The Effects of amHealth Intervention on Asthma Symptom Control in Inner-City Teens

Lola Awoyinka^1
1Center for Health Enhancement System Studies, University of Wisconsin

Journal MTM 1:4S:27, 2012
DOI:10.7309/jmtm.49

Abstract

Smartphone based technology has emerged as a promising tool for facilitating behavioral change and promoting healthy choices. CHESS, an extensively investigated eHealth system designed to provide information, support, and decision making tools for individuals was adapted for smartphones and tailored for use by teens with a current diagnosis of asthma. The M-CHESS (Mobile asthma Comprehensive Health Enhancement Support System) application provided periodic asthma education, case management, an asthma action plan, and access to peers with the primary goal of helping the participants learn to better control their asthma symptoms.

218 inner-city adolescent Medicaid recipients were enrolled into the study. Participants were randomized to either a control group (n = 87) which received a smartphone and access to an asthma education website or to an intervention group (n = 131) that received a smartphone preinstalled with M-CHESS. Surveys – including the Asthma Control Test (ACT), a measure of how well an individual’s asthma symptoms are being managed – were administered throughout the intervention period to both the control and M-CHESS teens via the smartphones.

Initial analysis shows a significant effect of M-CHESS on the change in ACT scores across the first 60 days on study (p=.011). On average, the M-CHESS group showed a 2% improvement in ACT score per day of study over the control group. There was no significant difference between groups on the change in ACT score from month 2 to month 4. These results indicate that M-CHESS may be an effective intervention for teens who have trouble controlling their asthma symptoms. Ongoing analysis will examine whether the drop-off in improvement of symptom control is related to a decline in use of the M-CHESS application and attempt to identify specific subgroups for which M-CHESS may provide the greatest benefit in asthma symptom control.

Mobile phone ownership and widespread mHealth use in 168,231 women of reproductive age in rural Bangladesh

Alain B. Labrique,¹Shegufta S. Sikder,¹Sucheta Mehara,¹ LeeWu,¹ Rezwanul Huq,²  Hasmot Ali,²  Parul Christian,¹  Keith West^1
1 Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., Baltimore ² The JiVitA Maternal and Child Health Project. Godown Road, Poschim Para, Gaibandha Bangladesh

Journal MTM 1:4S:26, 2012
DOI:10.7309/jmtm.48

Abstract

As part of a rapid cross-sectional assessment of vital and health status among a cohort of approximately 650,000 people tracked under surveillance in a decades-long community research population, we sought to collect data on two critical mHealth indicators, in a typical rural South Asian setting. Between January and May 2012, field workers visited 143,239 households and interviewed 168,231 women of reproductive age. Of this, data on 37,979 has been entered, and is presented here. Women aged 15 to 45 were asked about household working phone ownership and their use of mobile phones during an emergency health situation (such as to call for medical advice, call a health provider, arrange transport, or ask for financial support). We found that 71% of surveyed women (n=25,577) reported household ownership of at least one working mobile phone, while 29% (n=10,577) of women reported none. Irrespective of phone ownership, 20% of all women surveyed (n=7,244) reported using a mobile phone for an emergency health situation. Of these women who used a phone for emergencies, 85% (n=6,169) owned a household phone. Women who owned phones were 2.8 times more likely (95%CI: 2.6 – 3.0) to use a phone for an emergency health situation than those who did not own phones. Surprisingly, household electricity was not a barrier to phone ownership or use, as only 23% (n=8,720) of surveyed women reported having electricity. In the absence of formal mHealth systems, nearly a quarter of women reported using a phone during an emergency health situation. This reflects a promising opportunity to harness these ubiquitous systems to inform, educate, and connect vulnerable women in rural populations to advice and care, when and where needed. mHealth interventions should still consider equity gaps that may persist in access to mobile phones in rural communities in South Asia, although ownership should not be a pre-requisite for access, given the current degree of penetration of mobile technology

Improving health awareness through mobile based health messages in Bangladesh

Mafruha Alam,¹Ananya Raihan,¹Atik Ahsan^1
1D. Net, Bangladesh

Journal MTM 1:4S:25, 2012
DOI:10.7309/jmtm.47

Abstract

Background: MAMA Bangladesh is poised to reach approximately 3 million pregnant women, new mothers and their families within 3 years of national scale service with voice (IVR) and text (SMS) messages and achieve sustained improvements in health knowledge, behaviors, and outcomes under the brand name “ Aponjon” (meaning the ‘trusted one’). During a successful pilot phase, “Aponjon” served 1403 subscribers in a few selected urban and rural areas of Bangladesh. A core research team had evaluated various aspects of the service before large scale roll out at a national level.

Purpose: Formative research attempted to evaluate and understand users’ acceptance level of the service, get closer understanding of willingness to pay for the service, understand role of community health workers and popular media campaigns in subscriber acquisition, analyze the mobile technology and regulatory landscape to run such an innovative mHealth service etc.

Method: Formative research collected feedback from 359 subscribers through extensive in-depth interviews, phone surveys, field visits and system generated reports.

Results: Receiving information through mobile phone was well accepted by women and gatekeepers. Women who were less educated chose to receive recorded voice messages while women who were educated chose text messages. Not all women had access to mobile phones, 41% of women depended on the handset of their family members. A significant number (53%) of gatekeepers opted to receive the service alongside the women. Families were following advice on immunization, nutrition, family planning, hygiene, breastfeeding and household healthy practices towards pregnant members, infants and mothers. Though trust on mobile content is high (91%) willingness to pay for mobile based messages is low across all socio-economic classes. Willingness to pay differs between women and gatekeepers; gatekeepers tend to pay more for the service as they control the phone bills.

Conclusion: Inclusion of gatekeepers/important family members in the service is essential both from the perspective of sustained behavioral change as well as additional revenue generation. Engaging community agents is an effective way of registering the underprivileged women in rural Bangladesh. Longer term financial sustainability would depend on successful implementation of a potential business model which suggest alternative source of revenue generation and cross subsidies.infrastructure to trace and bring patients back to treatment. Treatment outcomes, such as sputum-smear or culture, testing is low. Further research is needed to evaluate this interactive intervention’s potential.

TextTB: A parallel design randomized control pilot study to evaluate acceptance and feasibility of a patient-driven mobile phone based intervention to support adherence to TB treatment

Sarah Iribarren,¹ Christina Chirico,²  Mirta Echevarrria,²  Daniel Cardinali^2
1University of Utah, College of Nursing, USA, ²Health Region V TB Program, Hospital Dr A Cetrangolo, Argentina

Journal MTM 1:4S:23-24, 2012
DOI:10.7309/jmtm.46

Abstract

Background: Argentina’s treatment success rate remains well below the World Health Organization (WHO) TB key target of 85%, averaging 46% from 2008-2010. Few studies have applied mobile phone-based interventions for TB management. This study assessed feasibility, acceptance and explored the initial efficacy of a short message service (SMS)-based intervention to improve patient adherence and support TB patients in a setting where self-administration is the standard care.

Methods: Newly diagnosed TB patients were screened from November 2011 – September 2012 from a hospital-based outpatient clinic within a pulmonary specialized reference hospital in Argentina. Patients were randomized into control and intervention in a 1:1 allocation ratio in block randomization of 10. The intervention arm received standard of care plus a SMS-based intervention which included instructing patients to ‘text-in’ after self-administration of medication; reminders/check-in when patient did not ‘text in’; receipt of bi-weekly SMS education messages; and the option to consult during the first two month intensive treatment phase. Educational messages were selected based on the Informational-Motivational-Behavioral Skills Model. FrontlineSMS open-source software was used as the SMS platform. Semi-structured, in depth, individual interviews were conducted with 9 patients and 3 others responded to structured questions via text-messages. Outcomes of feasibility (e.g. number of potential participants with mobile phones), acceptability (e.g. participant and staff perceptions, type of messages) and initial efficacy (e.g. notification rates, sputum conversion) were assessed.

Results: Thirty-seven participants were enrolled from 122 screened, of whom 3 potential participants did not have access to a phone and 3 did not know how to send text message. Other feasibility issues included: varying mobile phone coverage (58% interviewed notified having some technical difficulties, e.g. missed sent/received messages), modem partially capturing data, feature limitations of FrontlineSMS (e.g. manual individual entry of each educational message, time stamp 2 hours early), computer security and challenges with infrastructure/staffing to track and bring patients who did not notify back to treatment. Most participants found intervention acceptable (82% would highly recommend to others), reported being “cared for” and “having a friend when all others wanted nothing to do with them” and that notifying made them feel that they were “responsible for their treatment”. Four participants were not included in final analysis (1 transferred care, 1 withdrew, 2 due to modem technical problems). Average notification rate (n=14) over 60-day period was 77% (22-100%), of those 83% (53-100%) notified without reminder. Running out of credit and technical difficulties were reported as reasons for missing notification. On average, participants texted in 2 questions (2-6) and 1.5 messages that reported side-effects (0-8). Only 15 (45%) had follow-up sputum smear or culture tests, the difference between groups was non-significant.

Conclusions: Mobile phones and text messaging was prevalent among potential participants making intervention contextually appropriate in this setting. Intervention was largely accepted. Feasibility issues may be improved with adjunct programs to manage educational texts, free-to-text in number and strengthening infrastructure to trace and bring patients back to treatment. Treatment outcomes, such as sputum-smear or culture, testing is low. Further research is needed to evaluate this interactive intervention’s potential.

Twitter + Health: The psychosocial impact of short-form text-based messages on wellbeing

Lauren Wagner^1
1University of Oxford, Oxford Internet Institute, Oxford UK

Journal MTM 1:4S:22, 2012
DOI:10.7309/jmtm.45

Abstract

Social relationships are one of the most well-documented psychosocial factors influencing physical and mental health. Benefits include decreased mortality and levels of distress, increased feelings of security, belonging, and self worth, and a source of regulation for maintaining healthy behaviors.

Over one billion people are a member of at least one online social network, designed to forge and maintain social ties, and 75% of the world’s population communicates through a mobile phone. This study quantifies how digital exchanges impact wellbeing and feelings of perceived social support among users. Hypotheses were tested using Twitter, the interactive microblogging service that is utilized on a mobile device by 300 million active users.

My research puts forth a new theory known as the theory of perceived companionship, concluding that short-form text-based communication presents unique affordances to facilitate the development of companionate relationships known to improve health. Hypotheses were tested with an online survey of 61 Twitter users, which evaluated network structure, expectations for interactions, and explicit reactions to digital correspondences along metrics known to boost wellbeing.

Results indicate that Twitter users are not directly connected through channels outside of Twitter but nonetheless accrue some personal benefit from interactions with these weak ties, especially during interactive exchanges such as retweets and replies. Reciprocal online interactions enhanced wellbeing for users, notably through a perceived boost when a tweet is acknowledged. In addition, subjects experienced feelings of heightened recognition, connectedness, and appreciation, especially in the retweet and reply scenarios.

By identifying digital interactions known to improve wellbeing, researchers and developers may employ these principles in order to configure interactions that consider the psychological impact of online use and advance its known benefits. The study underscores the influential role that interaction and social design plays in influencing user perception of digital conversationpartners and community, which promotes engagement and impacts user wellbeing.