions and enhance effectiveness and sustainability. Keywords: mHealth, Community involvement, Stakeholder management

Role of Mobile Phone in Health Worker's Work Routine

India has recently experienced exponential growth in its telecommunications industry, reaching rural areas to a significant extent in the form of mobile phone. This study was undertaken to understand Female Health Worker's workload, their work flow, how they presently handle their work flow, and what support can the m-Health product offer to improve the efficiency of their work-flows. This study, carried out in 6 Primary Health Centers in Mysore district, confirmed the near universal availability and use of mobile phones by all health workers and a majority of their clients, providing further support to the proposed mHealth initiative that will be attempting to exploit the mobile phone technology to the fullest extent, going beyond calling and receiving calls, to make the health workers more productive and improving the quality of services they provide.

Research challenges in measuring data for population health to enable predictive modeling for improving healthcare

At the core of the healthcare crisis is a fundamental lack of actionable data, needed to stratify individuals within populations, to predict which persons have which outcomes. A new health system with better health management will require better health measurement, to improve cost and quality. It is now possible to use new technologies to provide the rich datasets necessary for adequate health measurement, which enables new information systems for new health systems. This report is a summary of a workshop on Measuring Data for Population Health , sponsored by the NSF SmartHealth program with assistance from the NIH mHealth initiative, held on January 12--13, 2012 in Washington DC. There were 42 attendees, including invited researchers from academia, government and industry, plus program officers from NSF and NIH. The workshop had background talks by leaders in health systems and information systems, followed by breakout discussions on future challenges and opportunities in measuring and managing population health. This report describes the observations on what problems of health systems should be addressed and what solutions of information systems should be developed. The recommendations cover how new information technologies can enable new health systems, with support from future initiatives of federal programs. The workshop and its report identify research challenges that utilize new computing and information technologies to enable better measurement and management for practical healthcare. The measurement technologies focus on deeper monitoring of broader populations. The management technologies focus on utilizing new personal health records to provide personalized treatment guidelines, specialized for each population cohort. This would enable predictive modeling for health systems to support viable healthcare at acceptable cost and quality. A workshop website contains background and discussion notes: https://wiki.engr.illinois.edu/display/hiworkshop/NSF+Workshop+Population+Health