The Smartphone’s are equipped with our mobile software. The Smartphone’s are used by the CHWs (a) to enter, store and transfer data (such as anthropometric, clinical and basic demographic) to the cloud server, working both online and offline till they are able to submit via cellular network; (b) to disseminate NCD related information with multimedia support for eg. Short videos on NCD awareness and prevention; and (c) to provide lifestyle intervention education in terms of creating awareness to healthy eating, physical activity, avoiding smoking and harmful drinking.
The personal simple/basic cell phones (which are routinely used to make and receive phone calls and send SMS messages) possessed by most of the participants in the study is used to receive messages (appointment reminders and health messages). These mobile phones receive Interactive Voice Recordings (IVR) for people with low literacy or vision problems and SMS messages for people who can read the regional language, Tamil. Our experience in working with the target population for the past few years made us realize that mobile phones are ubiquitous. Mobile phones have invaded households as they have become a prerequisite for daily living in terms of communicating essential information, especially related to their daily occupation. Our surveys have revealed that most adult members of household possess a mobile phone. Therefore, our project capitalizes on the universal availability of simple/basic mobile phones among the participants – owned by them - in the target area and would not require smartphones at the participant level.
Jointly with Dimagi, our technology partner, and with funding support from USAID Development Innovation Ventures (DIV), we have developed and deployed a mobile application for Community Health Workers (CHWs) enabling real-time data collected through a smart phone and transferred and stored on a cloud server. Using Dimagi’s open-source mobile platform data input into mobile phones can be sent directly over a cellular data network to host cloud server and patient data can be accessed by CHWs and other stakeholders offline on their mobile devices. As the application works online and offline, data is saved on the phone to be sent directly to the server once the phone gains connectivity. The unique aspects of the software are: (1) Data collection module - use mobile phones for complex data collection and longitudinal patient management, and viewing incoming data in real-time on the web. The data collection includes nutritional data with help of condensed nutrition questionnaire, developed jointly with the nutrition team at Tufts University, Boston, assessment of physical activity levels by modified Global Physical Activity Questionnaire (GPAQ) and basic demographic and clinical data; (2) Intervention module - we have built a multimedia supported interface that tailors educational application for low-literate users, by decreasing reliance on text, and more emphasis on visual cues that serve as multimedia job aids to improve the CHW overall performance, patient engagement and standardize education. The application is also customizable in multiple languages to enable local language support with audio-visual cues for users with low literacy capacities; (3) Follow-up module - the data collection includes tracking and monitoring critical clinical parameters (BMI, waist circumference, blood pressure, blood sugar and other available lab data) and seven self-care behaviors as per the American Association of Diabetes Educators (AADE); and (4) Program monitoring module - reports on field-level workforce activity, providing essential data on CHW performance to enable more efficient program supervision.
Findings from our study suggested that the appropriate use of mobile technology facilitates a cost-effective, scalable, rural healthcare delivery model for case finding, care-linkage and treatment compliance within the existing public rural healthcare infrastructure. Our results with our mobile application show that (1) the software tools for data collection facilitate process improvements leading to more efficient and reliable data collection, and track outcomes in real time; (2) culturally appropriate educational videos through mobile phones are well received by participants and serve as valuable adjunct to patient education; (3) with the help of pre and post program follow up modules we are able to track prior knowledge, attitude and practice and post program knowledge improvement in real time; (4) with periodic appointment reminders we are able ensure follow-up with PHCs and ensure medication compliance; and (5) we are able to track compliance to standards and guidelines by CHWs in the field.
The NNOS Foundation was formed in 2005 to promote deceased donor organ transplantation. It has worked closely with the Government of Tamil Nadu in establishing a regulatory framework and in the successful running of the PPP program for organ sharing among hospitals in the State. The deceased donor rate has increased from 0.1 to 1.1 per million population per year in the State of Tamil Nadu, which exceeds by 10 times the national average. Soon after starting this effort, NNOS realized that a majority of organ failures are related to NCDs, such as, diabetes and hypertension. To address growing NCD epidemic, after studying various options suited to ground realities in rural India, NNOS established the Rural m-Health NCD Prevention Program with the use of mobile technology and local CHWs as a cost-effective, scalable PPP model for case finding, care-linkage and treatment compliance for NCDs within existing rural healthcare infrastructure.
From the beginning our goal has been to use easily accessible, appropriate technology taking into consideration needs of all stakeholders, which included the providers, caregivers and the beneficiaries/end-users in the community. As we progressed from community-based screening/data collection, disease identification to intervention we gradually built our mobile solutions/tools with inputs from various stakeholders. Thus the mobile software we had developed from the initial design has gone through many additions and revisions, to enhance data collection, data analysis, to track overall program delivery/ efficiency. As Program continues to expand changes in the software are continued to be incorporated resulting in better efficiency and making the mobile usage more user friendly.