Results of Communication Enhancement Used in eIMCI Decision Support for the Treatment of Children Under Five in Tanzania

Seneca Perri¹, Bethany Hedt², Thomas Routen³, AmaniShao⁴, Clotilde Rambaud-Althaus⁵, Ndeniria Swai⁶, Marc Mitchell^2
1University of Utah, Salt Lake City, UT, United States, ²Harvard School of Public Health, Boston, MA, United States, ³Thingsprime, Freiburg, Germany, ⁴National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania, ⁵Swiss Tropical and Public Health Institute, Basel, Switzerland, ⁶City Medical Office of Health, Dar es Salaam, United Republic of Tanzania

Journal MTM 1:4S:44, 2012
DOI:10.7309/jmtm.65

Abstract

The use of standardized decision support protocols have been shown to improve the quality of health service delivery in pediatric patients of low-resource populations if appropriately followed. However, even when clinical services are good, low levels of health literacy levels among caretakers of children may compromise the fulfillment of treatment plans. This study examines whether the use of mobile technology can improve the impact of counseling of children’s caretakers and result in better understanding of what needs to be done at home after the clinical visit and whether this results in better care of the child.

Utilizing mobile technology, we attempted to address the gap in communication during pediatric health care visits by incorporating specific, customized communication prompts into an eIMCI mobile decision support protocol. We utilized a randomized cluster design to include 310 participants from six municipal clinics in Dar es Salaam, Tanzania. The test arm of the study (electronic arm) included a 25-second video formatted for the mobile phone aimed at educating caretakers on relevant health information, embedded prompts within the protocol containing important messages for caretakers, and a customized summary screen compiling the results of the clinical encounter. The control arm (paper arm) provided equivalent information to the electronic counseling messages in written text as part of the protocol. The counseling delivered by health workers and resulting caretaker knowledge were evaluated by an observer and a short questionnaire of the caretakers after the clinic visit. Our research demonstrated that clinicians provided significantly more counseling to caretakers when using the electronic mobile protocol and caretakers were overall better able to recall what they were supposed to do when they returned home. We believe these results are highly valuable to the greater mHealth community seeking to improve the chain of health service delivery for low-resource populations.

Prescribe Wellness Automated Digital Intervention (ADI) Effectiveness to Increase Medication Adherence

Terry Olson^1
1Prescribe Wellness

Journal MTM 1:4S:43, 2012
DOI:10.7309/jmtm.64

Abstract

Medication non-adherence is pervasive within all areas of the U.S. health care system. Non-adherence has been estimated to range between 17 and 80%: involving 38% of patients on short-term treatment, 43% of patients on long-term treatment, and 75% of patients instructed to make a lifestyle change (DiMatteo, 1994). Approximately 133 million Americans, almost half of the country’s population, live with at least one chronic disease (CDC, 2010). It is estimated that by 2020, 164 million people will be diagnosed with a chronic disease, and 24% of all Americans will have two or more chronic conditions (CDC, 2010). Improving medication adherence can have a great potential to contribute to effective chronic disease state management and overall better health outcomes.

Prescribe Wellness, LLC partnered with leading local pharmacies in the Greater Los Angeles area to create a supplemental Automated Digital Intervention (ADI) to be used with patient-centered Medication Therapy Management (MTM) sessions. This proprietary first generation ADI template, aimed to increase medication adherence through the pharmacy’s intervention process, sends out appropriate motivational, behavioral, and educational messages through timely and relevant communications using the Voice of Authority (VOA).

The purpose of this quantitative study was to determine whether a relationship exists between the PrescribeWellness’ ADI and patient medication adherence. The relationship between variables was examined by implementing descriptive statistics and Chi-squared analysis. Pharmacy patients (n=12) were taken through a standard MTM session followed by ADI voice messaging during the subsequent 90-day period. Results showed there was an association between PrescribeWellness’ ADI and patient medication adherence, as medication adherence rates increased from 66.7% to 85.7%. Additional findings showed there was an increase in adherence rates for those patients with chronic conditions of hyperlipidemia (60% to 93.3%), hypertension (76.2% to 90.5%) and diabetes (47.6% to 57.1%).

A Qualitative Analysis of Emergency Department Patients’ Experiences with TExT-MED, a Text-message Based mHealth Program to Improve Diabetes Management

Elizabeth Burner,¹Sanjay Arora,¹  Elena Taylor,²  Michael Menchine^1
1Keck Medical School of USC Department of Emergency Medicine ²USC Memory and Aging Center

Journal MTM 1:4S:42, 2012
DOI:10.7309/jmtm.63

Abstract

Background: In the United States, diabetes plagues Latinos, and their diabetes can be difficult to manage due to cultural, language and access barriers. The extent of benefits from mHealth technologies to improve the management of diabetes among low-income Latinos is currently unknown. Understanding the complex changes to self-efficacy and health beliefs can be difficult to measure quantitatively, especially in minority populations were traditional health belief models may not translate well culturally.

Methods: A text-messaged based educational and motivational program designed to improve disease knowledge, self-efficacy and glycemic control among low-income, inner-city Latinos was piloted for feasibility. Self-efficacy, diabetes knowledge and frequency of healthy behaviors were measured at the start and end of the trial. Focus groups were then convened to explore patient experiences with the program, and the program’s impact on patients’ self-efficacy and health beliefs. The findings of these sessions were used to reanalyze the quantitative data measured previously in the study.

Results: 23 patients were recruited for the feasibility study. Through qualitative analysis, we found thatmen and women had different information sources and differing self-efficacy towards diet management. Using this knowledge, the quantitative data gather was stratified by gender, and differential changes were noted between genders in diabetes knowledge, self-efficacy and healthy food choices.

Conclusions: Men and women have differences in self-efficacy towards diet management and information sources. These differences may affect the effectiveness of mHealth interventions to improve diabetes. Gender and culture should be considered when designing interventions to achieve maximal impact.

Are We Sure That Mobile Health Is Really Mobile?

Brie Turner-Mc Grievy,¹Deborah Tate^1
[1]Department of Health Promotion, Education and Behaviour, Arnold School of Medicine, University of Southern California

Journal MTM 1:4S:41, 2012
DOI:10.7309/jmtm.62

Abstract

The “m” in mHealth is often thought of as the ability to receive health information and monitor behaviors on the go. The term “wireless” stands in for smartphones, tablets, etc. that can travel through time and space; while “wired” is the traditional desktop access method. Little is known about how people actually use mobile vs. traditional access methods. This study examines the results of 2 mobile weight loss interventions (Pounds Off Digitally (POD 1 and 2)) where participants were required to own a mobile device (POD1: Mp3 player; POD2: smartphone) for study entry and received weight loss information delivered via podcast. In POD1, participants were randomized to theory-based podcast (TPB) (n=41) or general weight loss podcast (n=37) conditions. In POD2, participants were randomized to either TPB (n=49) or TPB+mobile (a diet/PA app and Twitter app) (n=47). Examining data from both studies in aggregate, despite a mobile delivery method, 75% of participants accessed the podcasts at their home or work, 65% were sitting when listening, and 55% used a non-mobile device to access the podcasts (desktop computers). Examining objective download data for POD2, 49% of downloads (2889/5944) originated from non-mobile delivery methods (e.g., QuickTime) vs. mobile platforms (3055/5944). At 3 months, 46% of posts to Twitter originated from the web site (n=665 posts) vs. an app (n=540; 38%) or dashboard tool (e.g. TweetDeck) (n=233; 16%). Combining POD1 and 2, use of a mobile device for podcasts access was not related to % weight loss or podcasts downloaded at 3 months, but number of podcasts downloaded was related to % weight loss (β=-0.13; P<0.01). In conclusion, providing people with multiple platforms may be more important than providing only mobile options. Future studies should examine why people choose wired over wireless methods and how we can tailor delivery method to optimize use.

Using social networking technologies for mixed methods HIV prevention research

Sean D Young,¹Devan Jaganath^2
[1]Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA ²David Geffen School of Medicine, University of California, Los Angeles, CA, USA

Journal MTM 1:4S:40, 2012
DOI:10.7309/jmtm.61

Abstract

Background: Rapid growth in social networking usage, especially among at-risk populations, enables these technologies to be used as tools for mixed (qualitative and quantitative) methods HIV prevention research. We seek to analyze quantitative and qualitative data from a study-recruited social networking group to determine 1) participants willingness to use social networking technologies for HIV prevention research, 2) the topics and content discussed on social networking groups, and 3) the relationship between online discussions about HIV-related behaviors and actual HIV behavior change, among men who have sex with men (MSM).

Methods: Participants, primarily African American and Latino, were invited to join a “secret” Facebook group where participation was voluntary. Peer leaders, trained in HIV prevention, posted HIV-related content. Participant public group conversations were qualitatively and thematically analyzed. Multivariate quantitative methods tested associations between qualitative data, participants’ demographic information, and likelihood of requesting a home-based HIV testing kit.

Results: Latino and African-American participants (N=57) voluntarily used Facebook to discuss the following HIV-related topics (N=485 conversations): Prevention and Testing; Stigma; Knowledge; and Advocacy. Older participants more frequently discussed Prevention and Testing, Stigma, and Advocacy, and younger participants more frequently engaged in HIV Knowledge-related discussions. The proportion of messages related to Prevention and Testing and HIV Stigma increased during the course of the study. Results showed that participants posting about HIV Prevention and Testing (compared to those who did not) were significantly more likely to request an HIV testing kit (OR 11.14, p = 0.001).

Conclusions: Social networking technologies are engaging platforms that can be used for increasing HIV prevention-related conversations behaviors. Data from these technologies can be analyzed used both qualitative and quantitative methods.

I’ll text you if there’s a problem: How the Canadian Cancer Society used live text chat to help you g adults quit smoking

Trevorvan Mierlo,^1,2
1Evolution Health Systems Inc. ²Henley Business School, University of Reading

Journal MTM 1:4S:39, 2012
DOI:10.7309/jmtm.60

Abstract

Background: Smoking rates are higher among young adults, especially in Quebec where 30% of 18-24 year-olds smoke. In 2010-2011, the Canadian Cancer Society (CCS) Quebec Division launched Phase I of SMAT (Service de Messageiretexte pour Arrêter le Tabac), which utilized proactive and reactive text messaging to promote cessation. Based on the success of Phase I, CCS Quebec launched Phase II in December 2011 adding live expert text chat.

Purpose: To test feasibility and outcomes of a proactive and reactive text messaging smoking cessation service including live text chat support by trained Quit Specialists.
MethodsText and Chat Integrated (TaChI) enabled telephone Quit Specialists to simultaneously coach multiple participants.

Results: Out of 994 participants 51% were male (n=508). 40.5% (n=403) were between 18-24 and 22.1% were full time students. On average, participants smoked 17 cigarettes per day for 12.3 years.

A total of 42,613 algorithm-based proactive messages were sent to participants.

65% (n=651) of participants used the reactive keyword text service, with equal usage by men and women. Keyword users tended to be younger (28 years) than non-keyword users (34 years), with the most popular keywords “distraction”, “envie” (translation: craving), and “stress” sent 825, 791 and 690 times, respectively.
A total of 1,099 text-chats occurred, with 38% (n=374) using the text-chat service at least once. Slightly more women 52% (n=196) than men 48% (n=178) chatted with a Quit Specialist.
Complete self-report cessation data is being collected. To date, 28% of respondents (8% of total participants) indicated via text survey that they had quit smoking.

Conclusions: Interactive features of the SMAT program (reactive messaging and text chat) were especially engaging, particularly among younger demographics. In order to remain relevant and efficient, cessation services must quickly react to the rapid adoption of new technological modalities. Limitations and future directions will be discussed.