groups » Trial Management » May Issue of the Month - Using Technology (all types!) for Global Health Research, what are your experiences?
Technology is used throughout most steps of health research – whether it’s data management, mobile data capture, eCRFs, creating an online presence for your research site, using an online tool to write a protocol, eLearning and eTraining, cloud storage of documents, even just emailing other staff – and all manner of other things. Of course, with technology there are inevitably problems which will arise, particularly in developing countries.
This month, we’re discussing technology in global health research in the broadest sense, and we’re interested to hear about your experiences and any problems you’ve faced. Mike Workman of the South African faculty group has written a fantastic article (which you can find here: http://globalhealthtrials.tghn.org/articles/technology-issues-research-remote-areasdeveloping-regions/) about the considerations that need to be taken into account when planning trials in developing regions – everything from the relative cost of equipment in different locations, to network capacities and computer literacy.
We were also interested to find this article in PLoS, ‘An Introduction to Social Media for Scientists’ (http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1001535). This article explains how to use social media, and which applications should be used for which functions: when facebook groups are applicable versus twitter, for example. Using social media can be a very useful way of engaging with an audience and sharing content and news.
We are interested to hear your experiences of using technology. Where do you think the particular limitations lie for global health? Have you tried to run an mHealth study, perhaps? Have you found it easy to train your staff via online training tools? Have you set up a website for your research site – was it difficult to do this and keep it maintained?
Please share your experiences! If Global Health Trials members want, we can aim to get expert advice to help to overcome any problems you need advice on. Please let us know what you think.
I cannot add anything to Mike's article, which is quite complete. However, I would like to draw the attention to a very interesting paper of Howitt el al, "Technologies for global health", published in 2012 (The Lancet, Volume 380, Issue 9840, Pages 507 - 535, 4 August 2012. doi:10.1016/S0140-6736(12)61127-1).
A new Commission examined how medical technology should best be used to improve health in low- and middle-income countries. The report concluded (http://www.thelancet.com/commissions/technologies-for-global-health) that instead of relying on hand-me-down technologies from wealthier countries, which can be costly, inappropriate for local conditions, and even dangerous, a renewed effort is needed towards developing what they call "frugal technologies"—cost-effective technologies that are developed specifically to cope in local conditions.
Even if this is related to medical technology and not to research as such, some of these concepts could/should drive also our reflection,
Reading Mike's article reminded me of some of the issues we had to deal with during the CAMPS trial (text messaging for adherence to HIV medication): network failures, cellphones missing, inability to use the text messaging function, etc. Moving a step forward, once we have successfully initiated remote communication with our clients, are we ready to deal with the feedback? This is an opportunity for clients to express unmet needs via novel means of communication. I would like to share some of these issues identified in a recently published manuscript related to the CAMPS trial(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635937/).
Thanks Lawrence, I find it very encouraging that people are looking to use mobile phones in innovative ways. However, I do have a problem with how many initiatives for Africa target SMS messaging.
First and foremost is literacy - as the CAMPS artice says, your inclusion criteria was'...who could read text messages...', and then there was a choice of '...English or French...'. I do not know Cameroon demographics, but what proportion of the population can read English or French?
To me, the advantage for Africa of the mobile phone is that it is a telephone - an audio channel can reach people that are excluded from text messages. It does not have to be a one-on-one conversation, but voice messages can reach many more people.
Secondly, SMS delivery is not guaranteed. The 'Class of Service' is 'Best Effort' and if the networks are unreliable or overloaded, SMS messages are delivered hours later, or even dropped by the network. First world networks almost never delay or drop messages, but its quite common in Africa.
And I see you recognise that the service may not be affordable. A toll-free number can lead to nuisance calls, so an option may be the 'Please call me' service (I don't know if it is available in Cameroon) where the participant sends a preprogrammed free SMS to a specified number asking to be called in return. This could enable you to reach many more people.
So although the Denmark asthma study shows an increased adherence when SMS reminders are sent, your study shows we cannot just apply such results in Africa.
Thanks for that brief eye opener analysis. I agree with you about the unreliability of telephone service providers in Africa. poor networks, overloaded servoers etc have been at the root of delayed delivery of mesages many people in Cameroon compain of today. Missed calls are even sometimes seen later than the time of the call, oftsen eliciting unitended responses.
Yes, In Cameroon, the majority speak french (eihght of ten regions), although in five regions, french is not the principal panguage (fofoulde in three northern regions and english in two anglosaxon regions. Because of the dominance of french in almost all aspects of corporate public life, almost everyone interacts in french at some point in time, either chasing files in the public service, finding better job in economic capital or attending higher education in schools offering professional training often incligned to french language).
The call me back service exist and is an opportunity to reach lot more people if harnessed. An operations research is being planned on how mobile technology can enhance uptake, adherence and use of rapid diagnostic tests for malaria for community management of fevers and malaria with expensive artemisnin based therapy. I will keenly follow the nature of mobile intervention that will finally be implemented for the scale up. Any ideas on what can be fitting? Just to mention that one issue to deal with include the reliability of network and communication services by network providers.
Dear all, thanks for this discussion. I just wanted to post about a new initiative on the Global Health Network which may help with at least one aspect of technological difficulties, which is promoting research sites online so as to find new researsch collaborations. The Global Health Network has just launched Site-Finder, a The Global Health Network announces the launch of 'Site-Finder', a free and open access online facility which enables research sites to promote themselves to potential collaborators and sponsors. In parallel, research groups planning studies can let others know about their ideas and that they are looking for others to work with. Sponsors with trials can also conduct highly detailed and informative searches for trial sites that are tailored to their specific needs. Using technology adapted from dating websites, Site-Finder will automatically suggest suitable collaborations, and will inform sites of new studies which are relevant to them. We have heard from so many research sites that finding collaborations, whether that's with a University, Industry, an NGO, or other research sites, can be really problematic - and that not having consistent research collaborations on the go can mean that valuable staff members are lost at the end of contracts. We hope that facilitating research collaborations through Site-Finder will really help to overcome this problem.
To view more information, you can visit the site at www.site-finder.org.
I am involved with a company in Uganda, which developed an extensive health information management system. The system is used by both the research community and the private sector. The system has incorporated figure-print verification, to ensure that the correct patient is treated, this also facilitates the retrieval of the electronic medical record.
Some benefits of the system are that records are more legible than handwritten notes, which eliminates drug mix-ups, omission of key data, and miscommunication. There is less, and at some facilities, no paper being handled, which means charts and medical records are never, this also means less storage room is required.
Users have also found that the system extremely valuable in the generation of reports for the Ministry of health, Pepfar, etc. It has streamlined and expedited a once manual process, and produces more accurate data. It is easy to review demographic data, and monitor drug compliance, adherence to visit windows, etc
Similar challenges, as those stated in the articles were also observed, such as user computer literacy, power outages, network reliability, but most of them can be addressed, and the user dependency and acceptance of the system has been remarkable, especially in the rural areas, where some of the people including the hospital staff, only started to use computers about three years ago. The learning curve was steep, especially with regards to password protection, but the enthusiasm to embrace the technology was evident.
Great efforts. Weldon. I am so sure that technological advancement will surely have a great impact on clinical research , the quality of data and full adherence to research protocol. I am sure that very soon devices that will monitor PIs at various sites shall soon be developed.
You have so nicely put the case for the HIMS appliace. Can we know what nature tha appliance take and what energy requirements are imposed? a link?