Towards A Framework for Holistic Contextual Design for Low-Resource Settings

Healthcare inequality is ubiquitous globally, but the effects are most striking in low-resource settings. In these settings, current methods for the design of medical devices are failing to address specific needs. The associated publications rarely describe how the context was studied at the front-end of design. There is a latent need for a holistic contextual framework for guiding the design decision-making process for devices in these complex contexts. We present results from a systematic literature review and expert interviews that informed the development of a framework for contextualized design for low-resource settings. The contextual factors identified are described and compared for different types of medical devices. This taxonomical framework aims to guide designers towards gaining a better understanding of the context of use when designing products for global challenges in low-resource settings.The National Council of Science and Technology (CONACYT) in Mexico supported this research

Barriers for user acceptance of Mobile Health applications for Diabetic patients: Applying the UTAUT model

The literature illustrates that technology will widen health disparity if its use is restricted to patients who are already motivated and demonstrate good self-management behaviours. Additionally, despite the availability of free mobile health (m-health) applications for diabetes self-management, usage is low. There are also limited studies of m-health acceptance in South Africa. This research is delineated to the Western Cape, South Africa. The populace suffers from increasing numbers of diabetic patients. Segments of the population also suffer from technological forms of exclusion, such as limited internet access. Therefore, the objective of this study was to identify challenges for user acceptance that discourages the use of m-health applications. This study analysed 130 semi-structured interviews, using thematic content analysi

Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study

BACKGROUND: Mobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting. METHODS: We conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction. RESULTS: All of the participants were women, ranging from 18–64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas. CONCLUSION: In a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health

What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions

Background Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Methods Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Results Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62–100, STD 14.18) and the top quartile reported 91.3–100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Conclusions Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of intervention effectiveness of a health-related outcome and reported economic data, many did not report all recommended economic outcome items and were lacking in comprehensive analysis. The identified economic evaluations varied by disease or condition focus, economic outcome measurements, perspectives, and were distributed unevenly geographically, limiting formal meta-analysis. Further research is needed in low and low-middle income countries and to understand the impact of different mHealth types. Following established economic reporting guidelines will improve this body of research

R code for network analysis for understanding context of medical devices in resource-limited settings

Code developed for the analysis of networks describing the context of use of medical devices in resource-limited settings

Using digital fabrication tools to provide humanitarian and development aid in low-resource settings

The emergence of new digital fabrication tools is radically changing the way products are designed and manufactured. Recently the humanitarian and development sector has become interested in how digital fabrication tools (3D printers, laser cutters and CNC mills) can help to address the world’s most pressing problems. The benefits of these technologies have been widely reported in the context of high-resource settings, however there is little understanding about their use in more resource constrained settings. In order to address this gap in knowledge, this paper presents a systematic literature review of digital fabrication-led interventions in the humanitarian and development sector in low-resource settings. The review analyses various applications of digital fabrication tools and introduces six product archetypes that describe approaches for using digital fabrication tools in the humanitarian and development sector. Additionally, the study discusses the key benefits, challenges and enablers associated with using digital fabrication tools in low-resource settings. In conclusion, the review draws attention to the need for more holistic, long-term thinking about the social sustainability of these digital design and fabrication-led interventions.The research is supported by funding from the EPSRC Doctoral Training Programme, grant number EP/L504920/

The impact of 3D printing on the humanitarian supply chain

Additive Manufacturing or 3D printing is radically changing the way products are designed and manufactured. The humanitarian sector has started exploring how 3D printing can help match supply with the global rise in humanitarian needs. However, there has been very little academic research in the field. This study aims to bridge this gap by reviewing twelve case studies of 3D printed products to examine the effects of 3D printing on the humanitarian supply chain. The findings reveal four supply chain archetypes, which demonstrate that 3D printing is impacting the humanitarian supply chain with respects to networks, governance, processes and products. We compare the benefits and challenges of these archetypes to contest that 3D printing will not necessarily simplify and shorten the supply chain. Instead, we suggest the need for a holistic supply chain approach that includes the local production of 3D printers and filament, alongside local design and manufacture. This much-needed study provides the foundations for future academic research and offers relevant guidance for practitioners using 3D printing in the humanitarian sector