A ground-up approach to mHealth in Nigeria: A study of primary healthcare workers’ attitude to mHealth adoption

Mobile Health (mHealth) has been piloted in developing countries to transform the delivery of healthcare services. Despite this heightened focus on mHealth, the number of fully operational mHealth solutions implemented in these locations remains surprisingly low. To extend mHealth projects beyond pilot stage it is imperative that the primary end user is positively predisposed to engaging with the mHealth intervention. Through exploring initial perceptions, we can inform later stages of mHealth projects or develop interventions to convert attitudes into commitment or motivation to use mHealth. This qualitative exploratory study aims to understand end users’, namely Primary Healthcare (PHC) workers, initial attitudes towards a mHealth project called IMPACT (usIng Mobile Phones for Assessing, Classifying and Treating sick children). We conducted a field study in Enugu State, Nigeria to understand end users’ perceptions of the relevance, benefits, threats and initial understanding of the technology influencing end users’ attitudes towards adoption of mHealth. The initial findings indicate that PHC workers expressed positive perceptions regarding the relevance and benefits associated with the IMPACT app. PHC workers focus on how the technology could support them to be more efficient and effective in their roles. However, they advocate the need for community wide education and training to eradicate negative perceptions or misgivings about the potential use of mHealth as part of a patient’s assessment

Mobile Clinical Decision Support Systems – A Systematic Review

In this review article, we provide a descriptive analysis of the current state of mobile decision support systems in the healthcare domain based on studies published in the following databases: Business Source Complete, CINAHL, Cochrane library, MEDLINE, PsycINFO, PubMed, ScienceDirect and Web of Science databases. A total of 29 studies were identified and analyzed to understand the current state of development, evaluation efforts, usability and challenges to adoption by patients and care providers. Our aim is to evaluate these systems and identify the key challenges which hinders their widespread adoption. Although, mobile based decision support systems in healthcare context have the potential to improve clinical decision making, the current state with low adoption rate and early stage of development need to be addressed for successful health outcomes

Supply-chain strategies for essential medicines in rural western Kenya during COVID-19

Problem: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach: Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients' COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting: Τo implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes: In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt: Our revolving fund pharmacy model has ensured that patients' access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities

Emergency Accident Alert

The escalation of the fatalities of road user has triggered a serious concern in the country. Factors identified were communication problem between the caller and the call-taker cause delay in the process of saving the victim which then become a source for insufficient preparation at the hospital. By utilising the knowledge of the current evolving technology which is now a trend, the author suggests to develop a mobile application that encourages bystander and eyewitness of road accident to immediately send details of victim’s condition to the emergency operator. The method used for the development of this Emergency Accident Alert is the Rapid Application Development (RAD) model. A prototype that describes the functionalities of the system will be developed using Phonegap that blends in HTML, CSS, Javascript and Jquery (scripting languages) to produce the desired mobile applicatio

Use of technology to prevent, detect, manage and control hypertension in sub-Saharan Africa : a systematic review

Objective: To identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA). Design: Systematic review. Data sources: Medline, Embase, Scopus and Web of Science. Eligibility criteria: Studies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA. Methods: Databases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results: 1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified. Conclusions: There are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies. PROSPERO registration number: CRD42020223043

Evaluating a South African mobile application for healthcare professionals to improve diagnosis and notification of pesticide poisonings

Acute pesticide poisoning (APP) is a major global public health problem, particularly in low- and middle-income countries (LMICs) including South Africa. However, healthcare professionals (HCPs) worldwide have limited training in handling environmental health risks such as from pesticide exposures. Most HCPs lack basic training on APP and, this presents a challenge to HCPs when diagnosing and notifying pesticide-related poisonings. With a recent increase in mobile application technology, this gives a convenient platform to provide training support for HCPs in their clinical practice. An example is the integration of a South African pesticide notification guideline into an existing Emergency Medicine (EM) mobile application. This pesticide notification guideline (PNG) within the EM mobile application aims to provide an immediate point-of-care tool to help HCPs in diagnosis and notify pesticide poisoning cases. Despite this useful platform for training HCPs, there are limited studies that have evaluated mobile applications or technologies to promote HCPs training in LMICs. This study, therefore, aimed to evaluate the Centre for Environmental and Occupational Health Research (CEOHR)'s PGN adapted for the EM mobile application as a tool for improving HCP's ability to diagnose and report APPs. The protocol (Part A) provides information and a justification for the research study and, describes the methods used to gather and analyse the data. The extended literature review (Part B) provides an overview of studies assessing HCPs' knowledge of and training in pesticide poisonings and the role mobile health technologies play in improving HCPs' knowledge and training in clinical practice. Furthermore, the literature review illustrates the relevant theoretical frameworks and concepts that helps to understand HCPs' behaviour changes when using clinical guidelines or algorithms. The journal manuscript article (Part C) provides this study's research findings and how it could contribute to the body of knowledge. A total of 50 emergency medicine physicians and registrars participated in th

Development and usability testing of a data visualisation platform for an African trauma data registry

Introduction Trauma is a significant contribution to the global burden of mortality and disease, especially in sub-Saharan Africa. The methods for tracking, recording, and analysing the incidence and causes of trauma are underdeveloped. To address this, The African Federation for Emergency Medicine (AFEM) developed a trauma form and Trauma Data Registry to collect trauma data in multiple sites in sub-Saharan Africa. We undertook a study to create, and assess the usability and functionality of, a trauma data visualisation platform for use in conjunction with the Trauma Data Registry. Methods We created a web-based trauma data visualisation platform for use with the AFEM Trauma Data Registry. This study involves a usability assessment of the AFEM Trauma Data Visualisation Platform to determine the specific website features and analytical needs of African trauma research facilities. This was done by surveying individuals from healthcare facilities that are currently using the AFEM Trauma Form. Two types of questionnaires were administered: Questionnaire I gathered information on the study population and their expectations for the platform, and Questionnaire II assessed the usability of the platform after it was introduced. Surveys took place in person and online, with the last group of questionnaires being administered on-site at the healthcare facility. Data were captured via Survey Monkey online and paper survey. The results were entered into Excel and analysed using descriptive statistics using Stata Version 14. Results A total of 45 healthcare practitioners from eight countries participated in the background survey. The greatest proportion were trained in Tanzania (14, 31.1%) and Ethiopia (14, 31.1%). The mean age of participants was 32.6 (SD=6.6). The mean number of years reported for working at their current facility is 3.7 (SD=3.5). The greatest number of participants in the survey were physicians (22, 48.9%) and specialists (11, 24.4%). Over half (53.3%, n=24) selected that they had moderate experience with data analysis, and the majority reported that they had less than three publications. A total of 34 HCPs participated in the usability study. The mean scores for the usability questionnaire portion were high, with all of the scores being above 6. Major positive themes of the participant comments included easy to use and time saving, major negative themes included feasibility concerns, and comments specific variable to add were common. Discussion There is a lot of heterogeneity in the data analysis and technology experience of participants. The participants were overall satisfied with the Trauma Data Platform. Participants’ comments and suggestions on elements to add indicate that there is still work to be done to design a Trauma Data Platform that is suitable for this setting. Conclusions Overall satisfaction with the Trauma Data Platform was high, and the user comments and suggestions will be incorporated into future versions of the platform. This research highlights the importance of considering the feasibility of health technology in its introduction

Classification And Analysis Of Mobile Health Evaluation Through Taxonomy and Method Development

This manuscript documents the creation and evaluation of a taxonomy for mobile health (m-health) evaluation and a method for m-health evaluation. M-health as a field within IS has seen significant amounts of growth in recent years due to improvements in technology leading to more affordable and portable computing power. The application of these technologies to the healthcare domain has created many new opportunities and benefits for patients and providers alike. This research seeks to study how these m-health projects are being evaluated and to determine what the characteristics of these evaluations are. To accomplish this goal, the research process is conducted as design science and the research outputs of taxonomy and method are presented as design science artifacts. The two artifacts are evaluated during their creation and once more afterwards to determine their utility. The taxonomy is created by collecting and analyzing documentation on m-health evaluation and using that information to generate descriptive categories by following a series of guidelines for creating a classification system. After evaluation of the artifact, a method is created for conducting m-health evaluation. This method is a series of guidelines built upon constructs and relationships derived from the taxonomy. Evaluation of the artifacts consists of expert surveys, cluster analysis, and attribute analysis. After evaluation of both artifacts, a descriptive theory explaining the selection of m-health evaluation types is created and presented. Theory development is based on the idea of kernel theories and their transferability to the information systems (IS) and design science domains. Contributions of this research are as follows: a classification system for m-health evaluation, a series of guidelines for individuals working on evaluations in the field of m-health, and a descriptive theory on the selection of evaluation type in an m-health context

O papel da mHealth na gestão de doenças crónicas na África Subsariana: revisão sistemática da literatura

RESUMO - Introdução: Nos últimos anos, os países da região da África Subsariana registaram uma maior incidência e prevalência de doenças crónicas, tendo como principal factor de risco a hipertensão arterial. Ao mesmo tempo, têm registado um crescimento exponencial do mercado de telecomunicações, o qual suscitou interesse para o desenvolvimento de estratégias da chamada saúde móvel (“mobile health”, ou mHealth) na gestão de doenças crónicas na região. Objectivos: Examinar os potenciais benefícios, aceitação e operacionalização da mHealth na educação em saúde sobre hipertensão arterial e prevenção de doenças crónicas na África Subsariana. Metodologia: Optou-se por realizar uma revisão sistemática da literatura, através de pesquisa nas bases de dados científicas da PubMed, Cochrane, B-On, Science Direct, e Google Scholar. Foram incluídos estudos de metodologia mista (quantitativa e qualitativa), decorridos entre 2010 e 2018. Resultados: Foram seleccionados 5 estudos decorridos em dois países da região (África do Sul e Gana).Os mesmos abordaram uma das multi-componentes operativas da mHealth (educação ao utente), na identificação e avaliação de aspectos como alterações no conhecimento e nos comportamentos de saúde dos participantes, e factores associados à aceitabilidade (ou não) na adesão terapêutica da hipertensão arterial. Conclusão: Os resultados dos 5 artigos mostram que o uso da mHealth na gestão de hipertensão teve resultados positivos no conhecimento e na alteração de comportamentos de saúde dos participantes. No entanto, concluiu-se igualmente que é uma área com pouca evidência disponível na África Subsariana e que necessita de uma investigação mais aprofundada.ABSTRACT - Introduction: In recent years, Sub-Saharan Africa countries have registered a higher incidence and prevalence of chronic diseases, with the main risk factor being hypertension. At the same time, there has been an exponential growth in the telecommunications market, which has attracted interest in the development of mobile health strategies (mHealth) in the management of chronic diseases in the region. Objectives: The current dissertation pretends to examine the potential benefits, acceptance, and operationalization of mHealth in health education on hypertension and chronic disease prevention in sub-Saharan Africa. Methodology: It was decided to do a systematic review of the literature, through research in the scientific databases of PubMed, Cochrane, B-On, Science Direct, and Google Scholar. The included studies had a mixed methodology (quantitative and qualitative), were developed between 2010 and 2018. Results: Five studies were conducted in two countries in the region (South Africa and Ghana). They addressed one of mHealth's multi-operational components (client education), in the identification and evaluation of aspects such as changes in health knowledge and behavior of the participants, and factors associated with acceptability (or not) in the therapeutic adherence of hypertension. Conclusion: The results of the 5 articles show that the use of mHealth in hypertension management had positive results in the health knowledge and changes in health behaviors of the participants. However, it has also been concluded that it is an area with a lack of evidence available in sub-Saharan Africa, with needs of further investigation