Cell Phone Surveys among Women of Reproductive Age in Burkina Faso: Identifying Sources of Error

The rapid growth of cell phone ownership in low and middle income countries (LMIC) provides an opportunity to frequently collect data at low cost by calling respondents remotely. However, little is known about the validity of reproductive health estimates derived from cell phone surveys in LMIC – either collected through computer assisted telephone interviews (CATI) or interactive voice response (IVR). This dissertation identifies sources of frame and non-response error using four datasets collected between 2016 and 2018 among women of reproductive age in Burkina Faso. In Aim 1, we used data from the Performance Monitoring and Accountability 2020 (PMA2020) Survey Round 4, a nationally representative population-based FTF survey of women of reproductive age conducted in 2016. For Aim 2, we conducted a follow-up cell phone survey of cell phone owners identified in Round 4. These women were randomized to receive either a CATI or IVR survey that was introduced with a human operator. Finally, in Aim 3 we used data from a national probability FTF survey (PMA2020 Round 5) and a CATI phone survey selected through RDD. We found 47% of women in Burkina Faso owned a cell phone based on PMA2020 Round 4 survey data, with greater ownership among women with secondary education or higher (Odds Ratio (OR) = 4.3, 95% confidence interval 2.9 – 6.2), women who resided in urban areas, women from wealthier households (highest wealth quintile), and women who were over the age of 19. When examining non-response patterns in the second aim, we found the survey response rate was higher among women randomized to CATI (50%) versus Hybrid IVR (19%). Cell phone owners who consented to our follow-up cell phone survey were more likely to reside in an urban area, were more educated and were more likely to be over the age of 20 years old compared to women who did not consent to participate (were not contacted or refused participation). Finally, the results of Aim 3 showed that the estimate of modern contraceptive use generated by the CATI survey with RDD sampling was not equivalent but higher to the FTF PMA2020 Round 5 (R5) survey estimate (RDD: 40%, FTF: 26%), even after applying post-stratification weights (RDD weighted modern contraceptive prevalence estimate: 39%). The odds of modern contraceptive use remained significantly higher among RDD respondents versus FTF respondents, even after adjustments for additional covariates. This dissertation identified sources of error for both follow-up and RDD cell phone surveys in Burkina Faso suggesting that over-estimation of modern contraceptive use in phone surveys stems from frame bias rather than non-response bias and potentially measurement bias

Mobile phone text messaging data collection on care-seeking for childhood diarrhoea and pneumonia in rural China: a mixed methods study

Background. Health information systems are inadequate in many countries. For childhood diarrhoea and pneumonia specifically, the leading infectious causes of child mortality worldwide, current data collection methods are not providing sufficient information for surveillance. The collection of health data could be greatly assisted with the use of mobile devices (mHealth). Mobile phone text messaging is widely used, but its potential for health data collection has not yet been realised. Aim. To explore the application of mHealth-based collection of information relevant to childhood diarrhoea and pneumonia in rural China. Methods. A mixed methods approach was used: (i) a survey and semi-structured interviews to assess the usage of mobile phones by caregivers of young children; (ii) cognitive interviews, usability testing and a cluster randomised cross-over study to determine the validity of a text messaging survey on care-seeking for childhood diarrhoea and pneumonia; and (iii) researchers’ observations and structured interviews with participants of the cross-over study to evaluate factors influencing participation in mHealth-based studies. Results. Many of the 1854 survey participants (1620; 87.4%) used mobile phones. Of 1014 participants in the cross-over study, 662 (65.3%) responded to the first text message. Of 651 participants willing to participate, 356 (54.7%) completed the text messaging survey. Overall, text message data were moderately to substantially equivalent to face-to-face data. The text messaging survey was acceptable to parents, but grandparents were often unable to use text messages. Among many factors influencing participation were trust, perceived usefulness and ease of use. Conclusions. Text messaging can be applied to collect data on care-seeking for childhood diarrhoea and pneumonia in rural China, but several questions remain, including how to improve accuracy and response rates. Further work needs to advance innovative mHealth-based data collection methods that can improve health surveillance, enhance implementation of appropriate interventions and ultimately save children’s lives.Open Acces

Mobile phone based applications in implementing cholera prevention and control education in complex humanitarian emergencies : a feasibility study in Mogadishu, Somalia

The aim of this study was to identify and describe the viability of using cell phones to conduct rapid assessments, pass key health messages and conduct monitoring and evaluation in complex emergencies. The study setting was in a cholera outbreak response situation in Mogadishu, the capital of war torn Somalia. Qantitative, descriptive research was conducted to determine the feasibility. Data collection was done using structured questionnaires, self-response mailed questionnaires as well as follow-up telephone interviews. Three groups of respondents participated in the study. The respondent groups included 383 internally displaced persons (IDPs), 5 water, sanitation and hygiene (WASH) specialists and 5 specialists from 5 mobile phone providers in Mogadishu. The study showed that there is good potential for an effective, cost efficient and scalable short message service (SMS) based public health education platform in Somalia. The study has also come up with recommendations on key considerations to ensure viability of the Public health education platform. It is envisaged that the recommended platform shall increase speed, access, spontaneity, coverage and reduced cost per capita, a combination of which form the hallmark of a good emergency health response. Ultimately this effort shall contribute to improved health, reduced suffering and reduced deaths in fragile humanitarian contexts.Health StudiesM.A. (Public Health

eHealth in Chronic Diseases

This book provides a review of the management of chronic diseases (evaluation and treatment) through eHealth. Studies that examine how eHealth can help to prevent, evaluate, or treat chronic diseases and their outcomes are included

mHealth in Practice

This book is available as open access through the Bloomsbury Open Access programme and is available on www.bloomsburycollections.com. There has recently been an explosion of interest around the application of mobile communication technologies to support health initiatives in developing countries (mHealth). As a result, there is a need to promote and share rigorous research for better informed policy, programming, and investment. There are, however, few platforms for the exchange of information and proven practice between practitioners and researchers. The subtopic of prevention, well-being, and health promotion within mHealth is particularly ripe for deeper exploration. While many reports tout the potential of mobiles to influence behaviour change for health, there is limited knowledge about what works (and what does not work), and about how to evaluate current and future programs. This is a focused edited volume with contributions from leading researchers and practitioners to identify best practices in using mobile technologies to promote healthy behaviours (and reduce unhealthy ones) in resource-constrained settings with a special focus on developing countries. This topic is inherently interdisciplinary. Though the opportunities to leverage mobile phones for health are new, the challenges confronting researchers and practitioners are well-established and theoretically complex, with roots in decades of work on mediated behaviour change campaigns and theories

mHealth in Practice

This book is available as open access through the Bloomsbury Open Access programme and is available on www.bloomsburycollections.com. There has recently been an explosion of interest around the application of mobile communication technologies to support health initiatives in developing countries (mHealth). As a result, there is a need to promote and share rigorous research for better informed policy, programming, and investment. There are, however, few platforms for the exchange of information and proven practice between practitioners and researchers. The subtopic of prevention, well-being, and health promotion within mHealth is particularly ripe for deeper exploration. While many reports tout the potential of mobiles to influence behaviour change for health, there is limited knowledge about what works (and what does not work), and about how to evaluate current and future programs. This is a focused edited volume with contributions from leading researchers and practitioners to identify best practices in using mobile technologies to promote healthy behaviours (and reduce unhealthy ones) in resource-constrained settings with a special focus on developing countries. This topic is inherently interdisciplinary. Though the opportunities to leverage mobile phones for health are new, the challenges confronting researchers and practitioners are well-established and theoretically complex, with roots in decades of work on mediated behaviour change campaigns and theories

Describing the use of social media as a point-of-care tool in facility-based emergency care in Africa

Background Despite privacy and legal concerns, social media is used to provide real-time clinical support to emergency care providers. It can be particularly beneficial for those in Africa, who might lack adequate training or access to information. This PhD aimed to describe the use of social media as a point-of-care telemedicine tool in facility-based emergency care in Africa, to further inform its use. Methods A scoping review was conducted to map available literature on use, benefits, and risks associated with social media as a point-of-care platform. A mixed methods approach was then taken using a cross-sectional survey and semi-structured interviews to obtain a comprehensive description of use of social media as a point-of-care tool in facility-based emergency care in Africa. Results The scoping review identified 13 publications describing use of social media as a point-of-care tool in emergency medical settings. No studies were located in low-income countries. All studies evaluated WhatsApp use for real-time consultations, and those that assessed reliability found it to be highly reliable for consultations. A total of 70 emergency care providers in African facilities responded to the survey; nearly all worked in low- or lower-middle-income countries. Responses showed that clinicians use social media multiple times each day, primarily to share and receive advice. The majority felt social media positively impacts patient and provider experiences and improves speed and safety. Finally, eight African emergency care providers were interviewed to gain an in-depth understanding of how social media use impacts emergency care. All participants noted routine use for a range of professional purposes, including consultations, administrative tasks, and education. Concerns were mentioned by all participants, including legality, privacy, and lack of employer regulations. Conclusions This dissertation provides insight into social media use of African emergency care physicians, showing that social media use in this group is ubiquitous. Most clinicians use social media multiple times each day for a range of point-of-care purposes, and many feel social media is positively impacting both the patient and provider experiences. Post-doctoral work will focus on developing a framework to guide use of social media in facility-based emergency care in the African setting

Using social media and mobile gaming to improve the vegetable intake of young adults

Australian Dietary Guidelines recommend five servings of vegetables daily for prevention of chronic disease, but only 7% of adults achieve this. The initial stages of this thesis involved secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey data. Results showed young adults aged 18-24 years were the poorest consumers of vegetables, with mean intake of 2.7 serves daily. To inform the design of a targeted intervention using new technology the PhD candidate systematically reviewed the literature and found mobile-phone based interventions have positive effects on vegetable consumption (Cohen’s d 0.15,95% CI 0.04–0.28). Notably, engagement was low among young adults and few studies harnessed novel strategies such as social media or gamification for program delivery. Yet 95% of young adults own a smartphone and 91% use their device for game play or social networking. The final stage of this thesis involved the development of a 4-week social media and mobile-gaming intervention underpinned by behavioural theory, to addresses key barriers to, and psychosocial determinants of, vegetable intake. Behaviour change techniques demonstrated to mediate success, such as goal setting and self-monitoring were integrated. Short mobile-phone delivered cooking videos were developed to address the low level of cooking literacy among this age group, with focus group testing confirming their acceptability among the target audience. A factorial study design was used to determine the feasibility of delivering the program. This was the first study to explore the impact of social support using social media in combination with gaming elements in a nutrition intervention for young adults. The research revealed that it is feasible and practical to deliver behaviour change interventions to young adults using these novel communication mediums. The accessibility of these platforms could allow the dissemination of individual behaviour change interventions at scale

An Investigation of the Public Health Informatics Research and Practice in the Past Fifteen Years from 2000 to 2014: A Scoping Review in MEDLINE

Objective: To examine the extent and nature of existing Public Health Informatics (PHI) studies in the past 15 years on MEDLINE. Methods: This thesis adopted the scientific scoping review methodology recommended by Arksey and O’Malley in 2005. It proceeded with the five main stages, which were: Stage I - identifying the research question; Stage II - identifying relevant studies; Stage III - study selection; Stage IV - charting the data; and Stage V - collating, summarizing, and reporting the results. Each methodological stage was carried out with the joint collaboration with the academic supervisor and a final result and conclusion were set forth. Results: The results of this study captured a total number of 486 articles in MEDLINE focused in PHI. Out of them, a majority belonged to the USA followed by the UK, Australia and Canada. Only about one fifth of the articles were from the rest of the world. Further, About 60% of the articles represented infectious disease monitoring, outbreak detection, and bio-terrorism surveillance. Furthermore, about 10% belonged to chronic disease monitoring; whereas public health policy system and research represented 40% of the total articles. The most frequently used information technology were electronic registry, website, and GIS. In contrast, mass media and mobile phones were among the least used technologies. Conclusion: Despite multiple research and discussions conducted in the past 15 years (starting from 2000), the PHI system requires further improvements in the application of modern PHT such as wireless devices, wearable devices, remote sensors, remote/ cloud computing etc. on various domains of PH, which were scarcely discussed or used in the available literature