MobileActive.org

Handheld computers have untapped potential to improve HIV/AIDS programs in sub-Saharan Africa, particularly in the collection of survey data. We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior.

Participants were asked about their HIV/AIDSrelated knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition. These results suggest that using handheld computers in data collection in sub-Saharan Africa may lead to biased reports of HIV/AIDS-related risk behaviors.

This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.

The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.

The major thematic areas include:

• Treatment Compliance
• Data Collection and Disease Surveillance
• Health Information Systems and Point of Care Support
• Health Promotion and Disease Prevention
• Emergency Medical Response

The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.

A PDA-based program for data collection was developed using Open-Source tools. In two cross-sectional studies, we compared data concerning sexual behavior collected with paper forms to data collected with PDA-based forms in Ancon (Lima).

The first study enrolled 200 participants (18–29 years). General agreement between data collected with paper format and handheld computers was 86%. Categorical variables agreement was between 70.5% and 98.5% while numeric variables agreement was between 57.1% and 79.8%. Agreement and correlation were higher in those who had completed at least high school than those with less education.

The second study enrolled 198 participants. Rates of responses to sensitive questions were similar between both kinds of questionnaires. However, the number of inconsistencies (p = 0.0001) and missing values (p = 0.001) were significantly higher in paper questionnaires.

This study showed the value of the use of handheld computers for collecting sensitive data, since a high level of agreement between paper and PDA responses was reached. In addition, a lower number of inconsistencies and missing values were found with the PDA-based system. This study has demonstrated that it is feasible to develop a low-cost application for handheld computers, and that PDAs are feasible alternatives for collecting field data in a developing country.

The ability to collect data is key to the success of many organizations operating in the developing world. Given the weaknesses of current tools and the surge in mobile phone growth, there's an opportunity for mobile and cloud technologies to enable timely and efficient data collection. This paper discusses Open Data Kit (ODK), a suite of tools that enable efficient and timely data collection on cell phones. ODK is designed to let users own, visualize, and share data without the difficulties of setting up and maintaining servers. The tools are easy to use, deploy, and scale. They also go beyond open source - they're based on open standards and supported by a larger community.

Epi Data and Epi Info are often used together by public health agencies around the world, particularly in developing countries, to meet their needs of low-cost public health data management; however, the current open source data management technology lacks a mobile component to meet the needs of mobile public health data collectors. The goal of this project is to explore the opportunity of filling this gap through developing and trial of a personal digital assistant (PDA) based data collection/entry system. It evaluated whether such a system could increase efficiency and reduce data transcription errors for public surveillance data collection in developing countries represented by Fiji.

120 participants were recruited from the Fiji School of Medicine were randomly assigned to be interviewed by one of six interviewers in one of the two ways: (1) paper-based survey followed by PDA survey and (2) PDA survey followed by paper-based survey. Data quality was measured by error rates (logical range errors/inconsistencies, skip errors, missing values, date or time field errors and incorrect data type). Work flow and cost were evaluated in three stages of the survey process: (1) preparation of data collection instrument, (2) data collection and (3) data entry, validation and cleaning. User acceptance was also evaluated in the two groups of participants: (1) data collectors and (2) survey participants.

None of the errors presented in 20.8% of the paper questionnaires was found in the data set collected using PDA. Sixty-two percent of the participants perceived that the PDA-based questionnaire took less time to complete. Data entry, validation and cleaning for the PDA-based data collection from 120 participants took a total of 1.5 h, a 93.26% reduction of time from 20.5h required using paper and pen. The cost is also significantly reduced with PDA-based protocol. Both data collectors and participants prefer to use PDA instead of paper for data collection. The trial results prove that eSTEPS is a feasible solution for public health surveillance data collection in the field. Several deficiencies of the softwarewere also identified and would be addressed in the next version.

eSTEPS offers the potential to meet the need for an effective mobile public health data collection tool for use in the field. The eSTEPS field trial proves that PDA was more efficient than paper for public health survey data collection. It also significantly reduced errors in data entry. The later benefit was derived from the software providing its users with the flexibility of building their own constraints to control the data type, range and logic of data entry.

In this paper, we present a phone-based application called CommCare which supports community health workers (CHWs) as they provide home-based care and social support to HIV+ and other chronic patients. We report on our experience developing and testing the application with five CHWs in Dar es salaam, Tanzania. We have developed a simple and easily useable system by rapidly prototyping CommCare with the community health workers, in quick iterations based on their feedback. The system guides the user through about 15 questions during each household visit. The CHWs answer the questions using the phone’s number pad, and the results are submitted over the cellular network to our server when the session is over.

We report on lessons learned from training and our initial deployment. We discuss the few hardware and software problems that arose during our initial piloting, most of which have been addressed. This use of CommCare has little effect on the time or efficiency of home visits, but results in much easier, much faster, and potentially more accurate reporting. In particular, it saves the CHWs approximately four hours per month spent on compiling reports in the paper system.

Finally, we conducted an initial qualitative assessment of the perception of the phone-based system by the clients of the CHWs who used it. We report on the findings below, which generally show a favorable impression of the system, including an appreciation that a phone can be more discreet than paper notebooks and that it can report data more quickly.

Background: To investigate the feasibility, the ease of implementation, and the extent to which
community health workers with little experience of data collection could be trained and successfully supervised to collect data using mobile phones in a large baseline survey

Methods: A web-based system was developed to allow electronic surveys or questionnaires to be
designed on a word processor, sent to, and conducted on standard entry level mobile phones.

Results: The web-based interface permitted comprehensive daily real-time supervision of CHW
performance, with no data loss. The system permitted the early detection of data fabrication in
combination with real-time quality control and data collector supervision.

Conclusions: The benefits of mobile technology, combined with the improvement that mobile phones offer over PDA's in terms of data loss and uploading difficulties, make mobile phones a
feasible method of data collection that needs to be further explored.

Over four and a half billion people live in the developing world and require access to services in the financial, agricultural, business, government and healthcare sectors. Due to constraints of the existing infrastructure (power, communications, etc), it is often difficult to deliver these services to remote areas in a timely and efficient manner.

The CAM framework has found success as a flexible platform for quickly developing and deploying high-impact applications for these environments. Many of the applications built with CAM have relied on a model where a field worker with a mobile phone regularly returns from a disconnected environment to one with connectivity. In this connected state, the phone and a centralized server can exchange information and get the collected data backed up on reliable media.

We propose extending CAM’s networking model to enable continual operation in disconnected environments. Using a set of heterogeneous paths made available through social and geographic relationships naturally present among workers, we describe a system for asynchronously routing data in a best-effort manner.

The overall goal of the PDAs for Malaria Monitoring in Maputo and Gaza Provinces, Centre was to improve the management of public health dat using handheld computers in order to provide the malaria program the Lubombo Spatial Development Initiative (LSDI) with appropriate assessment tools and the ability to make informed decisions.

The specific objectives of the project that would contribute to the achievement of the overall goal were

1. to enable personnel from District level of the health service to collect data and provide it to the Provincial level in a timely fashion;
2. to develop training courses and appropriate collection tools designed for use with handheld computers; and
3. to evaluate the utility of handheld computers for the malaria control program to provide data rapidly and accurately to allow better targeting of interventions and resources.

AED-SATELLIFE developed and successfully deployed electronic data collection tools which catalog drug and rapid diagnostic test stocks; spray operators daily work performance; weekly health facility data; localization of individual households with GPS, including demographic data on household members, house structure and divisions; and health facility surveys linked to GPS positioning. Training materials were developed inPortuguese.

Independent evaluation confirmed that the electronic data collection/transmission tools proved to be a useful, adoptable, and result in higher user satisfaction compared to paper based approaches. Some challenges need to be addressed before there can be widespread adoption of the technology, such as limited infrastructure, especially cellular coverage.

Results of proof-of-concept testing for an mHealth solution for reproductive health in Uttar Pradesh, India. The text messaging tool based on FrontlineSMS, is a family planning service that relies on the Standard Day Method system of birth control. This method of birth control depends on the woman's fertility cycles to avoid pregnancy. Women can text the date of their menses and user receives their fertility status. Additionally, women can receive information about other family planning options, and support. Presented are observations on the appropriatenss of the technology from focus group discussions. The authors share the input given by target users in the product and service design. Women tested the solution to give insight on feasibility and design.

Implementation of Monitoring and Evaluation (M&E) programmes are predominantly dependant on paper forms to measure organisational impact. These forms are then manually captured into an electronic system for analysis. This methodology results in high costs, questionable data accuracy and long turnaround times. Additionally inadequately skilled employees, remote locations and high staff turnover add to these challenges. A solution that allows for flexibility and extendibility within the NGO sector is required to decrease costs and allow for NGO’s to focus their attentions on their main areas of expertise. One potential solution is the use of mobile phones to collect the data.

This paper presents the experiences of implementing a mobile phone based M&E system and the lessons learnt in scaling this system from pilot to national. These include system flexibility, easy-to-learn interfaces, identification of champions and detailed site assessments. Today the system is being used nationally, with over 70 000 electronic surveys submitted and over 300 facilitators using the system.

The  usage  of  mobile  phones  is  abundant  in  our  daily  lives  in  various  aspects from making phone calls or sending text messages to checking e-mails or news updates to planning our activities or managing our budget. This project aims at making use of this wide spread usage of mobiles to help in the  data  collection  process.  It  designs  and  develops  a  web  based  system  called “MobiCollect”  that  is  used  for  creating  forms  or  questionnaires  to  be  later accessed  by  the  data  collectors  using  their  mobile  phone  web  browser  in  order fill in the form with the appropriate data. 
 
Once  the  system  design  and  implementation  is  completed  it  will be  tested  and evaluated to ensure the satisfaction of at least the minimum requirements of the proposed system.

This paper provides an overview of the implications of this trend for the delivery of healthcare services and population health. In addition to addressing how mobile phones are changing the way health professionals communicate with their patients, a summary is provided of current and projected technologic capabilities of mobile phones that have the potential to render them an increasingly indispensable personal health device. Finally, the health risks of mobile phone use are addressed, as are several unresolved technical and policy-related issues unique to mobile phones. Because these issues may influence how well and how quickly mobile phones are integrated into health care, and how well they serve the needs of the entire population, they deserve the attention of both the healthcare and public health community.

A how-to guide on using and implementing RapidSMS for mobile data collection and communication.

An increase in gang and drug activity in South Africa has been causing tension within communities and has a negative effect on society. Treatment and counselling facilities are finding it difficult to cope with the influx of substance abuse cases. Traditional face-to-face counselling and telephone help-lines have come under pressure with this increased demand. This presented an opportunity to use mobile and web technologies to provide advice and support to people impacted by substance abuse problems.

This study indicates how a substance abuse counselling service called Drug Advice Support (DAS) uses technologies such as Mobile Instant Messaging (MIM) and social networks to benefit and empower these communities in tension (CiT). The service makes it easy for persons with a mobile device with internet connectivity to access the service.

This paper takes an evolutionary journey through the design and development of the DAS system. It studies how the system evolved as an environment in which DAS was operating and co-developed with citizens in the Athlone Living Lab (ALL). The DAS system started with one advisor advising a few people, to multiple advisors advising as much as 471 conversations during a two hour period. It also shows how the implementation of such a system could be used to aid communities facing other social issues in South Africa and other parts of the world.