Mobile Health (mHealth)

Recently, mobile health, among other information and communication technologies (ICTs) for development, has been gaining interest. These tools hold the promise for bridging the digital divide – “the division between people who use modern digital tools and information services for personal and professional purposes and those who don’t.” ^[1] However, beyond just broadening access to information, what has become clear in recent years is that if disenfranchised users in rural areas of the developing world can adopt information tools and devices in a sustainable way, we can achieve various development objectives. ^[2] Mobile health applications in particular have shown promise to play a vital role in regional, community, and individual health. In this article we will discuss the role of mobile health applications in the rural developing world and their role in empowering various stakeholders within the healthcare system to have better access to health information and resources and ultimately empower providers and patients towards better health outcomes.

Situation Analysis

Mobile health relies on the use of small hand-held information tools, including mobile phones, which typically have a small-form factor, are battery-powered, and have connectivity through mobile carriers or radio networks. Mobile phone technology is extremely pervasive, with an estimated 3.3 billion people using mobile phones worldwide. ^[3] In the developing world, there is an estimated 33% penetration of mobile technology, with rates increasing to 90% in some high-risk urban populations. ^[3]

Through these devices patients, physicians, and other health knowledge workers interact with other health stakeholders over a number of mediums including SMS, email-based applications, and applications where patients interact with a system through a web-browser. ^[4] These applications span a variety of health domains including disaster aversion and mitigation, health promotion, health diagnosis and care, disease surveillance, and patient-to-provider communication.

One of the areas where mobile health seems to play a significant role in rural healthcare is in managing chronic diseases. Such diseases typically require a treatment regime over a long period of time and are addressed through broad based community health interventions. Establishing and maintaining a connection to patients over a long time period and across a distributed geographic area is necessary, although this is often difficult in rural areas of developing countries due to time, cost, and geographical barriers. With the advent of mobile health applications, preventative messaging has been used to help develop a culture of change and reject behaviors associated with for instance tobacco or diets high in fat and sugar. Overall, mobile health uses IT to bridge the geographical gap and deal with chronic cases that require complex interventions. Mobile health can facilitate ongoing interactions between patient and physician and encourage continuous care when face-to-face interaction is difficult.

There are a number of information modalities that these mobile devices enable. A summary of the applications of mobile health are listed below:

Social Networking: Social networking is typically used to create a virtual community and in the case of mobile health, elicit a community-based intervention. Sample interventions include disaster intervention, or warning systems, as well as systems which intend to build a culture-of-change and include preventative health messaging.

Web Surfing: Given the amount of content available online, web surfing in some cases can allow patients greater flexibility when trying to find an answer to health related queries. Various systems have been built specifically intended to be accesses through a mobile device and connect patient questions to health expert answers and advice.

Web-Based Learning: Web-based learning has also shown promise to help provide training to health workers operating in rural areas. Such applications remove constraints and limitations on the number of instructors, facilities, or lessons provided and allow instruction to reach a distributed user-audience. It also can allow training to become asynchronous – accessible at any location and time, and tailored to match the students time or skill-level limitations. Furthermore, these systems can reduce the costs associated with health worker training.

Web-based data entry: Many applications connecting physician to patient, or rural health worker to health facility require the collection and aggregation of various types of health data. Prior to mobile health, data was typically first written on paper and then inputted into health systems and their associated databases through manual data entry. Web-based data entry, through mobile devices, simplifies this process by allowing the user to enter data directly on their mobile device, thus increasing efficiency and reducing the cost of health record data entry and maintenance.

Major Players

mHealthAlliance: A collaborative effort formed in partnership by the United Nations, Rockefeller Foundation, and Vodafone Foundation to increase the impact and use of mobile health technologies in developing countries. The alliance provides leadership in the mobile health arena, a forum for global advocacy on use of technology, and facilitates partnerships on mobile health projects with both the public and private sector.

Open Mobile Consortium: A network of mobile technologists and developers who are leveraging open-source mobile solutions to improve humanitarian relief efforts. The consortium promotes data-sharing capabilities between member technologies and improve efficiency in development, roll-out and use of m-health technologies

OpenROSA: An organization of developers that creates open-source tools for collecting, aggregating, analyzing, and reporting mobile data. A variety of participants are involved in the consortium, including small private companies, Google, University of Bergen, Makerere University, and the University of Washington

Sample Case Study in Developing Nation

Project Masilukeke: A collaboration in South Africa between mobile phone operator MTN, the South African National AIDS Helpline, the National Geographic Society, and Nokia Systems Networks. The mission of the project is to educate South Africans about prevention for HIV and tuberculosis. Automatic text messages are generated about call centers where people can receive health information about HIV/AIDS.

Challenges

While mobile health applications in each of these domains promise added benefit, the risks associated with the implementation and usage of such systems must be monitored and minimized. Beyond technical risks including data input correctness, information security, and scalability in resource constrained environments, other risks include:

• Information literacy: misunderstanding or misinterpreting information presented in graphical or textual formats within the mobile health information system
• Incorrect information: incorrect data entry
• Loss of confidentiality: Access to patient data must not only be secured between information touch-points in the system, but insuring privacy to patient data between the different stakeholders who have access to the system is important.
• Loss of human interaction: In many cases mobile health systems help connect various health stakeholders together; in some cases physicians to patients in others, or perhaps patients to other patients or physicians to physicians. In any case, the mobile information system only ensures reliable information transfer between each user. What is more important is to ensure human-follow-up with the system – that interactions that begin with the system are recorded and maintained, and that those human interactions have follow through so that the patient is not left without proper case, or with misinformation.

External Links

• HealthAlliance: http://www.unfoundation.org/global-issues/technology/mhealth-alliance.html
• Open Mobile Consortium: http://www.open-mobile.org/
• OpenRosa: http://www.openrosa.org/

References

1. ↑ Tapan S. Parikh, Using Mobile Phones for Secure, Distributed Document Processing in the Developing World, IEEE Pervasive Computing Magazine, Vol. 4, No. 2, April 2000
2. ↑ Tapan S. Parikh, Paul Javid, Sasikumar K., Kaushik Ghosh and Kentaro Toyama, Mobile Phones and Paper Documents: Evaluating a New Approach for Capturing Microfinance Data in Rural India, ACM Conference on Computer-Human Interaction (CHI), April 24-27, 2006, Montreal, Canada
3. ↑ ^{3.0 3.1} Kahn, Yang and Kahn. “Mobile Health Needs and Opportunities in Developing Countries.” HEALTH AFFAIRS 29 No. 2 (2010): 254-261.
4. ↑ J. Lester Feder. FederCell-Phone Medicine Brings Care To Patients In Developing Nations