The feasibility of using mobile phone technology for sexual behaviour research in a population vulnerable to HIV: a prospective survey with female sex workers in South India

Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review

Background

With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems.

Objective

We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature.

Methods

A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools.

Results

The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories.

Conclusions

In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.

Reliability of the revised Scoliosis Research Society-22 and Oswestry Disability Index (ODI) questionnaires in adult spinal deformity when administered by telephone

BACKGROUND CONTEXT

The non-response rates are as high as 20% to 50% after 5 years of follow-up in adult spinal deformity (ASD) surgery. Minimizing loss to follow-up is essential to protect the quality of data in long-term studies. Phone and internet administration of outcomes instruments has grown in popularity and has been found to not only provide a convenient way of collecting data, but also show improved response rates.

PURPOSE

The study aimed to examine the reliability of the revised Scoliosis Research Society-22 (SRS-22r) and the Oswestry Disability Index (ODI) questionnaires in ASD patients when administered by telephone.

STUDY DESIGN/SETTING

This is a single-center, randomized crossover phone validation of ASD patients.

PATIENT SAMPLE

The study included ASD patients presenting to a tertiary spine care center.

OUTCOME MEASURES

The outcome measures were ODI and SRS-22r.

METHODS

Forty-nine patients (mean age: 55.7 years) with ASD were randomized in a 1:1 ratio to either phone completion of the SRS-22r and ODI followed by in-office completion, or to in-office completion followed by phone completion. An interval of 2 to 4 weeks was placed between administrations of each version. A paired t test was used to assess the difference between the written and phone versions, and intraclass correlation coefficients were used to assess homogeneity. Finally, goodness-of-fit testing was used to assess version preference.

RESULTS

There was no significant difference between the phone and in-office versions of the SRS-22r (p=.174) or the ODI (p=.320). The intraclass correlation coefficients of the SRS-22r and ODI were 0.91 and 0.86, respectively. Completion over the phone was the most popular option (57% preferred phone, 29% preferred in-office, and 14% had no preference).

CONCLUSIONS

Phone administration of the SRS-22r and ODI to ASD patients provides a convenient and reliable tool for reducing loss of follow-up data.

Potential use of telephone surveys for non-communicable disease surveillance in developing countries: evidence from a national household survey in Lebanon

BACKGROUND

Given the worldwide proliferation of cellphones, this paper examines their potential use for the surveillance of non-communicable disease (NCD) risk factors in a Middle Eastern country.

METHODS

Data were derived from a national household survey of 2,656 adults (aged 18 years or older) in Lebanon in 2009. Responses to questions on phone ownership yielded two subsamples, the 'cell phone sample' (n = 1,404) and the 'any phone sample' (n = 2,158). Prevalence estimates of various socio-demographics and 11 key NCD risk factors and comorbidities were compared between each subsample and the overall household sample.

RESULTS

Adjusting for baseline age and sex distribution, no differences were observed for all NCD indicators when comparing either of subsamples to the overall household sample, except for binge drinking [(OR = 1.55, 95 % CI: 1.33-1.81) and (OR = 1.48, 95 % CI: 1.18-1.85) for 'cell phone subsample' and 'any phone subsample', respectively] and self-rated health (OR = 1.23, 95 % CI: 1.10-1.36) and (OR = 1.16, 95 % CI: 1.02-1.32), respectively). Differences in the odds of hyperlipidemia (OR = 1.27, 95 % CI: 1.06-1.51) was also found in the subsample of 'any phone' carriers.

CONCLUSIONS

Multi-mode telephone surveillance techniques provide viable alternative to face-to-face surveys in developing countries. Cell phones may also be useful for personalized public health and medical care interventions in young populations.

Feasibility and acceptability of cell phone diaries to measure HIV risk behavior among female sex workers

Individual, social, and structural factors affecting HIV risk behaviors among female sex workers (FSWs) are difficult to assess using retrospective surveys methods. To test the feasibility and acceptability of cell phone diaries to collect information about sexual events, we recruited 26 FSWs in Indianapolis, Indiana (US). Over 4 weeks, FSWs completed twice daily digital diaries about their mood, drug use, sexual interactions, and daily activities. Feasibility was assessed using repeated measures general linear modeling and descriptive statistics examined event-level contextual information and acceptability. Of 1,420 diaries expected, 90.3 % were completed by participants and compliance was stable over time (p > .05 for linear trend). Sexual behavior was captured in 22 % of diaries and participant satisfaction with diary data collection was high. These data provide insight into event-level factors impacting HIV risk among FSWs. We discuss implications for models of sexual behavior and individually tailored interventions to prevent HIV in this high-risk group.

Engaging Patients through Mobile Phones: Demonstrator Services, Success Factors, and Future Opportunities in Low and Middle-income Countries

OBJECTIVES

Evolving technology and infrastructure can benefit patients even in the poorest countries through mobile health (mHealth). Yet, what makes mobile-phone-based services succeed in low and middle-income countries (LMIC) and what opportunities does the future hold that still need to be studied. We showcase demonstrator services that leverage mobile phones in the hands of patients to promote health and facilitate health care.

METHODS

We surveyed the recent biomedical literature for demonstrator services that illustrate well-considered examples of mobile phone interventions for consumer health. We draw upon those examples to discuss enabling factors, scalability, reach, and potential of mHealth as well as obstacles in LMIC.

RESULTS

Among the 227 articles returned by a PubMed search, we identified 55 articles that describe services targeting health consumers equipped with mobile phones. From those articles, we showcase 19 as demonstrator services across clinical care, prevention, infectious diseases, and population health. Services range from education, reminders, reporting, and peer support, to epidemiologic reporting, and care management with phone communication and messages. Key achievements include timely adherence to treatment and appointments, clinical effectiveness of treatment reminders, increased vaccination coverage and uptake of screening, and capacity for efficient disease surveillance. We discuss methodologies of delivery and evaluation of mobile-phone-based mHealth in LMIC, including service design, social context, and environmental factors to success.

CONCLUSION

Demonstrated promises using mobile phones in the poorest countries encourage a future in which IMIA takes a lead role in leveraging mHealth for citizen empowerment through Consumer Health Informatics.

Future prospects of health management systems using cellular phones

BACKGROUND

Cellular phones enable communication between healthcare providers and patients for prevention, diagnosis, and treatment of diseases. However, few studies have examined the user-friendliness or effectiveness of cellular phone-based medical informatics (CPBMI) for healthcare.

MATERIALS AND METHODS

This study investigated the use of CPBMI to identify its current status within the medical field, advantages and disadvantages, practicability, clinical effectiveness, costs, and cost-saving potential.

RESULTS

CPBMI was validated in terms of practicality and provision of medical benefits. It is critical to use CPBMI in accordance with the different features of each disease and condition. Use of CPBMI is expected to be especially useful for patients with chronic disease.

CONCLUSIONS

We discussed the current status of the clinical use, benefits, and risks of CPBMI. CPBMI and information technology-based health management tools are anticipated to become useful and effective components of healthcare management in the future.

Studying alcohol use prior to sexual intercourse among female sex workers in eastern Indonesia

Researching female sex workers (FSWs) in Indonesia, where commercial sex tends to be hidden or undercover, is challenging but possible. This is even more challenging when it involves investigation of sensitive behaviors, such as their alcohol use, a known disinhibitor to risk behavior. The adoption of effective strategies is needed to increase response rates and improve data quality. This article describes procedures used to research FSWs' alcohol use during commercial sex in the Eastern part of Indonesia. Challenges, lessons learned, and recommendations for best practices are discussed.

Use of a novel technology to track adherence to product use in a microbicide trial of short duration (MTN-007)

Adherence measurement in microbicide trials is challenging. To decrease recall and social desirability bias, we used an interactive voice response system (IVR) in a rectal microbicide trial. Forty-six participants were asked to report product use daily for 1 week. Participants received an incentive per call plus a bonus for calling every day. We examined adherence to calling the IVR and to gel use; we compared the latter to applicator counts. Adherence to calling the IVR daily was high (mean = 89.9 %, SD = 20.7 %). Adherence to gel use per IVR was very good (mean = 90.7 %, SD = 19.1 %), and consistent with applicator counts in 80.4 % of cases. Neither adherence to calling nor gel use were associated with temporal factors like day calls started, number of days since first call, or weekday vs. weekend. Daily reporting allowed identification of irregular product use. IVR appears useful for daily reporting in brief trials.