15 reports, peer-reviewed papers written about CommCare in 2014

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2014 was a big year for research on CommCare! Below is a list of 15 peer-reviewed publications and online reports that came out this year. Dimagi led some of this research, but the majority was led by our partners, including Pathfinder International, Catholic Relief Services, and University of Cape Town, in addition to independent research assistants. See below for all publications about CommCare this year, including short summaries. You can also check out the original CommCare Evidence Base here

Nicola Dell, Ian Francis, Haynes Sheppard, Raiva Simbi, Gaetano Borriello. Field Evaluation of a Camera-Based Mobile Health System in Low-Resource Settings. 16th International Conference on Human-Computer Interaction with Mobile Devices and Services (MobileHCI ’14). September 22-26 2014, Toronto, Canada. [Paper]

  • Over a two month period health workers captured and transmitted 1828 malaria tests using Commare with only 114 (6.2%) identified as having errors. The median time it took to capture and process the test and record patient data was 1.5 min. Strong agreement wsa demonstrated between the system’s computed diagnoses and trained health workers’ visual diagnoses, which suggests that the system could aid disease diagnosis in a variety of scenarios.

Bhavsar, M., Grijalva, K. From paper to Mobile: Design Considerations for Field Level Worker Programs. Mobile Communication For Development Conference. April 2014. Dakar, Senegal. [Paper]

  • Drawing from survey of 34 CommCare users in India to present a mobile design framework. Demonstrates that “when a mobile tool like CommCare is deployed, “the effect on the program extends beyond the tool, acting as a forcing function for wide program and organizational level change.”

Mobile Technology Strengthens Behavior Change Communication and Referrals by Community Health Workers for Maternal, Newborn, and Child Health in Rural Afghanistan. World Vision, 2014 [Report]

  • After 20 months in the intervention, mothers in the intervention areas were found more likely to have developed a birth plan (76% vs. 63%); to have had at least one a ANC)visit (73% vs. 53%); and to know at least two danger signs (71% vs. 58%), and delivered in a facility (58% vs. 47%).  Mothers in the intervention area were significantly more likely than mothers in the comparison group to have had a CHW coordinate referral to a facility (17% vs. 5%).

Anju Sinha. Feasibility of Cell Phones as Data Collection Tools in a Pediatric HIV Disease Burden Estimation Study in a District in India. IEA World Congress of Epidemiology. August 17-21, 2014, Anchorage, Alaska. [Poster]

  • Feasibility study of transitioning community-based studies from paper based forms to the use of CommCare as a data collection tool. CommCare was shown to improve data transfer in real time, and prompted reporting using SMS alerts.

Schuttner Linnaea, Sindano Ntazana, Theis Mathew, Zue Cory, Joseph Jessica, Chilengi Roma, Chi Benjamin H., Stringer Jeffrey S.A., and Chintu Namwinga. A Mobile Phone-Based, Community Health Worker Program for Referral, Follow-Up, and Service Outreach in Rural Zambia: Outcomes and Overview. Telemedicine and e-Health. August 2014, 20(8): 721-728. doi:10.1089/tmj.2013.0240. [Paper]

  • CommCare demonstrates feasibility of planned aspects of surveillance and outreach in  a clinical rural setting. From January to April 2011, 24 Community Health Workers (CHWs) surveyed 6,197 households with 33,305 inhabitants. Of 15,539 clinic visits, 1,173 (8%) had a follow-up visit indicated and transmitted via a mobile phone to designated CHWs. CHWs performed one or more follow-ups on 74% (n=871) of active requests and obtained outcomes on 63% (n=741). From all community visits combined, CHWs referred 840 individuals to a clinic.

R Kanter, J Alvey, D Fuentes. Creation of mobile-phone application for assessing supermarket offerings for Guatemalan-based exploration of the Nutrient Environment Measurement Survey-Stores (255.1). The FASEB Journal, April 2014.  [Paper]

  • The NEMS-S CommCare app provides for more rapid data collection, with equivalent reliability and validity when compared to the NEMS-S paper version. It has the advantages over a paper-based survey of  the capability of multiple languages and concomitant data entry

Surka S, Edirippulige S, Steyn K, Gaziano T, Puoane T, Levitt N. Evaluating the use of mobile phone technology to enhance cardiovascular disease screening by community health workers. Int J Med Inform.2014;83(9):648–654. doi: 10.1016/j.ijmedinf.2014.06.008. [Paper]

  • A study in South Africa found that FLWs that use paper- based tools during trainings for cardiovascular disease screening (CVD) took four times longer to complete than the trainings where FLWs used CommCare (12.25 hours compared to 3 hours). When it came to the actual screening of clients, it took FLWs using the paper tool an average of 36 minutes to complete one screening, compared to 21 minutes for a FLW using CommCare.

Mohamed, N., Lesh, N., Conte, F., & Findlater L. Using ICT4CHW To Influence Decision Makers. Mobile Communication For Development Conference. April 2014. Dakar, Senegal. [Paper, page 190]

  • A pilot project of 111 Accredited Health Social Activists (ASHAs) in Kaushambi, India found a 24% improvement in ASHAs’ knowledge of high impact maternal and newborn care interventions since first using CommCare five months earlier. It also demonstrated a 34% increase in FLWs who encouraged clients to use a health service, a 22% increase in FLWs who encouraged clients to ask questions or speak during visits, and a 25% increase in FLWs who waited for clients to respond to a question.

Todd A. Davidyock, Denis Rybin, Vikram S. Kumar, Pushwaz Virk, Davis Tang, Jeremey Wacksman, Gheorghe Doros, Anne Fuhlbrigge, George T. O’Connor. “Validation of ScreenFlow – A COPD Population Screening Instrument Using a Combination of a Questionnaire and Peak Expiratory Measurement.” Respiratory and Critical Care Medicine. 2014. [Paper]

  • CommCare was used to develop a COPD screening tool. A total of 190 subjects used the screening tool to diagnose COPD. The Screen instrument “had good discriminatory ability for subjects with moderate or worse COPD.”

McNabb, M., Chukwu, E., Ojo, O., Shekhar, N., Salami, H., Jega, F. Assessments of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study. Pathfinder International 2014. [Report]

  • Integrating CommCare lead to improvements in quality of ANC care by CHEWs, improved quality scores related to 2014 frequency that CHEWs performed technical aspects of care, and a strong effect on counseling provided by CHEWs. More specifically, CommCare increased the quality score for ANC visits from 13.3 at baseline to 17.2 at the endline (p<0.0001), out of a possible score of 25. The study cited that, with CommCare, there was an improvement and increase in CHEWs counseling beneficiaries and an increase in the frequency at which CHEWs performed more technical aspects of care.

Hoy R, Rubin J, Mitchell M, Using mobile technology to address the ‘three delays’ to reduce maternal mortality in Zanzibar,  (International Journal of User-Driven Healthcare, Jan 2014) [Paper]

  • This project used CommCare to deploy a system used by traditional birth attendants to address the three delays in two  districts in rural Zanzibar. Mobile phones provided: clinical algorithms to screen pregnant mothers for danger  signs; phone numbers and mobile banking to arrange and pay for transportation; and contacts for health facility staff to alert them of referrals. The intervention achieved a 71.0% facility delivery rate in the project zone, compared to the regional average of 32%

Nascimento, N., Cannon, M., Perales, N., Chariyeva, Z. Assessment of an mHealth initiative to improve patient retention. USAID, PEPFAR, Measure Evaluation. August 2014. [Report]

  • A study by MEASURE Evaluation in Mozambique found that CommCare was more efficient, effective, and cost-effective tool than traditional paper systems in conducting searches for HIV/AIDS patients that defaulted on their ARTs, missed appointments, or lab test dates.

Flaming, A., Khan, A. Interoperability of CommCare within India’s ASHA framework: a study of mobile health in Kishangarh block of Ajmera, Rajasthan. National Conference for Undergraduate Research. April, 3-5, 2014. [Paper]

  • CommCare strengthens ASHA workflow by improving ASHA performance, improving the ASHA-beneficiary interaction, changing 2014 health norms in community, and improving the monitoring of ASHAs within the health system.

Amoah, B., Arthur Anto, E., Crimi, A. Phone-based Prenatal Care for Communities and Remote Ultrasound Imaging. Mobile and Information Technologies in Medicine. November 20-21, 2014. [Paper]

  • The pilot project showed promising results by using an application for low-cost mobile phones and portable ultrasound machines. Proving professional monitoring and supervision in rural areas where ANC was previously difficult.

King, C., Hall, J., Banda, M., Beard, J., Bird, J., Kazembe, P., & Fottrell, E. (2014). Electronic data capture in a rural African setting: evaluating experiences with different systems in Malawi. Global Health Action, 7, 10.3402/gha.v7.25878. doi:10.3402/gha.v7.25878 [Paper]

  • CommCare was used in two prospective cohort research studies. The first investigated the relationships between pregnancy intentions and maternal and neonatal health. The second was investigating risks of treatment failure in community treatment of pneumonia in children.  CommCare was chosen specifically for these two projects because of the ‘case’ function which allowed multiple interviews to be reliably linked, as well as the child’s interviews to be linked to the mother’s in the first project.



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