How eyes in the sky can cut survey costs and enable researchers to identify key but hard-to-reach populations

Collecting representative survey data on large populations of people can be a very time-consuming and expensive undertaking. But it doesn't have to be; Marco J. Haenssgen and Ern Charoenboon explain how they have used freely available satellite images to survey hard-to-reach communities in Thailand and Laos

A Comparison of Patients' Local Conceptions of Illness and Medicines in the Context of C-Reactive Protein Biomarker Testing in Chiang Rai and Yangon.

Antibiotic resistance is not solely a medical but also a social problem, influenced partly by patients' treatment-seeking behavior and their conceptions of illness and medicines. Situated within the context of a clinical trial of C-reactive protein (CRP) biomarker testing to reduce antibiotic over-prescription at the primary care level, our study explores and compares the narratives of 58 fever patients in Chiang Rai (Thailand) and Yangon (Myanmar). Our objectives are to 1) compare local conceptions of illness and medicines in relation to health-care seeking and antibiotic demand; and to 2) understand how these conceptions could influence CRP point-of-care testing (POCT) at the primary care level in low- and middle-income country settings. We thereby go beyond the current knowledge about antimicrobial resistance and CRP POCT, which consists primarily of clinical research and quantitative data. We find that CRP POCT in Chiang Rai and Yangon interacted with fever patients' preexisting conceptions of illness and medicines, their treatment-seeking behavior, and their health-care experiences, which has led to new interpretations of the test, potentially unforeseen exclusion patterns, implications for patients' self-assessed illness severity, and an increase in the status of the formal health-care facilities that provide the test. Although we expected that local conceptions of illness diverge from inbuilt assumptions of clinical interventions, we conclude that this mismatch can undermine the intervention and potentially reproduce problematic equity patterns among CRP POCT users and nonusers. As a partial solution, implementers may consider applying the test after clinical examination to validate rather than direct prescription processes

You've got a friend in me: how social networks and mobile phones facilitate healthcare access among marginalised groups in rural Thailand and Lao PDR

The seeming “ubiquity” of mobile phones has spawned a wave of interventions that use mobiles as platforms for health service delivery (mHealth). Operating in more than 100 countries, mHealth interventions commonly aspire to make healthcare more inclusive and efficient. Yet, mobile phone diffusion also stimulates locally emerging forms of health-related phone use that could create new digital inequalities among marginalised groups or compete with mHealth and other technology-based development interventions. We aim to inform this subject by asking, “How do mobile phone use and social support networks influence rural treatment-seeking behaviours among marginalised groups?” We hypothesise that (1) resource constraints drive marginalised groups towards informal healthcare access, and that (2) mobile phone use and social support networks facilitate access to formal healthcare with a bias towards private doctors. Analysing representative survey data from 2141 Thai and Lao villagers with descriptive statistics and multi-level regression models, we demonstrate that: (a) health-related phone use is concentrated among less marginalised groups, while social support networks are distributed more equitably; (b) marginalised villagers are more likely to utilise informal healthcare providers; and (c) mobile phones and social support networks are linked to increased yet delayed formal healthcare access that is directed towards public healthcare. We conclude that mobile phone diffusion has a mildly positive association with rural healthcare access, operating in a similar fashion but without (yet) appearing to crowd out social support. However encouraging, this is problematic news for mHealth and technology-based development interventions. The potential behavioural consequences of “informal mHealth” reinforce the notion that mobile phones are a non-neutral platform for mHealth and development interventions. The long-term implications require more research, but the literature suggests that increasing phone-aided healthcare facilitation could undermine local social support networks and leave already marginalised rural dwellers in yet more precarious circumstances

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Mobile phone diffusion and rural healthcare access in India and China

Three decades of mobile phone diffusion, thousands of mobile-phone-based health projects worldwide ("mHealth"), and tens of thousands of health applications in Apple's iTunes store, but fundamental questions about the effect of phone diffusion on peopleâs healthcare behaviour remain unanswered. Empirical, theoretical, and methodological gaps in the study of mobile phones and health reinforce each other and lead to simplifying assumptions that mobile phones are a ubiquitous and neutral platform for interventions to improve health and healthcare. This contradicts what we know from the technology adoption literature. This thesis explores the theoretical link between mobile phone diffusion and healthcare access; develops and tests a new multidimensional indicator of mobile phone adoption; and analyses the effects of phone use on people's healthcare-seeking behaviour. My mixed methods research designâimplemented in rural Rajasthan (India) and Gansu (China)âinvolves qualitative research with 231 participants and primary survey data from 800 persons. My research yields a qualitatively grounded framework that describes the accessibility and suitability of mobile phones in healthcare-seeking processes, the heterogeneous outcomes of phone use and non-use on healthcare access, and the uneven equity consequences in this process. Quantitative analysis based on the framework finds that mobile phone use in rural India and China increases access to healthcare, but it also invites more complex and delayed health behaviours and the over-use of scarce healthcare resources. Moreover, increasing phone-aided health action threatens to marginalise socio-economically disadvantaged groups further. I present here the first quantitative evidence on how mobile phone adoption influences healthcare-seeking behaviour. This challenges the common view that mHealth interventions operate on a neutral platform and draws attention to potential targeting, user acceptance, and sustainability problems. The framework and tools developed in this thesis can support policy considerations for health systems to evaluate and address the healthcare implications of mobile phone diffusion.</p

Satellite-aided survey sampling and implementation in low- and middle-income contexts: a low-cost/low-tech alternative

Background The increasing availability of online maps, satellite imagery, and digital technology can ease common constraints of survey sampling in low- and middle-income countries. However, existing approaches require specialised software and user skills, professional GPS equipment, and/or commercial data sources; they tend to neglect spatial sampling considerations when using satellite maps; and they continue to face implementation challenges analogous to conventional survey implementation methods. This paper presents an alternative way of utilising satellite maps and digital aides that aims to address these challenges. Results The case studies of two rural household surveys in Rajasthan (India) and Gansu (China) compare conventional survey sampling and implementation techniques with the use of online map services such as Google, Bing, and HERE maps. Modern yet basic digital technology can be integrated into the processes of preparing, implementing, and monitoring a rural household survey. Satellite-aided systematic random sampling enhanced the spatial representativeness of the village samples and entailed savings of approximately £4000 compared to conventional household listing, while reducing the duration of the main survey by at least 25 %. Conclusion This low-cost/low-tech satellite-aided survey sampling approach can be useful for student researchers and resource-constrained research projects operating in low- and middle-income contexts with high survey implementation costs. While achieving transparent and efficient survey implementation at low costs, researchers aiming to adopt a similar process should be aware of the locational, technical, and logistical requirements as well as the methodological challenges of this strategy

Manifestations, Drivers, and Frictions of Mobile Phone Use in Low- and Middle-Income Settings: A Mixed Methods Analysis of Rural India and China

<p>Against the backdrop of alleged mobile phone ubiquity and the enthusiasm about the developmental value of mobile technology, this paper examines the manifestations, drivers, and frictions of mobile phone use in two low- and middle-income settings where mobile technology has diffused rapidly. Qualitative data from 231 participants and survey data from 800 adults in rural Rajasthan and Gansu provide consistent and strong support for the claim that the notion of ‘ubiquity’ can mislead development practice because it obscures persistent non-use, under-utilisation, and heterogeneous engagement with mobile technology despite its apparently wide accessibility in rural field sites. The paper suggests avenues for further work on the indicators of technology adoption, and it cautions that phone-based development interventions (and their benefits) may diffuse unevenly if the assumption of ubiquitous technology use is violated.</p

NCRM podcast: Using satellites to slash survey costs

Carrying out surveys on hard to reach populations in far flung parts of the world can be challenging and expensive. But researchers from the Centre for Tropical Medicine and Global Health at the University of Oxford have used freely available satellite images to help identify and sample households in Thailand and Laos, as part of a research project looking at medicine and health behaviours. Ahead of their presentation at the 2018 Research Methods Festival, we catch up with Marco Haenssgen and Ern Charoenboon in the middle of their field work to discuss how their work will help other researchers save money whilst gathering data that could help the global health crisis of our growing resistance to antibiotics

Determinants of household safe drinking water practices in Kabul, Afghanistan: New insights from behavioural survey data

More than 2 billion people worldwide lack access to safe drinking water. Household water treatment (HWT) is an interim option for reducing the risk of water born disease. Understanding the factors that influence HWT behaviour is crucial for delivering successful interventions aimed at scaling relevant technologies, but the literature tends to emphasise psychological determinants with little consideration of socioeconomic and contextual factors. This article responds to this literature by using the COM-B model to examine the determinants of HWT practices through a comprehensive and context-sensitive behaviour definition. We informed this model through a cross-sectional survey design in which we collected data from 913 households in two peri‑urban neighbourhoods of Kabul, Afghanistan. Our findings from descriptive statistical and regression analysis highlight the importance of not only psychological but also socio-economic and contextual determinants of HWT behaviour: Especially the COM-B dimensions of reflective and automatic motivation, and physical opportunity – which are heavily influenced by local context and economic circumstances – had statistically significant associations with performing HWT. The practical significance of these dimensions was similarly pronounced. For example, an increase in the physical opportunity index by 0.1 units from an average value of 0.7 to 0.8 would be associated with a 7.7 percentage-point higher likelihood of HWT performance. These results suggest that the COM-B model can be utilised to systematically design interventions aimed at promoting HWT practices, while highlighting the need to broaden behavioural analyses of HWT and consider contextual factors to develop interventions that are tailored to the specific needs and obstacles of different communities