Poor uptake by healthcare workers in mHealth pilot program

A pilot study of an app for mobile healthcare workers in a rural South African multidrug-resistant tuberculosis (MDR-TB) treatment program has valuable lessons for scaling new mHealth initiatives in other resource-constrained environments, concludes an article published in PLoS Medicine. The app, called Mobilize, electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.

In a seven-month pilot, the article's authors assessed the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and to evaluate mobile healthcare workers perceptions. However, according to the article, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers, who traveled daily to patient homes to administer and monitor therapy.

"This pilot experience demonstrated poor uptake by [healthcare workers] despite positive responses to using mHealth," states the article. "Though our results should be interpreted cautiously because of the small number of mobile [healthcare workers] and MDR-TB patients in this study, we recommend carefully exploring the motivations of [healthcare workers] and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings."

Mobile healthcare workers submitted nine of 33 (27 percent) expected adverse events forms, conflicting with qualitative results in which they stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. In addition, when presented with the conflict between their expressed views and actual practice, mobile healthcare workers cited forgetfulness and believed patients should take more responsibility for their own care, states the article.

"We were able to successfully train and deploy a customized mHealth program in a rural, resource-poor, sub-Saharan Africa setting with high acceptability and buy-in from clinical coordinators and health professionals but fell short of our goal to feasibly improve the quantity of adverse events monitoring," conclude the article's authors. "If mHealth is to assist, research should further explore the motivations of [healthcare workers] within the context of their workflow limitations and improved technology for closer, real-time performance monitoring to create a scalable intervention that is more likely to improve our awareness of adverse events that have occurred and then ultimately turn our focus towards properly managing these events."

In related news, mobile healthcare technology used to monitor patients in poor urban areas demonstrated that it can improve their access to care while reducing costs, according to a study commissioned by the New Cities Foundation, an international non-profit organization. In an 18-month pilot project undertaken in Brazil's Santa Marta, an underserved community of Rio de Janeiro, a clinic was provided with a backpack kit with portable diagnostic tools to track blood pressure, glucose levels, blood oxygenation, heart rate and other health measurements during weekly house calls for 100 elderly patients with chronic diseases and mobility problems. 

The backpack kit allowed clinic staff to provide fast and accurate on-site tests that led to improved treatment of high blood pressure, diabetes and other ailments. In addition, Brazil's public health system was able to save hundreds of thousands of dollars due to enhanced patient monitoring that led to better management of diseases.

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