2/11/2015 Today’s topics • Trevor Perrier, SMS Computing and Global Health • Phone messaging Lecture 6 • Messaging technologies Patient Support • Example Projects • Messaging studies Winter 2015 • Adherence Richard Anderson • Health information systems 2/11/2015 University of Washington, Winter 2015 1 2/11/2015 University of Washington, Winter 2015 2 Readings and Assignments Organization • SMS For Life • Patient support • WelTel Study • Treatment support • Iron Tablet Adherence • Worker support Study • Behavior Change Communication • Homework 6 – Design an SMS syntax for cold chain reporting 2/11/2015 University of Washington, Winter 2015 3 2/11/2015 University of Washington, Winter 2015 4 Patient Support Phone Messaging • Messaging • Different types of messaging – Spam – What is the intended behavior to be influenced – Reminders – What is the theory of behavior change – Interaction • Health knowledge – Adherence messaging • Promotion of a specific activity • Adherence (other than messaging) • Reminder of action • Information services • Interaction with health system 2/11/2015 University of Washington, Winter 2015 5 2/11/2015 University of Washington, Winter 2015 6 1
2/11/2015 Adherence Obstacles to Adherence • Medication • Why do people stop taking medication? – HIV ART – Tuberculosis – Diabetes – Iron Pills • Lifestyle – Diet – (Not) smoking 2/11/2015 University of Washington, Winter 2015 7 2/11/2015 University of Washington, Winter 2015 8 Reminders Technology • Appointment reminders • SMS, Voice, SmartPhone Apps, Social Media – ANC visits – TB Testing • Immunization reminders • Long term birth control 2/11/2015 University of Washington, Winter 2015 9 2/11/2015 University of Washington, Winter 2015 10 Personal mobile phones Mobile Phone Issues • Handsets • Mobile phones have tremendous reach, but – Generally available, prestige good – Vast variety in different situations • Airtime – Rapid change – Prepaid. Costs vary dramatically • Signal – Widely available, spotty coverage, no coverage • Electrical power – Depends on the electrical grid • Simcards • Monopolies 2/11/2015 University of Washington, Winter 2015 11 2/11/2015 University of Washington, Winter 2015 12 2
2/11/2015 Mobile Phones and Gender SMS • Available on almost all mobile phones • Phone ownership models • Restricted message length – Shared across household (less common) • Highly variable cost – Household phone – Individual phones – Although essentially no cost for carrier • Highly variable usage • Common practices – Different populations and countries – Men have better phones than women • Gateway Issues – Children have access to mothers phone • SPAM! 2/11/2015 University of Washington, Winter 2015 13 2/11/2015 University of Washington, Winter 2015 14 Voice Smartphone Apps and Social Media • Universal on phones • Applicability depends on demographics • IVR – Interactive Voice Response • Rapid change • Automated calls with recorded messages • For global health, often an • Callbacks triggered by missed call emphasis in reaching late adopters 2/11/2015 University of Washington, Winter 2015 15 2/11/2015 University of Washington, Winter 2015 16 Example projects Walter Curioso • Early work in SMS reminders in Latin America – Voxiva • Messages aimed at high risk populations to influence behavior • Many issues around confidentiality and privacy 2/11/2015 University of Washington, Winter 2015 17 2/11/2015 University of Washington, Winter 2015 18 3
2/11/2015 Mobile Technology for Community Text4Baby / MAMA Health (MOTECH) • Platform developed by Grameen Foundation with support from BMGF – Motechsuite.org • Evolving platform Free t4b msg: Morning sickness • Significant deployment through BMGF may be caused by a change in your hormones. Try eating grantees in Bihar crackers or dry cereal. Eat small meals often. Don’t go without • Initial work in Ghana eating. 2/11/2015 University of Washington, Winter 2015 19 2/11/2015 University of Washington, Winter 2015 20 MOTECH Architecture Motech Ghana • Initial deployment in Northern Ghana • Early version of Motech developed to support deployment • Maternal messaging and phones for nurses 2/11/2015 University of Washington, Winter 2015 21 2/11/2015 University of Washington, Winter 2015 22 Lessons learned Evaluation Studies • Very different approaches to evaluation based on discipline • Phones for nurses • Medical evaluation – Phone management and logistics – Define intervention – Nurses did not feel the phones helped them in – Construct study design reporting – Enroll study subjects in different arms • Messaging – Conduct study without further intervention • Computer Science – Voice, not SMS – Develop technology with initial field tests – Tremendous challenges in localization – Deploy technology in field with iterative adjustments • Expense for translation – Analysis of multiple sources of ad hoc data from deployment – Cost and sustainability challenges – Promote large scale deployment or use – Significant formative work in identifying needs 2/11/2015 University of Washington, Winter 2015 23 2/11/2015 University of Washington, Winter 2015 24 4
2/11/2015 WelTel Study WelTel Study • HIV Patients on ART • Simple intervention – Send patients a weekly SMS: Mambo – Patients respond: Sawa / Shida • Measured outcomes – Self reported adherence – Viral suppression 2/11/2015 University of Washington, Winter 2015 25 2/11/2015 University of Washington, Winter 2015 26 Adherence to Iron Pills Sian Hospital Study • High anemia rates, low utilization of iron pills • Evaluate if voice messaging improves – Pills available for free, but 70% of women fail to take adherence to taking pills them • Study goal – evaluate mHealth intervention • Forgetfulness, dislike of pills with measurable health outcome • Intervention – Recorded voice calls from doctor – Anemia is highly prevalent for low income women – Three messages per week in local language in India – Positive, affective messages – Simple treatment – iron pills – Measurable results – Hemoglobin test Hello, this is Dr . Niranjan Pai. We met in Sion Hospital. Your backache may increase. Don’t worry, take rest. Take the prescribed pills regularly as they are important for you and your child’s health. I will call you again in a couple of days. Thank you 2/11/2015 University of Washington, Winter 2015 27 2/11/2015 University of Washington, Winter 2015 28 Results How to do a literature review • Slight positive results, • Determine if there has treatment superior to been prior work on control, but not assessment of voice statistically significant based adherence • What went wrong support in developing – Study failed to enroll sufficient number of countries subjects who completed study On PubMed and IEEE Xplore, we included all studies that – Difficulty in following up to contained both an adherence keyword and a phone keyword in the title or abstract, with at least one of the keywords get final Hb appearing in the title. For adherence keywords, we used “adherence” , “adhere” , “adhered” , “compliance” , “comply” , – Early subjects had to be and “complied” . For phone keywords, we used “phone” , de-enrolled due to poor “phones” , “telephone” , “telephones” , “interactive voice” , quality Hb measurements “voice response” , “automated calls” , and “automated voice” . 2/11/2015 University of Washington, Winter 2015 29 2/11/2015 University of Washington, Winter 2015 30 5
2/11/2015 Adherence TB Drug Distribution • Direct Observation Therapy • Fingerprint scanning in drug distribution 2/11/2015 University of Washington, Winter 2015 31 2/11/2015 University of Washington, Winter 2015 32 SMS Reporting Pill box notifications • Send confirmation code associated with each pill 2/11/2015 University of Washington, Winter 2015 33 2/11/2015 University of Washington, Winter 2015 34 Health Information Awaaz De 2/11/2015 University of Washington, Winter 2015 35 2/11/2015 University of Washington, Winter 2015 36 6
2/11/2015 Health Line, Pakistan Next week • Voice based health information system • Treatment Support • Target low-literate users • Speech recognition research challenges 2/11/2015 University of Washington, Winter 2015 37 2/11/2015 University of Washington, Winter 2015 38 7
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