Mobile Technology As A Promising Tool For Health Research In The Social Sciences

Marcos  Reyes-Estrada¹, MarinildaRivera-Diaz²,NelsonVaras-Diaz^2
1Ponce School of Medicine and Health Science, Pontifical Catholic University of Puerto Rico, Puerto Rico²University of Puerto Rico, Puerto Rico

Journal MTM 1:4S:2, 2012
DOI:10.7309/jmtm.26

Abstract

Background: Mobile technology has revolutionized the way that behavioral scientists collect, store, and analyze data (Press, 2011). Recent literature has begun to point out the effectiveness of this technology for research in health scenarios (Miller, 2011). Therefore, researchers need to continue exploring the use of specific mobile technology and its relevance to the study of health related issues, particularly physician/patient interactions.

Purpose: The purpose of our study was to document the behavioral manifestations of HIV/AIDS-related stigma in physician/patient interactions.

Methods: In order to achieve the aims of this study, a sequential mix method approach using focus groups and standardized patient technology was implemented. The qualitative phase included 9-focus group composed of 66 participants with an HIV/AIDS diagnosis. A qualitative analysis using iAnnotate-application on the iPad allowed the development of a behavioral manifestation of HIV/AIDS-related Stigma Inventory (BMHASI). The quantitative phase was based on three HIV/AIDS case simulations, which generated 91 video recordings of patient/physician interactions, and the administration of a previously validated scale to assess HIV/AIDS-related stigma attitudes. The stigma scales were completed in vivo by medical students using the iSurvey application on the iPad. Standardized patients also completed the BMHASI. In the third phase, six researchers use the BMHASI developed on iSurvey to evaluate the 91 medical interactions between the medical students and standardized patients.

Results: The preliminary analysis identified eight stigmatizing behaviors manifested by medical students during simulated interactions including: avoid shaking hands to the patient, avoid physical contact needed to perform physical examination required by medical protocol, and excessive physical distance.

Conclusions: The iPad is an emergent and valuable research tool for the behavioral sciences field with great potential for documenting socially stigmatized interactions in the health scenario.

WelTel Retain: A randomized controlled trial protocol of a text-messaging intervention to improve patient retention in pre-antiretroviral therapy HIV care

Mia Van Der Kop¹, DavidOjakaa²,Lennie Bazira², LehanaThabane³,LilianMbau²,HelenGakuruh² Koki Kinagwi², Edward Mills⁴, Carlo Marra⁵, Richard Lester⁵,

¹University of British Columbia Centre for Disease Control, Vancouver, Canada,  ² African Medical and Research Foundation, Nairobi, Kenya ³McMaster University, Hamilton,Canada⁴University of Ottawa, Ottawa, Canada⁵University of British Columbia, Vancouver,  Canada

Journal MTM 1:4S:1, 2012

DOI:10.7309/jmtm.25

Abstract

High levels of patient retention after first clinical contact contribute to the timely initiation of antiretroviral therapy (ART) and better health outcomes. In Kenya (WelTel Kenya1), a weekly short message service (SMS) text message led to improved ART adherence and viral load suppression.

The objectives of this study are to: 1) determine if the WelTel intervention improves retention in Stage 1 HIV care (patient receives CD4 count results); 2) determine whether the WelTel intervention improves 12-month retention; and 3) evaluate the cost-effectiveness of the WelTel intervention.

A randomized controlled trial will be conducted at the Kibera Community Health Centre in Nairobi, Kenya. Over one year, HIV positive individuals newly enrolling at the clinic will be recruited and randomly allocated to an intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive a weekly SMS ‘check-in’ to which they will be required to respond within 48 hours. An HIV clinician will follow-up and triage any problems that are identified. Patients will be followed for one year, with a primary endpoint of retention in care at 12 months.

This study is in a pre-enrolment phase; a recruitment target of 686 participants provides 80% power to detect a proportionate difference of 15% in the primary outcome (alpha=0.05). Data will be analyzed according to intention to treat principles. Chi-squared tests will be used for categorical outcomes; and t-tests or Mann-Whitney U tests for continuous outcomes.

The WelTel Retain trial will contribute important information on the effectiveness of an established mHealth intervention to engage patients in care during the first year of HIV care, before initiating ART. Trial results and cost-effectiveness evaluation will inform how WelTel might contribute to the long-term success of PEPFAR-funded programs and towards a sustainable global HIV/AIDS response