Tag: mhealth

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New mobile HEAT application

I’ve recently been rewriting the mobile HEAT application and I now have a first version ready for people to test out. You can get the app from Google Play for installing on you Android phone. As it’s just a first version, I’d really appreciate any feedback (either email me directly or post a comment below), which is also why I’ve just posted it up here, rather than making it available on the Google Play store – which I’ll do once it’s been tested a little more.

Few notes comments on how to use the app and what it does:

  • As with the previous version, you’ll need a MQuiz login account (though you can register for this directly in the app). So you do need an active internet connection on your phone for this step.
  • Unlike the previous version, this app comes with no course content. This was one of the main reasons for rewriting this app: to decouple the content from the app. So after you’ve first logged in, click on the ‘manage modules’ button and you can get a list of the available modules you can install, so you can select which content you’d like to download. You’ll also need an active internet connection for doing this, though I have built in a way in which you can just put the course package directly on the phone SD card and it will auto install.
  • Once you’re logged in and have downloaded some content, an active internet connection is no longer needed.
  • For testing out the video content (in the “video demo” course), the videos are not included in the course download package (as it makes the download packages too large). If you’d like to test the video content, please download the .m4v files and place them all in the /mtrain/media/ directory on the phone sd card.

There are 3 main areas I’d really appreciate feedback on:

  1. Tracking: as you navigate through the content (play videos and take assessment exercises) the app records your activity to submit back to the server (for example, so your course tutor/supervisor can see how you’re doing). The app tries to do this whenever you complete an activity (so connects to the internet at this point), but it may be that you’re offline at the time. Note that a text page is only considered as being completed if you have spent at least 3 seconds on the page before moving to the next one (to at least give some pretence that you may actually have read the content ;-)). To cover the possibility that you may be offline when using the app, but you still want your activity logged, the app also installs a service to try to connect once an hour to submit your activity, even if you’re not using the app. I’m a little unsure that this is the best approach, since I’m not too keen on applications connecting to the internet in the background, but I haven’t yet thought of a better way to handle this. I may just add a preference to allow you to decide if this service is allowed to connect or not. But any comments/thoughts on this appreciated.
  2. Navigation: once inside a course module, I’d like some feedback on the navigation between the activities for each section in the course. Currently you can’t see a full list of all the activities for a given section, without clicking on the previous/next arrow buttons, as I wanted to avoid the user needing to go through another list selection page to get to the activity, but I’m not sure that what I’ve done so far is quite right.
  3. App name: I’m not too keen on the app name ‘mTrain’, so any suggestions for alternative names welcome!

In the next days, for those of you who don’t have an Android phone to test this on, I’ll post up a video of the app in action.

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Health post map

The map below shows the health posts and centres we’re currently working with, there are a few missing as I’ve not got all the GPS coordinates yet, so I’ll add to these as soon as I get the data (and some photos too):

Field Report: Our recent experiences

The Health Extension Workers (HEWs) in our maternal healthcare project have now been using the smartphones for almost 6 months, so we’re starting to build up a really good picture about what works and where there are issues. Most of the information here is based on field reports Araya has been sending back following the training sessions he has been running and follow up discussions with the HEWs.

For the last 2 months (since mid-November), the HEWs have been using the phones for recording real patient encounters, previously they were submitting test data, whilst they got used to the phones and protocols. We now have around 200 patient encounters recorded from 10 HEWs and 2 Midwives, including 12 delivery records.

The feedback we have received from the HEWs and midwives has been very positive. They seem most comfortable using the Tigrinyan versions of the protocols, HEWs can switch between English and Tigrinyan and are free to enter text data in either Latin or Ge’ez script, although very few questions require any text input. The HEWs and mothers seem very happy with using the protocols, as it checks that all the right questions are being asked during the patient encounter.

From a technical point of view, the phones are working well. There are some times when the GPRS connection is poor, so the HEWs are unable to submit the records immediately, but they are able to once the connection is restored a day or so later. We don’t seem to have had any major problems regarding recharging of the phones, although some HEWs have commented that battery life can be poor.

The main issues we have come up against so far are:
Patient Identification. This was always going to be an issue, since there isn’t a standard regional/national patient record number we can readily use. Each Health Post records patient visits in a log book and the patient id is simply the number of the next row in their log book. To try to save confusion between patients having different references in the log book and the electronic protocols, we are identifying patients by a combination of the health post name and the id from the log book – which also makes it easier to cross-reference between the two systems. Unfortunately we are getting a number of cases where patient id numbers are being entered on the protocols inconsistently or incorrectly. This may cause a visit record to be recorded against a non-existent patient registration, or, worse, against the wrong patient. However we are recording the patient age and year of birth on every protocol form submitted, so this helps to identify where errors may have occurred, but would be good to try to stop this happening in the first place. We are looking at a variety of ways in which we can resolve this, for example barcodes or fingerprints, but none of these are easy to implement.

Length of Visits. Some HEWs have mentioned that using the protocols takes a long time. I think it was always likely that the protocol forms would increase the time for a patient encounter. Not necessarily solely due to the technology, but also because we are asking them to ask quite a comprehensive set of questions and a physical examination. Previously, without the electronic protocols, the patient encounters may not have been as thorough.
From the start/end times (automatically logged by the phones) we can identify roughly how long an ante-natal care visit takes a HEW to complete, for an ante-natal care first visit the average time for the patient encounter is around 20 minutes

HEW engagement. We have a wide disparity in the number of visit records being entered by different HEWs. Some are recording visits regularly, whereas others have hardly entered any. We are looking in to the reasons for this and how we can encourage those who aren’t participating to take a more active role. There are many possible reasons for this, perhaps technical issues, not understanding what advantages using the protocols may bring, or that they have been out of post on other training.

Over the coming few weeks we hope to find ways in which we can address these issues.

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