Portable Health Clinic Research Articles

Potential Improvement in a Portable Health Clinic for Community Health Service to Control Non-Communicable Diseases in Indonesia

The COVID-19 pandemic has limited routine community health services, including screening for non-communicable diseases (NCDs). An adaptive and innovative digital approach is needed in the health technology ecosystem. A portable health clinic (PHC) is a community-based mobile health service equipped with telemonitoring and teleconsultation using portable medical devices and an Android application. The aim of this study was to assess the challenges and potential improvement in PHC implementation in Indonesia. This study was conducted in February–April 2021 in three primary health centers, Mlati II in Sleman District, Samigaluh II in Kulon Progo, and Kalikotes in Klaten. In-depth interviews were conducted with 11 health workers and community health workers. At the baseline, 268 patients were examined, and 214 patients were successfully followed-up until the third month. A proportion of 32% of the patients required teleconsultations based on automatic triage. Implementation challenges included technical constraints such as complexity of applications; unstable networks; and non-technical constraints, such as the effectivity of training, the availability of doctors, and the workload at the primary health center. PHCs were perceived as an added value in addition to existing community-based health services. The successful implementation of PHCs should not only be considered with respect to technology but also in terms of human impact, organization, and legality.

Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study.

Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems. A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness. Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status. ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621. DERR1-10.2196/41586.

A UAV-based portable health clinic system for coronavirus hotspot areas.

This study applied the World Health Organization (WHO) guidelines to redesign the Portable Health Clinic (PHC), as a Remote Healthcare System (RHS), for the spread of COVID‐19 containment. Additionally, the proposed drone‐based system not only collects people data but also classifies the case according to the main symptoms of coronavirus using the COVID‐19 triage process (CT‐process) based on the analysis of measurement readings taken from patients, where drones are used in a swarm as a PHC platform and are equipped with the required sensors and essential COVID‐19 medications for testing and treating people at their doorstep autonomously when a full curfew is imposed. This paper describes a complete framework and proposes currently in production hardware to build the suggested system, considering the effect of the extra payload weight on drone's durability. In addition, part of the proposed application was simulated using OPNET simulation tool. This work highlights the main aspects that should be considered when designing drone swarm‐based system and distributing the roles on system nodes with the main focus on the controlling messages for inter‐swarm and intra‐swarm communication and coordination.

Portable Health Clinic System for Maternal and Child Health Care in COVID-19 Pandemic Situation.

Rural women in developing countries do not have any option but to visit the distant city to see the obstetricians and gynecologists in case of any maternal and child health issues. However, it becomes more difficult to travel during the COVID-19 pandemic situation. Thus, the telehealth service using the Portable Health Clinic can be very effective for maternal and child health care services. Since the PHC system provides home delivery services through the local health workers, the rural women can avail regular continuum of care services. This study found a 300% increase in participation in the continuum of care. This is not because they receive the service at home but also because they can receive consultancy from urban specialist doctors without travel during the pandemic situation.

Standardization of Personal Health Records in the Portable Health Clinic System.

A personal health record (PHR) is not only a collection of personal health data but also a personal healthcare and disease management tool for individual patients. Recently, PHRs have been considered indispensable tools for patient engagement in the area of noncommunicable diseases (NCDs) and have gained a special importance. Unfortunately, similar to several other developing countries, Bangladesh remains far behind in establishing a standard PHR system for the country despite the fact that the growth of NCDs is extremely high and accounts for approximately 70% of the total diseases experienced in the country. The Portable Health Clinic system, which has a PHR feature, was established in Bangladesh in 2010. This PHR system requires standardization for each country. The objective of this research is to standardize this PHR system with reference to the PHR system proposed by the Japanese Clinical Societies, which is a pioneer of work in this field in Asia.

Portable health clinic COVID-19 system for remote patient follow-up ensuring clinical safety

BackgroundA developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities. MethodsThe PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients’ treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy. ResultsThis study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1–2 weeks. ConclusionsThis system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.

Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol.

The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.

Portable health clinic for sustainable care of mothers and newborns in rural Bangladesh

Background and objectiveRegular health checkups are important for mothers and newborns to detect health problems at an early stage; however, this is often difficult in resource-limited settings. Therefore, the portable health clinic (PHC) for maternal and child health (MCH), a telemedicine health checkup system, was introduced as an intervention study in a rural area in Bangladesh. The aim of this research project was to report findings that we had observed at a mid-point of the intervention period. MethodsThis was an intervention study conducted in Shariatpur, Bangladesh. The study population included pregnant/parturient women aged 15–49 years and their newborns. With the help of the newly created PHC for MCH, health workers, with a set of sensor devices in an attaché case, visited mothers and newborns at home to examine their health status. Their health status was triaged into four categories using a data management application, and in cases of affected or emergent health status, they were placed on remote video consultation with a doctor. ResultsIn total, 94 women were included in the PHC for MCH intervention. The rate of participants who received antenatal care at least four times or postnatal care at least once increased (from 29% to 51%, and from 27% to 78%, respectively) compared with before introducing PHC for MCH. Using the PHC for MCH, we detected health problems in pregnant/parturient women; a relatively high percentage had anemia (45–54%) and/or abnormal pulse rate (20–40%). Moreover, after introducing the PHC for MCH, more than 40% of women who received multiple antenatal care or postnatal care checkups improved their health status. ConclusionsThe PHC for MCH could be an effective system to improve the health of mothers and newborns by increasing the availability of care. In the future, this system is expected to be used as a primary resource for maternity healthcare, not only in rural areas but also in other social environments.

Redesigning Portable Health Clinic Platform as a Remote Healthcare System to Tackle COVID-19 Pandemic Situation in Unreached Communities.

Medical staff carry an inordinate risk of infection from patients, and many doctors, nurses, and other healthcare workers are affected by COVID-19 worldwide. The unreached communities with noncommunicable diseases (NCDs) such as chronic cardiovascular, respiratory, endocrine, digestive, or renal diseases became more vulnerable during this pandemic situation. In both cases, Remote Healthcare Systems (RHS) may help minimize the risk of SARS-CoV-2 transmission. This study used the WHO guidelines and Design Science Research (DSR) framework to redesign the Portable Health Clinic (PHC), an RHS, for the containment of the spread of COVID-19 as well as proposed corona logic (C-Logic) for the main symptoms of COVID-19. Using the distributed service platform of PHC, a trained healthcare worker with appropriate testing kits can screen high-risk individuals and can help optimize triage to medical services. PHC with its new triage algorithm (C-Logic) classifies the patients according to whether the patient needs to move to a clinic for a PCR test. Through modified PHC service, we can help people to boost their knowledge, attitude (feelings/beliefs), and self-efficacy to execute preventing measures. Our initial examination of the suitability of the PHC and its associated technologies as a key contributor to public health responses is designed to “flatten the curve”, particularly among unreached high-risk NCD populations in developing countries. Theoretically, this study contributes to design science research by introducing a modified healthcare providing model.

Influence of Factors on the Adoption and <i>Use</i> of ICT-Based eHealth Technology by Urban Corporate People

The aim of this study is to investigate the influence of the factors that affect the use of a PHC system (portable health clinic, an eHealth technology) by urban corporate people in Bangladesh. This study uses the first and second versions of the technology acceptance model and the unified theory of acceptance and use of technology model as the foundation. Additionally, health awareness factors are incorporated to develop the research model. Structural equation modeling was used to analyze a sample size of 264 urban corporate people in Bangladesh. Based on the total effects, the key to promoting the future use of a PHC system lies in the three most important factors: perceived usefulness (0.659), intention to use (0.454), and health awareness (0.447). These factors have a positive and direct influence on use. The findings offer proactively important and practical guidelines to service providers, implementers, and policymakers to promote the use of eHealth technology for regular health checkups.

Factors Influencing Rural End-Users' Acceptance of e-Health in Developing Countries: A study on Portable Health Clinic in Bangladesh.

Background: Existing studies regarding e-health are mostly focused on information technology design and implementation, system architecture and infrastructure, and its importance in public health with ancillaries and barriers to mass adoption. However, not enough studies have been conducted to assess the end-users' reaction and acceptance behavior toward e-health, especially from the perspective of rural communities in developing countries.Objective: The objective of this study is to explore the factors that influence rural end users' acceptance of e-health in Bangladesh.Methods: Data were collected between June and July 2016 through a field survey with structured questionnaire form 292 randomly selected rural respondents from Bheramara subdistrict, Bangladesh. Technology Acceptance Model was adopted as the research framework. Logistic regression analysis was performed to test the theoretical model.Results: The study found social reference as the most significantly influential variable (Coef. = 2.28, odds ratio [OR] = 9.73, p < 0.01) followed by advertisement (Coef. = 1.94, OR = 6.94, p < 0.01); attitude toward the system (Coef. = 1.52, OR = 4.56, p < 0.01); access to cellphone (Coef. = 1.37, OR = 3.92, p < 0.05), and perceived system effectiveness (Coef. = 0.74, OR = 2.10, p < 0.01). Among demographic variables, age, gender, and education were found significant while we did not find any significant impact of respondents' monthly family expenditure on their e-health acceptance behavior. The model explains 54.70% deviance (R2 = 0.5470) in the response variable with its constructs. The “Hosmer-Lemeshow” goodness-of-fit score (0.539) is also above the standard threshold (0.05), which indicates that the data fit well with the model.Conclusion: The study provides guidelines for the successful adoption of e-health among rural communities in developing countries. This also creates an opportunity for e-health technology developers and service providers to have a better understanding of their end users.

Growth Characteristics of Age and Gender-based Anthropometric Data from Human Assisted Remote Healthcare System

Growth monitoring and promotion of optimal growth are essential components of primary health care. The most popular approach to this topic has been developed and utilized for decades by the CDC (Center for Disease Control and Prevention) in the United States, resulting in its well-known clinical growth pattern charts for boys and girls. This metric comprises a series of percentile curves that illustrate the distribution of selected body measurements, by age. The results show a clear uptrend of three traditional measures: height, weight, and BMI. The chart also shows a trend with the corresponding 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentile data variations. Unfortunately, the CDC metric system only addresses ages 2–20 years. Apparently, no other studies show correspondingly systematic growth characteristic patterns for humans more than 20 years old. Our Portable Health Clinic system has for many years been archiving remote health care data records collected from different age and socioeconomic levels in many locations throughout Bangladesh. This data provides an important resource with which to study the age-related evolving nature of anthropometric data. We aim to see if there are any significant clinical growth patterns, specifically regarding height, weight, BMI, waist, and hip for humans over the age of 20 years. We could not determine a clear indication in terms of a specific age where the significant change from growth to decline occurs.

Lessons Learned from Co-Design and Co-Production in a Portable Health Clinic Research Project in Jaipur District, India (2016–2018)

Co-design and co-production with non-academic stakeholders has been recognized as a key approach in transdisciplinary sustainability research. The majority of transdisciplinary studies have been conducted in Europe and North America, with a marked lack of such research in the Asian context—particularly with regard to healthcare. Utilizing a case study involving mobile health check-ups performed using a portable health clinic system in Jaipur, India, from March 2016 to March 2018, this study identifies key factors in co-design and co-production that should be considered to ensure the project’s sustainability. Thoroughly reviewing all of the documents and materials related to the case study’s co-design and co-production, this study identifies the following key factors: (1) mutual stakeholder agreement on a long-term research plan, protocol, and budget; (2) harmonizing research objectives, frames, and the scale of stakeholder expectations; (3) stakeholders’ commitment and a sense of ownership derived from their needs and priorities; (4) stakeholder trust; (5) effective coordinators; (6) personality type and characteristics of stakeholder leaders; (7) capacity building and the empowerment of local research staff and participants; and (8) continuous efforts to involve stakeholders throughout the co-design and co-production processes. Facilitating effective co-design and co-production, these factors will help ensure the future sustainability of projects.

Consumer Acceptance of eHealth among Rural Inhabitants in Developing Countries (A Study on Portable Health Clinic in Bangladesh)

This paper explores and analyzes the current level of, reasons behind and factors affecting consumer acceptance of Portable Health Clinic (PHC), an e-Health initiative in Bangladesh. Our findings revealed that, 40% of the respondents have idea of using ICT in healthcare while 21% have their own experience of using any of the existing mHealth or eHealth systems. On the other hand, PHC’s acceptance rate among our respondents is 32% i.e. they have received healthcare services from PHC at least once. This research also analyzed consumer’s demographic and socio-economic factors that affect their acceptance of eHealth. Our finding says, consumer’s age, occupation and purchasing power have very strong influence on their acceptance of eHealth services while their gender, level of education, access to cell phone and previous eHealth knowledge have very insignificant or weaker impact.

Personal Health Book Application for Developing Countries

We introduce a Personal Health Book application that is used as a portable repository for Personal Health Records (PHR) in order to alleviate healthcare organizational problems in developing countries. The Personal Health Book application allows low literate people to access and carry their own medical history from a rural healthcare provider to an urban healthcare provider. This will improve the efficiency of medical care and lower costs for health clinics in underserved areas. This paper introduces a software application that can be ported onto a USB Smart Card or/and managed by smartphone or personal computer connected to cloud computing environment. The Portable Health Book application aims to ease the problem of interoperability between health clinics by accepting any file format and contents and applies a decomposed database to categorize, group and reorganize the data. Querying the application’s database, the consumer can create a unified report presentation that is understandable by the consumer, family, and healthcare provider. We tested the Personal Health Book framework by importing PHRs in an extensible markup language (XML) format with a basic structure, without checking the PHR content from the Grameen Portable Health Clinic database in Bangladesh and from different departments from a hospital in Japan. The Personal Health Book was able to generate a human readable output as its database reorganize and store any type of PHR including sensor device data.

Targeting Morbidity in Unreached Communities Using Portable Health Clinic System

Targeting Morbidity in Unreached Communities Using Portable Health Clinic System