Recap of Dimagi's 2012 Publications

Over the course of 2012, Dimagi had several papers published about our technologies. Below is a list of  paper summaries from all of our 2012 publications.

“Text Messaging to Improve Attendance at Post-Operative Clinic Visits after Adult Male Circumcision for HIV Prevention: A Randomized Controlled Trial.” Following male circumcision for HIV prevention, a high proportion of men fail to return for their scheduled seven-day post-operative visit. We evaluated the effect of short message service (SMS) text messages on attendance at this important visit. Text messaging resulted in a modest improvement in attendance at the 7-day post-operative clinic visit following adult male circumcision. Factors associated with failure to return were mainly structural, and included transportation costs and low educational level. [Website]

“Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: a cross sectional study for development and validation.” The goal of this study was to develop and evaluate a screening protocol to determine which HIV infected patients needed a full clinical assessment and which patients were stable enough to receive their medications without a doctor’s consultation. For this study, we developed an electronic, handheld tool to guide non-physician counselors through screening questions. The final screening protocol is highly sensitive and could reduce burden on ART clinicians by 30%. The uptake and acceptance of the handheld tool to support implementation of the protocol was high. Further examination of the data reveals several important questions to include in future referral algorithms to improve sensitivity and specificity. Based on these results, we identify a refined algorithm to explore in future evaluations. [Website]

“Optimizing network connectivity for mobile health technologies in sub-Saharan Africa.” Network reliability across large catchment areas can be a major challenge. We performed an analysis of network failure frequency as part of a study of real-time adherence monitoring in rural Uganda. We hypothesized that the addition of short messaging service (SMS+GPRS) to the standard cellular network modality (GPRS) would reduce network disruptions and improve transmission of data. Addition of SMS to standard GPRS cellular network connectivity can significantly reduce network connection failures for mobile health applications in remote areas. Projects depending on mobile health data in resource-limited settings should consider this upgrade to optimize mHealth applications. [Website]

“Strengthening Community Health Systems with Localized Multimedia.” Many ICT systems are currently used to support Community Health Workers (CHWs) in impoverished populations. However, the majority of these systems are textbased, making them difficult to use in areas of low literacy. We have added multimedia to one such system, CommCare, to aid CHWs in counseling clients and promoting healthy behaviors in their communities. This paper explores the benefits and challenges introduced by using multimedia CommCare through a qualitative review of CHW/client interactions and implementer interviews. We find that multimedia increases client engagement as well as CHW credibility and suggest identifying an engaging speaker and determining optimal audio message length as potential strategies for creating effective multimedia. [PDF]

“CommCare: Evaluation of a mobile application for maternal health.” This paper describes a user experience research study conducted over 10 weeks to evaluate CommCare, a mobile phone based job aid for community health workers in rural India called Accredited Social Health Activists (ASHAs). User experience research studies seek to evaluate a given technology from the perspective of the experience of the “user” of said technology. CommCare was employed by accredited Social Health Activists (ASHAs) in a behavioral intervention to persuade pregnant women and their families to adopt recommended maternal health practices.[PDF]

“Mobile phones for community health workers of Bihar empower adolescent girls.” A brief description of how CommCare is being used in Bihar to empower adolescent girls, featured in the WHO Southeast Asia Journal of Public Health. [PDF]

“Combating Rural Child Malnutrition through Inexpensive Mobile Phones.” Most organizations in the developing world still rely on paper for record keeping, giving rise to many problems in aggregation, storage, transmission and analysis of data. Errors and time delays associated with paper data are particularly problematic in the domain of healthcare. Through a three-month unsupervised field trial with ten rural health workers, we report data management gains from adopting CommCare in terms of data quality, completeness and timeliness for 836 recorded patient cases, and demonstrate strong preference of the system by health workers. We found that the motivation for use and acceptance of the system was tied to respect and social power in local communities associated with using the device, as well as non-work-related uses of the phone. [PDF]

“Automated quality control for mobile data collection.” Systematic interviewer error is a potential issue in any health survey, and it can be especially pernicious in low- and middle-income countries, where survey teams may face problems of limited supervision, chaotic environments, language barriers, and low literacy. Survey teams in such environments could benefit from software that leverages mobile data collection tools to provide solutions for automated data quality control. As a first step in the creation of such software, we investigate and test several algorithms that find anomalous patterns in data. We demonstrate the feasibility of tools for automated data quality control by showing that the algorithms detect the fake data in the labeled set with a high sensitivity and specificity, and that they detect compelling anomalies in the unlabeled sets. [Website]

“Improving community health worker performance through automated SMS.” Community health workers (CHWs) have been shown to be an effective and powerful intervention for improving community health. Despite these benefits, many challenges, including supervision and support, make CHW programs difficult to maintain. Taking advantage of the potential of mobiel tools, we evaluated the impact of SMS reminders to improve the promptness of routine CHW visits, first in a pilot study in Dodoma, Tanzania, followed by two larger studies with 87 CHWs in Dar es Salaam, Tanzania.  The reminders resulted in an 86% reduction in the average number of days a CHW’s clients were overdue (9.7 to 1.4 days), with only a small number of cases ever escalating to the supervisor. However, when the step of escalating to the supervisor was removed in the second study, CHW performance significantly decreased. [Website]