Browsing by Subject "mhealth"

Psychological treatments delivered by lay counselors, individuals with little or no previous mental health training, have been shown to be effective in treating a range of mental health problems. However, in low resource settings, the dearth of available experts to train and supervise lay counselors is a key bottleneck in scaling up lay counselor delivered psychological treatments. Locally sustainable solutions that allow experts to train and supervise large volume of lay providers are needed. Two proposed solutions include the use of digital health strategies and peer supervision. In study one, we used a human-centered design approach to develop a web application to support asynchronous clinical supervision of lay counselors providing a family therapy program in Kenya. The development process engaged seven previously trained lay counselors and three prior supervisors in a phased design process which resulted in a final application prototype, “REACH”, that supported audio and text communication via a chat and a structured session report form. In study two, we conducted a feasibility study with 30 counselors with the aim of describing the capacity of REACH support supervision practices, exploring the feasibility and acceptability of REACH compared to peer group supervision, and describing the treatment fidelity and clinical competency of a small group of counselors using REACH. REACH was perceived as highly acceptable from both peers and supervisors and demonstrated promising impacts on counselor fidelity and clinical competency. Content analysis of correspondence between the counselors and the superior via the REACH indicated the supervisor was able to implement a wide range of evidence-based supervision strategies. Limitations of bi-directional communication on potential supervision effectiveness are discussed. Overall, this project suggests digital asynchronous clinical supervision holds promise as a scalable method of clinical supervision in low-resource contexts.

Despite the clear benefits to women, families, and society, family planning is not universal. In 2015,12 percent of married or in-union women who want to prevent or delay pregnancy were are not currently using a method of family planning in 2015. In Africa, this rate is even higher, at 24 percent. In order to meet the unmet need for family planning, new approaches to service delivery are required. A critical question for anyone interested in ensuring universal access to sexual and reproductive health-care services like family planning is how to create new products, services and implementation models that work for users. The objective of this case study is to describe how Human Centered Design (HCD) was used to develop a digital marketplace for family planning in Kenya, called Nivi, and draw lessons for broader application to global health challenges. By using the HCD approach, we sought to better understand the challenges users face with the Nivi platform and the opportunities that exist to make improvements. By incorporating HCD, we were able to build a service with greater potential for use and usability for Nivi users. We believe that taking an HCD approach allowed us to build a product that has the potential to meet the unmet need for family planning services in Kenya. This case study highlights the strengths and challenges to inform the use of HCD for other health applications in emerging markets.

Background: Cervical cancer is the fourth most common cancer worldwide, despite its highly preventable nature. Cervical cancer disproportionately affects individuals in low- and middle-income countries (LMICs), especially those in sub-Saharan Africa. Kenya experiences the highest cervical cancer incidence rate within the East African region (33.8 per 100,000 women) and is among the highest in the world. Huchko et al. demonstrated that cervical cancer screening via Human Papillomavirus (HPV)-based self-collection, led by community health volunteers (CHVs), is acceptable and well attended. While well received by communities in Western Kenya, researchers highlighted key barriers to the scale and potential effectiveness of this approach, including a need for electronic data collection and a lack of protocol and decision support tools for healthcare providers, who are often lay providers. Based on high reported mobile phone ownership within Kenya generally and past research documenting success with text message-based delivery of screening results within Western Kenya, the introduction of a mobile application-based intervention to address the identified challenges to cervical cancer screening and prevention appears feasible. This study sought to iteratively develop an mhealth intervention with key stakeholders, evaluate the usability of the intervention, and describe factors that limit and build cervical cancer screening self-efficacy among lay providers.

Methods: Between June 2019 and January 2020, we conducted a two-part study in Kisumu, Kenya to develop and pilot a mobile phone application, “mSaada.” In the first part of the study, between June and August 2019, a purposive sample of 18 participants completed in-depth interviews (IDIs) in two waves to provide a detailed review of the mSaada app and its features. Iterative revisions of the app were informed by participant feedback. During the second part, between October 2019 and January 2020, we conducted a small-scale pilot usability study within three healthcare facilities in Kisumu, Kenya. A convenience sample of 10 community health volunteers incorporated the mSaada mobile application into their daily interactions with clients during cervical cancer screening and education sessions. Participants completed usability and self-efficacy surveys throughout the study period as well as an in-depth interview to provide insight into their experience using mSaada.

Results: Iterative development of the mSaada mobile application resulted in major changes to the app’s user interface, aesthetics and organization, as well as the addition and clarification of educational content included within the platform. Overall, mSaada usability ratings increased significantly during the study period (4.54 to 4.84, p<0.001). During qualitative interviews, participants highlighted the app’s ease of use, impact on their workflow, and the comprehensiveness of the included information as strengths of mSaada. Participants did, however, cite concerns about the feasibility of broader implementation of the platform within Kenya. Overall, CHV self-efficacy increased significantly from the beginning to the end of the study period (4.53 to 4.74, p=0.008). When asked about factors limiting self-efficacy, participants discussed language barriers, time constraints, supply shortage, and privacy issues. Reference materials, personal knowledge, and experience and repetition were seen as factors that build self-efficacy.

Conclusions: While mSaada’s usability increased and the platform was observed to improve lay provider self-efficacy, much research is still needed in this area. Specifically, there is a need to engage women eligible for screening in future studies to help tailor mSaada such that it can best benefit the client population. Also, further development of the technological infrastructure within this setting is needed to promote long-term feasibility and sustainability of an mhealth solution like mSaada.

There are currently over two million Palestinian refugees residing in Jordan, 370,000 of whom reside in refugee camps. Due to conflict-affiliated disease outbreaks among children in the region, the UN Relief and Works Agency for Palestine Refugees (UNRWA) has identified incomplete vaccination as a critical public health issue and has invested in the development and implementation of a text message reminder service for preventing loss-to-follow-up. Childhood immunization rates in UNRWA catchment regions are generally high, yet little is known about risk factors for missed appointments, which impose a substantial administrative burden due to the need to contact patients for rescheduling. Stronger user characterization is necessary for improved targeting and minimized cost as we develop a more robust SMS system capable of scaling across all health facilities.

This mixed-methods study prospectively recorded 6 months of immunization history among a cohort of children born in June 2014 at Taybeh Health Center in Amman. Demographic information was collected at the time of birth, and caregivers of cohort members were invited to participate in interviews that assessed immunization knowledge, preferences, decision-making, and experience with the SMS reminder system. Patients were more likely to significantly delay appointments during the Ramadan holiday and for doses further from the child date of birth. Future policies that might bridge these gaps include targeting pre-appointment SMS reminders to high-risk patients, implementing holiday shifts in clinic hours, and regularly updating patient contact information.

Background

This retrospective study examined the impact of a USAID-funded and FHI 360-implemented pilot project entitled "TB CARE SMS System" in Cambodia. The primary objective of this study was to compare the "sputum submission to treatment delay" (SSTD) before and after the TB Care SMS System was initiated in December 2011 in the health clinics in Cambodia that correspond to the Kampong Cham Referral Hospital (RH) and Chamkar Leu Referral Hospital. The secondary objective was to capture the impact and limitations of the pilot TB CARE SMS System from the perspective of the healthcare workers and Community Directly Observed Therapy (CDOT) Program workers who use it on a daily basis.

Methods

A time-series regression analysis was used to measure the effect of the pilot project on SSTD. Measuring the secondary objective was conducted with in-person interviews with health center and CDOT workers who have used the SMS system, at 5 health centers (HCs) that use either the Chamkar Leu RH or Kampong Cham RH lab.

Results

With a total of 85 patients used in primary analysis, it appears that the pilot TB Care SMS System did not have the expected impact on the period that the sputum was sent to the lab for testing until the time the patient started treatment (SSTD).. However, measuring the date from when the sputum labs were sent to when the lab results were received by the HCs, we did not find a statistically significant reduction in delay either, though the trend was in the expected direction, with an apparent reduction of 1.70 days. In the secondary objective, all of both HC staff and CDOT workers believed the new SMS system was better than the original paper-based system.

Conclusions

The results show that the TB CARE SMS System demonstrated no statistically significant impact on SSTD, in the limited 6 month timeframe. However, it is an overall success from the perception of the users.