Dimagi

Abstract: Community health workers (CHWs) have been shown to be an effective and powerful intervention for improving community health. Routine visits, for example, can lower maternal and neonatal mortality rates. Despite these benefits, many challenges, including supervision and support, make CHW programs difficult to maintain. An increasing number of mHealth projects are providing CHWs with mobile phones to support their work, which opens up opportunities for real-time supervision of the program. Taking advantage of this potential, we evaluated the impact of SMS reminders to improve the promptness of routine CHW visits, first in a pilot study in Dodoma, Tanzania, followed by two larger studies with 87 CHWs in Dar es Salaam, Tanzania. The first Dar es Salaam study evaluated an escalating reminder system that sent SMS reminders directly to the CHW before notifying the CHW's supervisor after several overdue days. The reminders resulted in an 86% reduction in the average number of days a CHW's clients were overdue (9.7 to 1.4 days), with only a small number of cases ever escalating to the supervisor. However, when the step of escalating to the supervisor was removed in the second study, CHW performance significantly decreased.

Abstract: Introduction: As the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDRTB) epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs), trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize) for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones. Objective: We assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period. Methods: All five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs’ usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment. Results: Mobile HCWs submitted nine of 33 (27%) expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care. Discussion: This pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations of HCWs and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings.

Abstract: Objectives: Low physician density undercapacitated laboratory infrastructures and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. Materials and methods: We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia one of the worlds poorest countries. Results: Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring evaluation and continued education of primary health care providers patient education and medical records documentation. Conclusions: The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.

Abstract: Disclosed are methods and systems that include receiving data associated with the compliance of a user with a self-care regimen, evaluating the data to determine a level of compliance of the user with the self-care regimen, and using at least one executable processor application to provide the user with an incentive based on the determined level of compliance.