The First HIFA SMART Goal: Mobile Healthcare Information For All

“By 2015, at least one telecoms provider, in at least one country, will endorse the vision of Healthcare Information For All, and will provide free access to essential healthcare knowledge in the local language, pre loaded on all new mobile phones they may sell and freely downloadable to all those who already have a mobile phone.”

Download the mHIFA flyer here

Trends and challenges for mHealth in developing countries. This overview focuses particularly on applications of mHealth to provide information about health and health care for the public, patients, lay carers and health professionals. Geoff Royston, September 2014 (PDF, 1Mb)

mHIFA research reveals lack of mobile access to health information in low-income countries

Dr. Christine Hagar, an assistant professor at the San José State University (SJSU) School of Library and Information Science, addressed the Healthcare Information For All by 2015 (HIFA2015) mHealth goal (mHIFA) during a poster showing at the 2014 BOBCATSSS conference in Barcelona. She explained the need for mobile access to healthcare information at the point of need in low-income countries where healthcare workers may not be available. You can view the poster here.

The research was also published in the journal Information Development, in September 2014:
Hagar C & Kartzinel H. Healthcare Information for All by 2015: Preliminary findings and future direction. Information Development 2014.

“Thousands of lives could be saved every day if all mobile phones had basic healthcare knowledge, including and especially first aid, maternal, and child health information” (HIFA2015).

The preliminary research findings revealed that of the 1,700 mHealth programs/projects scanned, there are very few [<1%] projects that empowered citizens in low-income countries with off-line information on their phones for them to consult as and when they need it.

The mHIFA SMART Goal was proposed and is led by the HIFA 2012-15 Challenge Working Group, which is specifically concerned with the health information needs of citizens, parents and children, in recognition of the huge (and largely unrealised) potential of mobile phones to meet basic healthcare information needs of citizens, parents and children. A concept note is available here

The mHIFA SMART Goal was ratified by the HIFA Steering Group on 24 April 2013. The mHIFA goal is loosely defined and open to interpretation. Our intention is to identify, monitor and stimulate any current and future initiatives by HIFA members and others, which may serve to meet the healthcare information needs of citizens, parents and families. The HIFA 2012-15 Challenge Working Group is not itself aiming to implement a practical initiative.

The role of the HIFA 2012-15 Challenge Working Group is to harness the power of our growing network to stimulate current and future initiatives by HIFA members and others. We are:
1. collecting information from HIFA members and others about relevant current and planned activities,
2. encouraging sharing of experience and lessons learned, and
3. agreeing indicators and monitor progress (see below).

We invite your comments and suggestions on what is currently being done already in relation to the mHIFA SMART Goal, and ideas on how we can accelerate progress. Please join the HIFA2015 forum and we shall collate your inputs.

We are grateful to Heather Kartzinel (Student) and Dr Christine Hagar (Assistant Professor) of the School of Library and Information Science, San Jose State University for their preliminary desk research (September 2013 – November 2013) presented here to identify existing relevant projects worldwide. The researchers identified only seven (less than 0.4%) relevant projects among an estimated total of 1500 mHealth projects in various directories and repostories – that’s only 0.4% of all mHealth projects. This indicates a serious lack of mhealth projects that empower people with the information they need to deal effectively with acute healthcare situations. By contrast, there is a plethora of projects that push health education messages to citizens (these projects are undoubtedly important, but arguably do little to empower citizens with as-needed information to guide first aid and decision-making in childhood illness).

Christine Hagar presented this work as a poster at the January 2014 BOBCATSSS International Library and Information Conference in Barcelona.

Contact: Neil Pakenham-Walsh (Acting Coordinator, mHIFA and HIFA 2012-15 Challenge Working Group): neil.pakenham-walsh AT ghi-net.org

Ensuring that mHealth applications provide essential healthcare information in low resource settings

A proposed framework by expert adviser Geoff Royston, April 2014 – click here for PDF version.

Introduction

The use of mobile communication technology is growing apace around the globe even – perhaps especially – in low resource settings. This offers the potential for major advances in the provision of essential – often life-saving – practical information about health and healthcare to “the bottom billion” who typically have poor access to health services but increasing access to mobile phones. Major mobile telecoms manufacturers and network operators are beginning to grasp this opportunity. Indeed the mHIFA goal challenges them to provide essential healthcare information on mobile phones without charge.

However, the successful delivery of mHealth programmes in low resource settings faces particular difficulties (see e.g. 1,2,3). Such difficulties have been strikingly evidenced by the recent survey by Kartzinel and Hagar (see above), conducted on behalf of HIFA which surveyed nearly 1700 mHealth projects, but found only 7 – less than 0.4% – that appeared well-aligned to the needs of users in low resource settings for essential, accessible and actionable information about health and health care.

This suggests that providers and potential providers of mHealth applications for supplying health and healthcare information in low resource settings would benefit from having an assessment tool that would indicate how well their application will meet users’ key needs. This should assist them to introduce successful new applications and to make desirable improvements to existing ones. Users and potential users also should find such a tool of value in deciding between applications. This article proposes some appropriate assessment criteria, describes how these could be operationalised in an assessment template that uses simple “traffic light” indicators, and illustrates its use with some real examples.

Requirements for action-oriented healthcare information

The provision of essential healthcare information to users is one piece of a complex jigsaw for empowering people to care better for themselves and their families. The jigsaw has been characterised by HIFA by the acronym SEISMIC (skills, equipment, information, structural support, medicines, incentives and communication facilities). Clearly, the more complete the jigsaw and the better its pieces fit together, the greater the chances of people taking appropriate and effective steps in caring for their health.

Taking that wider picture into account is important, but for mHealth the initial requirement is to focus on some more proximate factors. These will include not only technological but also cognitive and behavioural factors related to the comprehension, acceptance and use of information – for example information may not be accepted and used unless it is seen to be culturally appropriate. It will be important to draw upon current knowledge on what drives health-related behavior change, to ensure that information produces action.

The funnel diagram in Figure 1 below suggests a series of such factors, which can be regarded as a succession of filters all of which need to be passed through for a successful impact to be achieved.














Fig 1. A funnel diagram showing filters through all of which a mHealth application needs to pass to achieve HIFA aims (click on image to view).

A criterion set for mHealth information applications in low resource settings

From the above funnel diagram we can identify the following criteria and suggest some associated components:

• Significance of the health problem(s): Is the application focused on a significant health or healthcare problem – a widespread serious condition, or an emergency or urgent need?
• Appropriateness of the targeting: is the application aimed at use in low resource settings or by low income or other priority groups e.g. mother and child, health educators?
• Value of the information: Is the information relevant to users’ needs for addressing the health problem; is it reliable; can it be easily related to practical action?
• Ease of assimilation of the information: is the information presented in an appealing and easy to understand way such as a video; is it available in local language(s)?
• Availability of the application: is the application available across several regions or countries; is it available free to the user?
• Technological accessibility of the application: does it have a simple and intuitive user interface, is it accessible on a basic or featurephone; will it work “offline”; will it work on multiple operating systems; is it pre-loaded?

Clearly there is scope to add to or amend these criteria, for example some might prefer to take financial cost as a separate dimension, but the above should suffice for initial use of the approach.

A simple assessment template using “traffic light” indicators

To allow easy application of the set of criteria for assessment purposes a simple “traffic light“ indicator system is proposed, as shown in Figure 2 below. For each component of each criterion, attributes are described that broadly indicate increasing “fit” of an application to the achievement of HIFA goals. The attributes (of which there are generally three, occasionally two or four) are coded red, amber, or green, with red indicating poor alignment to HIFA goals, green a good fit and amber an intermediate match.




Fig 2. A template for assessing mHealth applications in relation to HIFA aims (click to view).

Illustration of the use of the assessment template

To illustrate the use of the assessment template, three mHealth applications – SmartHealth, HealthPhone and Safe Pregnancy and Birth, that are targeted at the provision of healthcare information in low resource settings, were assessed against the criteria. The results are shown in Figure 3.

Fig 3. Illustration of application of the assessment template

Fig 3. Illustration of application of the assessment template.










The results of such an assessment can be summarised by means of radar plots, as shown in Fig 4 below (the nearer to being completely shaded is the circle, the nearer to meeting HIFA aims is the application).

Fig 4. Illustrative summary assessments of SmartHealth, HealthPhone, and Safe Pregnancy and Birth.

Conclusions

It is noteworthy that the first example in Fig 4 above, whatever its merits in general, scores much less well in terms of its assessed relevance to the aims of Health Information for All than the second or third examples, despite it being supported by a vastly larger organisation. If mobile telecoms providers wish to develop health information applications that will be useful to and valued by the “bottom billion” that are becoming an increasingly important part of their customer base they must focus on what users in low-resource settings most need and can easily access and apply. Of particular importance will be to make use of what has been already learnt, from involving patients, carers, health workers, and other stakeholders in their co-production, about appropriate application features. Use of an assessment template along the lines of the one described here could assist that focus and help to provide the best foundation for their success.

References:
1. Tomlinson M et al, Scaling Up mHealth: where is the evidence? PLOS Medicine Feb 2013 10 (2) e1001382
2. Chakrabarti R, Perera C, The Growth of mHealth in Low Resource Settings. Journal of Mobile Technology in Medicine (2013) 2:1:1-­-2. DOI:10.7309/jmtm.75
3. The Netherlands Royal Tropical Institute (KIT) website at www.mhealthinfo.org focuses on this issue.
4. Assessment tools are of growing interest in mHealth more generally, see e.g. Powell AC, Landman AB and Bates DW, In search of a few good apps, JAMA online March 24 2014 doi 10.1001/jama 2014.2564
5. This article focuses on criteria of particular relevance to achievement of the HIFA aims, there are of course wider criteria, such as data security and privacy, that need to be considered when assessing mHealth applications.
6. SmartHealth , an initiative by Mobilium Global and Samsung, is a mobile app that provides information mainly on HIV/AIDS, TB and Malaria and also incorporates a mobile web based symptom checker. It is aimed at enhancing the health, health maintenance, health behaviors of individuals and their communities across Africa.
7. HealthPhone, a project of the Mother and Child Health Education Trust, is a personal video reference library and guide to better health and nutrition practices, for families and communities, including the illiterate, in their language, distributed on mobile phones.
8. Safe Pregnancy and Birth, from Hesperian, is a mobile app that provides health information that aims to support women, midwives and health workers to ensure safer pregnancies.

mHIFA Expert Advisers

Peter Benjamin is the coordinator for Capacity Building for the mHealth Alliance, and is currently based in Cape Town. Previously he was managing director of Cell-Life ( www.cell-life.org), South Africa. Professional interests: Using mobile technology to provide access to health information and services for the majority. In countries like South Africa, 90% of youth and adults have a cellphone. However, this is not well used as a channel to access healthcare. Mobile tech can become a way to get healthcare information that allows people to manage their own health (and their families). Mobile can also be the first point of contact with the health system – for health promotion & disease prevention; general health information and queries; triage services when there is a problem; linking & referral to health facilities; self-managed care for chronic conditions; maternal & child support; community monitoring of the health system.

Geoff Royston is an independent health analyst and researcher, former Head of Strategic Analysis and Operational Research in the Department of Health for England, and Past President of the UK Operational Research Society. His work has focused on informing the design, implementation and evaluation of policies and programmes in health and social care, and on fostering the capabilities of others to work in these areas. Associated activities have included modelling for understanding the performance of complex systems, analysis and communication of risk, and horizon scanning and futures thinking. He has also worked on information and communication technology in the health sector, notably in leading the design and national launch of the telephone and online health information and advice service NHS Direct. He has served on both scientific and medical UK Research Council panels, and as an impact assessor for the UK higher education Research Excellence Framework. He is a member of the editorial board for the journal Health Care Management Science and in 2012 was Guest Editor for its special issue on Global Health.?He has been a consultant for the World Health Organisation, is a long standing member of the EURO Working Group on Operational Research Applied to Health Services, and is an expert adviser to the mHIFA (mobile Health Information for All) 2015 programme. geoff.royston AT gmail.com