Supporting eradication of maternal child malnutrition in developing countries: a case from Nicaragua scenario.

World Health Organization actively stresses the importance of health, nutrition and well-being of the mother to foster children development. This issue is critical in the rural areas of developing countries where monitoring of health status of children is hardly performed since population suffers from a lack of access to health care. The aim of this research is to design, implement and deploy an e-health information and communication system to support health care in 26 rural communities of Cusmapa, Nicaragua. The final solution consists of an hybrid WiMAX/WiFi architecture that provides good quality communications through VoIP taking advantage of low cost WiFi mobile devices. Thus, a WiMAX base station was installed in the health center to provide a radio link with the rural health post "El Carrizo" sited 7,4 km. in line of sight. This service makes possible personal broadband voice and data communication facilities with the health center based on WiFi enabled devices such as laptops and cellular phones without communications cost. A free software PBX was installed at "San José de Cusmapa" health care site to enable communications for physicians, nurses and a technician through mobile telephones with IEEE 802.11 b/g protocol and SIP provided by the project. Additionally, the rural health post staff (midwives, brigade) received two mobile phones with these same features. In a complementary way, the deployed health information system is ready to analyze the distribution of maternal-child population at risk and the distribution of diseases on a geographical baseline. The system works with four information layers: fertile women, children, people with disabilities and diseases. Thus, authorized staff can obtain reports about prenatal monitoring tasks, status of the communities, malnutrition, and immunization control. Data need to be updated by health care staff in order to timely detect the source of problem to implement measures addressed to alleviate and improve health status population permanently. Ongoing research is focused on a mobile platform that collects and automatically updates in the information system, the height and weight of the children locally gathered in the remote communities. This research is being granted by the program Millennium Rural Communities of the Technical University of Madrid

Designing Social Networking Mobile App for Diabetes Management

The knowledge required for diabetes prevention and management among the rural people in developing countries vastly remains in the state of non-existence. To address this, a diabetic knowledge sharing platform, as an effective means for diabetes prevention, control, and treatment, can play role in increasing diabetes awareness and literacy. Currently researchers have emphasized the scope of peer-led learning by knowledge sharing on social media platforms in healthcare context. Therefore, by identifying this scope, we have prototyped a mobile app integrated with social media features to enable diabetic patients for cost-effective peer-led learning, knowledge sharing, and awareness building. In this process, we resorted to follow the cycles and guidelines as proposed in the Information System Research (ISR) framework for identifying users\u27 needs and preferences as well as building the theoretical foundation for the design of an app. This study demonstrates that the users had positive response and well acceptance to this prototype app as a medium for peer-led for diabetes management. Based on the findings, the researchers are optimistic about the potentiality of the app for a wider scale adoption by diabetic patients as a cost-effective peer-led learning platform

A Tele-Health Communication and Information System for Underserved Children in Rural Areas of Nicaragua

Millennium Development Goals point out the necessity of actively promoting maternal-child health care status, especially in underserved areas. This article details the development actions carried out between 2008 and 2011 in some rural communities of Nicaragua with the aim to provide a low-cost tele-health communication service. The service is managed by the health care center of Cusmapa, which leads the program and maintains a communication link between its health staff and the health brigades of 26 distant communities. Local agents can use the system to report urgent maternal-child health care episodes to be assessed through WiMAX-WiFi voice and data communications attended by two physicians and six nurses located at the health care center. The health and nutritional status of the maternal-child population can be monitored to prevent diseases, subnutrition, and deaths. The action approach assumes the fundamentals of appropriate technology and looks for community- based, sustainable, replicable, and scalable solutions to ensure future deployments according to the strategies of the United Nations

Sistema de información y comunicación para salud y nutrición de niños desatendidos en áreas rurales de Nicaragua

Los Objetivos de Desarrollo del Milenio señalan la importancia de promover el conocimiento del estado de salud materno-infantil, en especial en las zonas más desprotegidas. El presente artículo detalla las acciones llevadas a cabo durante los años 2008 y 2011 en algunas comunidades rurales de Nicaragua con el objetivo de brindar un servicio de comunicaciones de bajo coste. Dicho servicio es administrado por el centro de salud de Cusmapa, que lidera el programa y mantiene una estrecha comunicación entre su personal y los brigadistas de salud de 26 comunidades aisladas. Los agentes locales, a través de la red de datos y voz WiMAX/WiFi instalada, pueden utilizar el sistema de comunicaciones para informar acerca de episodios urgentes de salud materno-infantil a fin de que sean evaluados o atendidos por dos médicos y seis enfermeras que se encuentran en el centro de salud. El objetivo de monitorizar el estado de salud y nutrición de la población materno-infantil es prevenir la aparición de enfermedades, evitar la desnutrición e incluso la muerte. Esta investigación asume los principios básicos de la tecnología adecuada buscando soluciones basadas en la comunidad, sostenibles, replicables y escalables a fin de garantizar futuros despliegues de acuerdo con las estrategias de Naciones Unidas

Performance assessment of security mechanisms for cooperative mobile health applications

Mobile health (m-Health) applications aim to deliver healthcare services through mobile applications regardless of time and place. An mHealth application makes use of wireless communications to sustain its health services and often providing a patient-doctor interaction. Therefore, m-Health applications present several challenging issues and constraints, such as, mobile devices battery and storage capacity, broadcast constraints, interferences, disconnections, noises, limited bandwidths, network delays, and of most importance, privacy and security concerns. In a typical m-Health system, information transmitted through wireless channels may contain sensitive information such as patient’s clinic history, patient’s personal diseases information (e.g. infectious disease as HIV - human immunodeficiency virus). Carrying such type of information presents many issues related to its privacy and protection. In this work, a cryptographic solution for m-Health applications under a cooperative environment is proposed in order to approach two common drawbacks in mobile health systems: the data privacy and protection. Two different approaches were proposed: i) DE4MHA that aims to guarantee the best confidentiality, integrity, and authenticity of mhealth systems users data and ii) eC4MHA that also focuses on assuring and guarantying the m-Health application data confidentiality, integrity, and authenticity, although with a different paradigm. While DE4MHA considers a peer-to-peer node message forward, with encryption/decryption tasks on each node, eC4MHA focuses on simply encrypting data at the requester node and decrypting it when it reaches the Web service. It relays information through cooperative mobile nodes, giving them the only strictly required information, in order to be able to forward a request, until it reaches the Web service responsible to manage the request, and possibly answer to that same request. In this sense, the referred solutions aim any mobile health application with cooperation mechanism embedded. For test purposes a specific mobile health application, namely SapoFit, was used. Cryptographic mechanisms were created and integrated in SapoFit application with built in cooperation mechanisms. A performance evaluation of both approaches in a real scenario with different mobile devices is performed and presented in this work. A comparison with the performance evaluations of both solutions is also presented.Fundação para a Ciência e a Tecnologia (FCT)European Community Fund FEDER through COMPETE – Programa Operacional Factores de Competitividad

Understanding the determinants of mHealth apps adoption in Bangladesh: A SEM-Neural network approach

Due to the low adoption rate of mHealth apps, the apps designers need to understand the factors behind adoption. But understanding the determinants of mHealth apps adoption remains unclear. Comparatively less attention has been given to the factors affecting the adoption of mHealth apps among the young generation. This study aims to examine the factors influencing behavioral intention and actual usage behavior of mHealth apps among technology prone young generation. The research model has extracted variables from the widely accepted Unified Theory of Acceptance and Use of Technology (UTAUT2) alongside privacy, lifestyles, self-efficacy and trust. Required data were collected from mHealth apps users in Bangladesh. Firstly, this study confirmed that performance expectancy, social influence, hedonic motivation and privacy exerted a positive influence on behavioral intention whereas facilitating conditions, self-efficacy, trust and lifestyle had an influence on both behavioral intention and actual usage behavior. Secondly, the Neural Network Model was employed to rank relatively significant predictors obtained from structural equation modeling (SEM). This study contributes to the growing literature on the use of mHealth apps in trying to elevate the quality of patients' lives. The new methodology and findings from this study will significantly contribute to the extant literature of technology adoption and mHealth apps adoption intention especially. Therefore, for practitioners concerned with fostering mHealth apps adoption, the findings stress the importance of adopting an integrated approach centered on key findings of this study

A framework for evaluating telemedicine-based healthcare inequality reduction in Ethiopia : a grounded theory approach

Text in EnglishTelehealth makes healthcare services accessible by underserved and resource-constrained rural communities of developing countries such as Ethiopia. However, the limitation of frameworks on telemedicine-based healthcare inequality reduction is a challenge for developing countries. In Ethiopia there are four telemedicine projects; however, there is no evidence that any of these projects have been evaluated by considering contextual issues. This academic research explored telehealth practices in Ethiopia with the aim of developing a comprehensive telehealth evaluation framework for developing countries. Such a conceptual framework could be used to inform health institutes and governmental policy makers and in so doing create a vehicle for the implementation of improved health practices in Ethiopia. A grounded theory approach is used to qualitatively explore the usefulness of telemedicine practices in Ethiopia, in mitigating healthcare inequality. Grounded theory makes use of emerging insights in order to contribute to new knowledge. From the inductive analysis of the study, themes such as barrier removal, service quality, synergetic effect, localization, technical setup, resource utilization and managerial readiness emerged to formulate a framework for evaluating telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia. This study contributes to the understanding of the question of how telemedicine practices can be evaluated, to support the healthcare service and reduce the healthcare inequalities in resource constrained communities in Ethiopia. Moreover, the framework could be used during evaluation of telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia.School of ComputingPh.D. (Information Systems

'Connecting to Disasters": The Critical Success Factors of Mobile Phone Utilisation within Disaster Management Operations: The Case of Vanuatu

This study was an endeavour to contribute to the understanding of mobile phone use in disaster management. The main purpose of the study is to identify the factors necessary for mobile phones to successfully facilitate communication and information dissemination in disaster management operations in Vanuatu, which is viewed as a region experiencing significant risks to natural disasters, as well as a rapidly expanding mobile phone industry. The research uses qualitative data collected through semi-structured interviews from two months of fieldwork in Vanuatu. Interviews were conducted with participants sourced from mobile phone providers, civil society organisations, government departments, and Vanuatu communities. The research revealed a set of 16 critical success factors that affirmed a number of conclusions drawn from the literature but also revealed information unique to the Vanuatu context. The emerging factors necessary for mobile phone success were developed into a top-down framework with four categories. At the top, factors at the ‘Government Level’ highlighted the need for government leadership and ‘ownership’, particularly in ‘policy formulation’ and ‘sanctioning’ of disseminated information. Below this, key stakeholder groups involved in mobile phones and disaster management make up the ‘Stakeholder Level’, where there was a critical need for ‘communication’, ‘alignment’ and ‘collaboration’ between these groups. Stakeholder groups also need effective ‘staff training’, and a clear understanding of their ‘roles and responsibilities’ surrounding the mobile phone application. The means that enable stakeholders to operate this process make up the ‘Technology Level’, where critical factors include an ‘extensive network’ containing ‘resilient infrastructure’ with swift ‘maintenance and repair processes’. Finally, at the grassroots, community members make up the ‘User Level’. For users mobile phones must be both ‘affordable’ and ‘easy to use’, they also need ‘electricity access’ to meet phone charging needs, as well as knowledge of local areas with sufficient ‘network access’. These results reveal the importance of addressing ways to improve mobile phone use in disaster management. Mobile phones are now the most widely used information communication technology in Vanuatu, so improving their effectiveness in disaster management operations is important and could have significant implications for communities that are vulnerable to natural disaster hazards

Do superfast broadband and tailored interventions improve use of eHealth and reduce health related travel?

Do superfast broadband and tailored interventions improve use of eHealth and reduce health related travel? Introduction – eHealth has been shown to have promising health outcomes in numerous areas, however many people remain digitally excluded and therefore suffer an inequality in health service provision. Lack of internet infrastructure, personal skills, and service provision have been identified as potential barriers to eHealth but as yet there is no good evidence of the significance of these barriers and the impact of interventions to improve them. This PhD aimed to assess impact on eHealth uptake of three interventions (i) superfast broadband, (ii) a tailored booklet to help participants improve personal internet skills and support, (iii) GP interventions to improve health service provision of eHealth. A subsidiary aim was to assess the impact on miles travelled. Methods - In a cluster quasi-randomised factorial controlled trial, 1388 households from 78 postcodes were sampled in 2013 from the 20088 Cornish postcodes and allocated to the 8 (2X2X2) arms of the study. A unique sampling method was used to prevent contamination between arms. Comparison of ‘eHealth readiness’ and ‘miles travelled’ from baseline to 18-month follow-up between the 8 arms of the study was used to assess the impact of interventions. Interventions were tailored based on responses from the initial baseline survey and designed using aspects of the theory of diffusion of innovations. An overall eHealth Readiness score (0-10) was obtained from a validated self-completed questionnaire combining four sub-scales (Personal, Provision, Support, Economic). The standard deviation of the eHealth Readiness score represents a measure of eHealth inequalities. Findings – No significant differences were shown between each intervention arm of the study, either singly or in combination (all p>.05). eHealth Readiness significantly improved over the 18-month trial period (M=4.36 vs M=4.59, t(235)=4.18 p<.001, CI=0.13-0.35). This increase is evidenced by increases in Personal and Provision scores (t(255)=3.191 p=.002, t(258)=3.410 p=.001). There was no change in eHealth inequality. The proportion of internet users, mobile use and happiness with internet speed also increased. Average travel to GPs did not significantly differ between baseline and follow-up (12.3 vs 13.0, t(251)=.44, p=.66). No correlation was shown between eHealth Readiness and total travel miles to GP practices. Discussion – Individuals within Cornwall became more ready to adopt eHealth services over the 18 months of study, increasing in both their personal ability to use eHealth and their methods of access. This increase did not cause a larger digital divide. However, this increase could not be attributed to any of the three interventions. Further research should focus on making use of the improvement of infrastructure within Cornwall and seek to implement eHealth services. The eHealth readiness of Cornwall should be assessed in a longitudinal study to understand the effects of time of the superfast rollout. Qualitative studies should take place on persons of interest to help design more effective interventions with the aim to achieve a societal drive to sustainable use and adoption of eHealth.  Contribution to knowledge – Previously internet infrastructure has been acknowledged as a barrier to eHealth. This PhD was the first to analyse the impact of a high-speed internet rollout alongside other interventions on eHealth readiness. The methods in this study were unique and provide the basis for further work, both in the creation of a sampling method to reduce contamination between cluster interventions and as the first time a measure of eHealth readiness and eHealth inequality has been used to assess the effectiveness of eHealth interventions.Superfast Cornwal