Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review

Background: Proper monitoring of labor and childbirth prevents many pregnancy-related complications. However, monitoring is still poor in many places partly due to the usability concerns of support tools such as the partograph. In 2011, the World Health Organization (WHO) called for the development and evaluation of context-adaptable electronic health solutions to health challenges. Computerized tools have penetrated many areas of health care, but their influence in supporting health staff with childbirth seems limited. Objective: The objective of this scoping review was to determine the scope and trends of research on computerized labor monitoring tools that could be used by health care providers in childbirth management. Methods: We used key terms to search the Web for eligible peer-reviewed and gray literature. Eligibility criteria were a computerized labor monitoring tool for maternity service providers and dated 2006 to mid-2016. Retrieved papers were screened to eliminate ineligible papers, and consensus was reached on the papers included in the final analysis. Results: We started with about 380,000 papers, of which 14 papers qualified for the final analysis. Most tools were at the design and implementation stages of development. Three papers addressed post-implementation evaluations of two tools. No documentation on clinical outcome studies was retrieved. The parameters targeted with the tools varied, but they included fetal heart (10 of 11 tools), labor progress (8 of 11), and maternal status (7 of 11). Most tools were designed for use in personal computers in low-resource settings and could be customized for different user needs. Conclusions: Research on computerized labor monitoring tools is inadequate. Compared with other labor parameters, there was preponderance to fetal heart monitoring and hardly any summative evaluation of the available tools. More research, including clinical outcomes evaluation of computerized childbirth monitoring tools, is needed.publishedVersio

An Algorithm (LaD) for Monitoring Childbirth in Settings Where Tracking All Parameters in the World Health Organization Partograph Is Not Feasible: Design and Expert Validation

Background: After determining the key childbirth monitoring items from experts, we designed an algorithm (LaD) to represent the experts’ suggestions and validated it. In this paper we describe an abridged algorithm for labor and delivery management and use theoretical case to compare its performance with human childbirth experts. Objective: The objective of this study was to describe the LaD algorithm, its development, and its validation. In addition, in the validation phase we wanted to assess if the algorithm was inferior, equivalent, or superior to human experts in recommending the necessary clinical actions during childbirth decision making. Methods: The LaD algorithm encompasses the tracking of 6 of the 12 childbirth parameters monitored using the World Health Organization (WHO) partograph. It has recommendations on how to manage a patient when parameters are outside the normal ranges. We validated the algorithm with purposively selected experts selecting actions for a stratified sample of patient case scenarios. The experts’ selections were compared to obtain pairwise sensitivity and false-positive rates (FPRs) between them and the algorithm. Results: The mean weighted pairwise sensitivity among experts was 68.2% (SD 6.95; 95% CI 59.6-76.8), whereas that between experts and the LaD algorithm was 69.4% (SD 17.95; 95% CI 47.1-91.7). The pairwise FPR among the experts ranged from 12% to 33% with a mean of 23.9% (SD 9.14; 95% CI 12.6-35.2), whereas that between experts and the algorithm ranged from 18% to 43% (mean 26.3%; SD 10.4; 95% CI 13.3-39.3). The was a correlation (mean 0.67 [SD 0.06]) in the actions selected by the expert pairs for the different patient cases with a reliability coefficient (α) of .91. Conclusions: The LaD algorithm was more sensitive, but had a higher FPR than the childbirth experts, although the differences were not statistically significant. An electronic tool for childbirth monitoring with fewer WHO-recommended parameters may not be inferior to human experts in labor and delivery clinical decision support.publishedVersio

OpenROSA, JavaROSA, GloballyMobile– Collaborations around Open Standards for Mobile Applications. M4W

Abstract: The paper reports on three interrelated open standards and coding collaboration efforts: OpenROSA, JavaROSA and GloballyMobile. The OpenROSA consortium was established to reduce duplication of effort among the many groups working on mobile data collection systems. The goal is to foster open-source, standards-based tools for mobile data collection, aggregation, analysis, and reporting. JavaROSA is an open-source platform for data collection on mobile devices. At its core, JavaROSA is based on the XForms standard -the official W3C standard for next-generation data collection and interchange. The mission of GloballyMobile is to cooperate on mobile phone application development, testing, and implementation, while sharing plans, progress, and lessons learned, in order to promote innovation, increase efficiency, and maximize the impact of humanitarian assistance. The paper also give a brief overview of projects under the OpenROSA umbrella which uses JavaROSA as the mobile data capture solution

Negotiating cultural identity through the arts: The African Cultural Memory Youth Arts festival (ACMYAF)

Negotiating Cultural Identity through the Arts: The African Cultural Memory Youth Arts Festival (ACMYAF) examines ways in which African cultural memory, and the extent to which the arts based approaches benefited the cultural identity socialisation experiences of young people of African migrant descent. Arts were used to explore the identities of a group of youth of African descent, as a means to developing understanding of the issues relating to their bicultural socialisation and ways in which Arts-based strategies could be used to address them towards bicultural competence. Bicultural competence implies the ability to function successfully in both the dominant and subordinate culture. The research project was motivated by the fact that Australian youth of African descent experience psycho-social challenges to their cultural identity development. Quite often this includes a denigration of their African cultures and identities through monocultural and exclusive cultural practises of Eurocentric Australia. And yet the young people involved in this study carry with them embodied knowledge and memories from African culture acquired through cultural socialisation prior to arrival in Australia as well as in ‘African’ homes in Australia, through parental cultural education and transmission. Such knowledge and cultural values play a significant role in identity formation and self-concept of the African descendant youth in Australia. Accordingly the festival was organised as an aesthetic and educative theatrical event using the Ujamaa circle and the African centred pedagogy theory, Participatory action research and Performance as a research Inquiry for the project. A participatory approach, through educative dialogue and performance enabled the participants to reveal their own embodied knowledge about African cultural memory leading to an educative exploration of its relevance through theatrical events. The process also enabled the participants to recall and document their cultural memories and subsequently reflect on their significance to identity negotiation and construction. The methodological research process became a Bicultural Socialisation Education Program (BSEP) because it enabled the participants through the theatrical events to integrate both subordinate and dominant cultural ideas towards self-affirming epistemologies and achieve a positive self-concept of themselves. It is the study’s conclusion that the festival, as a third space, enabled the participants to explore African cultural memory educatively by enacting art forms and dialogue that informed their African Australian identities. Furthermore, the methodological approach enabled the participants to reveal factors that influenced their bicultural socialisation experience, namely: visibility, racism, criminal stereotyping, alienation and specific issues relating to intergenerational relations. These factors present ongoing psycho-social challenges to the participants and in turn influence their bicultural socialisation experience and self-concept. The methodological approach was effective in enabling the participants, as a group of diverse African identities to develop an African Australian sensibility and to become conscious of their own agency in mobilising African cultural memory in an Australian context, towards bicultural competence

African cultural education: a dialogue with African migrant youth in Western Australia

African Cultural Education: A dialogue with African migrant youth in Western Australia, examines cultural issues that concern a specific group of African migrant youths. The ten youth participants three of whom are male and seven female share their concerns and desires about issues relating to their cultural identity. As a minority group in a predominantly Eurocentric society they are faced with cultural challenges, which influence their being namely: Racism and the pressure to assimilate. The thesis adopts an African Centred Cultural Democracy approach: which proposes that African people must construct a 'new' African identity and must begin to perceive and interpret the world in its entirety from an African psychological, spiritual, and cultural frame of reference. This approach requires an ongoing critical assesement of both subjective lived experience and objective conditions. Through the Ujamaa circle process the youth participants along with the facilitator examined challenges to their cultural identities and alternative liberatory options. Growing up in a culturally alienating Eurocentric culture, they felt the need for an African cultural space, in which they could explore issues affecting them as African descendants. In particular racism and assimilation were of major concern to them. They were of the opinion that there should be an ongoing African Cultural Education Program to facilitate cultural re-evaluation and continuity. It is the study's conclusion that cultural education for a minority African migrant group in a dominant Eurocentric culture is essential for their identities and continued root-cultural connectedness. Within the African Cultural Education conceptual framework, in addition to African cultural re-evaluation, it is possible to critically explore oppressive and domineering practices of the mainstream culture. It is also possible that the African migrant youth may become equipped with alternative worldviews from an African perspective, which will enable him/her to make informed judgement and response towards inappropriate mainstream attitudes and values. Participation in the arena of cultural politics will therefore be based on informed practice

Workflow Partitioning for Offline Distributed Execution on Mobile Devices

Traditionally, workflow systems are built on the client/server architecture, in which a single workflow server takes the responsibility for the operation of the whole process, thereby requiring connections each time a task is completed. In cases where connection between client and server is not readily available - like in mobile environments, such an approach proves infeasible. Enabling the execution of a group of tasks by mobile clients in distributed and disconnected environments has been proposed as a possible solution. However, the partitioning of a workflow into groups of tasks for offline execution has not been adequately explored. This paper proposes an approach for workflow partitioning and an algorithm that enables automatic discovery of such partitions from a process model as a vital step in assigning grouped tasks. We have implemented the algorithm, evaluated and validated it and proposed ways in which it could be implemented in a real workflow environment

Process Aware Mobile Systems. Applied to mobile-phone based data collection

The quest to provide computing services to resource-constrained environments in developing countries is becoming a reality due to the wide use of mobile phones and penetration of mobile networks. Nowadays, many organisations use Mobile Data Collection (MDC) tools to enable the collection and digitalisation of data at source, hence improving quality and increasing efficiencies. Mobile devices and environments present challenges to computing and application design that need to be overcome. Beyond mere digitalisation of data, MDC tools need to consider the process-related aspects of data collection used in paper-based routines expressed through paper trails. This lack of process-related support hinders the adoption of MDC routines in cases where great attention is paid to the data collection process. In conventional information systems, process-related features are implemented using workflows which may be embedded in an application or separately defined using Workflow Management Systems. This has led to the development of Process-Aware Information Systems (PAISs), which are software systems for managing and executing operational processes involving people, applications, and/or information sources on the basis of process models. PAISs facilitate the inclusion of processrelated activities which include the ordering of various tasks undertaken to achieve a business goal (control flow), the collaboration among various entities, and the allocation and provision as well the exchange of relevant information necessary for decision making. The use of mobile devices to carry out tasks is not the most preferable choice due to hardware limitations. Mobile-based systems should integrate with existing desktopbased solutions to provide a multiple access platform for work execution. This calls for integrating workflow systems with generic mobile data collection tools, which would require modifications in approach, methods and architecture to cater for device and environmental constraints in order to enable the mobile devices to be used appropriately. This thesis proposes a range of techniques that can be used to enable workflow support for mobile data collection. The overall goal is to minimise changes in workflow systems architecture, since these are based on widely agreed standards. Therefore, we propose an approach for online execution of work, for scenarios where network connection is readily available, and offline execution of work controlled by a workflow engine, when the connection is not available. A workflow adapter is proposed to enable matching of forms for data collection and workflow specifications. A distributed architecture for offline data collection based on partitioning a process model into fragments for distributed execution is also proposed. The methods proposed have been implemented with the OpenXdata MDC suite used for data collection and YAWL workflow management system. The OpenXdata and YAWL platforms adhere to commonly agreed standards for mobile data collection and workflow management and thus provide generalizable concepts within the domain of process-aware mobile data collection. Experiments were carried out on foundational concepts in order to determine that all relevant workflow-related constraints are observed. In addition, artefacts developed from the application of these methods were implemented in real life projects. The findings and results of these applications were used to validate the methods and frameworks suggested

High-Fidelity Prototyping for Mobile Electronic Data Collection Forms Through Design and User Evaluation

Mobile data collection systems are often difficult to use for nontechnical or novice users. This can be attributed to the fact that developers of such tools do not adequately involve end users in the design and development of product features and functions, which often creates interaction challenges

High-fidelity prototyping for mobile electronic data collection forms through design and user evaluation

Background: Mobile data collection systems are often difficult to use for nontechnical or novice users. This can be attributed to the fact that developers of such tools do not adequately involve end users in the design and development of product features and functions, which often creates interaction challenges. Objective: The main objective of this study was to assess the guidelines for form design using high-fidelity prototypes developed based on end-user preferences. We also sought to investigate the association between the results from the System Usability Scale (SUS) and those from the Study Tailored Evaluation Questionnaire (STEQ) after the evaluation. In addition, we sought to recommend some practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. Methods: We developed a Web-based high-fidelity prototype using Axure RP 8. A total of 30 research assistants (RAs) evaluated this prototype in March 2018 by completing the given tasks during 1 common session. An STEQ comprising 13 affirmative statements and the commonly used and validated SUS were administered to evaluate the usability and user experience after interaction with the prototype. The STEQ evaluation was summarized using frequencies in an Excel sheet while the SUS scores were calculated based on whether the statement was positive (user selection minus 1) or negative (5 minus user selection). These were summed up and the score contributions multiplied by 2.5 to give the overall form usability from each participant. Results: Of the RAs, 80% (24/30) appreciated the form progress indication, found the form navigation easy, and were satisfied with the error messages. The results gave a SUS average score of 70.4 (SD 11.7), which is above the recommended average SUS score of 68, meaning that the usability of the prototype was above average. The scores from the STEQ, on the other hand, indicated a 70% (21/30) level of agreement with the affirmative evaluation statements. The results from the 2 instruments indicated a fair level of user satisfaction and a strong positive association as shown by the Pearson correlation value of .623 (P<.01). Conclusions: A high-fidelity prototype was used to give the users experience with a product they would likely use in their work. Group testing was done because of scarcity of resources such as costs and time involved especially in low-income countries. If embraced, this approach could help assess user needs of the diverse user groups. With proper preparation and the right infrastructure at an affordable cost, usability testing could lead to the development of highly usable forms. The study thus makes recommendations on the practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design