Tuesday 8 June 2010

Mobile challenge from a diabetic project developed and implemented in Trinidad and Tobago region

In the workshop on Telemedicine in Tromso, Norway, a very lively and motivating speaker has challenged the mobile community, so feel free to think along and give possible references that could help her strengthen her fantastic doctoral research idea.

Her question in short: is there any research on best mobile design delivery that could benefit her mobile project on diabetes, so she can augment her mobile design as to better reach the users (diabetic patients) that are using mobile phones to monitor and keep track of their chronic diabetes health?
Does anyone know of research looking at mobile content design to improve mobile learning assimilation or outcomes? Feel free to drop me a line.

Link to her project: www.salys.org/research.html
Notes on her project (rough notes taken during her presentation of the project):

Mobile dsms: a mobile diabetes self-management system based on peer support by Salys Sultan
Type two diabetes is studied because it is a lifestyle disease
DSMS: which focuses on sustained support, but because it is too costly and time consuming for 1 on 1 patient doctor relation,

Why go for a mobile platform
Mobile phone is personal
Increasingly intelligent
Available anywhere and anytime
Push and pull model

This project came out of the medinet project (link to word document on the medinet project): carribean wide health project
Pilot study of Trinidad and Tobago islands
Bluetooth between blood pressure machine and sugar calculator machine and phone of the patiens
With feedback loop for the patients health
Every islands would have their own medinet architecture
Because of the age, a personal assistant was given to the patients to give support extra.

Peer based mobile DSMS
Heisler (2006) has shown that models that build on peer support have proven to be both successful and cost effective as they combine the traditional peer support.
Group services: contact members, post discussion forums, share results, arrange meetings (real life meetings)
Personal services: capturing observations of daily living 5ODL) readings, activity, food intake, location … and reviewing past results.

Research contributions
Social networking for health care
Health data visualization
Social aspects to motivate and sustain patient adherence
User interface design for the visual impaired

To learn relevant techniques to ensure the design of the design of the patient interface services this suitable for motivating and sustaining patient adherence
To establish a plan of action/way forward for scaling the medinet project


discussions will be put into categories for discussing
ante project: diverse feedback on mobile use of different age groups
keeping access under three clicks to get to needed information
privacy issues, you as a user says what you want to share

mobile systems used is the operational system of windows, this was done because of the Microsoft funding and giving software and phones.
Java phone option is also available.
The project started and was implemented completely from the Caribean region (great!)
Started with paper prototypes given to the users in order to build the DSMS software (which was build by S. Salys.

A bit more on the evaluation factors that they use in the peer-based mobile project:
Peer-based medical service for DSMS by S. Sultan
Each diabetic group: max 5, hoping sense of competition as well as community, amount of users: 25.

Main outcomes to measure: knowledge health status, system usage, social outcomes,
Did the users increase overall subject matter knowledge. Tool: diabetes knowledge questionnaire by America standard.
Is the phone a good tool for delivering health care

Health status: better self-management behavior, hopefully (with diabetes test to see how there overall health improve?
Result: is mobile tool as health care instrument effective in health

Social outcomes
Did you feel part of the group, activity logs, how much the group feature was used, analyse the logs to make sense of what we saw by qualitative surveys.

Overall objective: whether phone instruments can have a positive effect on health, effective health care instrument.

Algorithm on what effect the combination of the group has on the outcomes (is looking to build an algorithm to improve the outcomes, as part of her doctoral thesis – really interesting!!!)
The groups background was kept as simple as possible: limiting the groups to a similar knowledge of diabetes background (the users were taken from a known group of diabetes people, so they all had similar knowledge of diabetes and how to control it). As the users came from Trinidad and Tobago their economic and social background was almost similar.

Longterm view: ten years down the road.
The trial will depend on the funding available depending on the cost of the strips used in the diabetic analysis (always look at the completeness of the trial, to also include measurable effects: for instance 1 year for short outcomes, 2 year is ideal for getting research value also longterm). Currently it will be a 3 month test to look at possible effects.

The experimental design has come from literature review of existing diabetes/mobile projects.

Peer support as main topic: there are other diseases how telemedicine can be used for discussion forums 2 NST pHd’s working, one on breast cancer, and one on psychiatry and drug abuse). Maybe look at other chronic diseases?

If you study intervention, do NOT do anything else BUT the intervention.
AND if you plan a study take into account festival days (in case of diabetes), as there are 15 festivals in Trinidad Tobago region, and during these festivals everyone is really enjoying life 

Large gaps in mHealth: cost/benefits analysis and parameters suggested: usability, analyse major issues to include in the research using e.g. the physical systems that are already in place as informal observations moments, in the one on one environment an observer can look at the pick-up rate of the competencies (but most users prefer to start using the material once they are in their home, comfort zone). Health care is a private matter: people will change their behavior when they are observed, because of perceived expectations.

Design: text or text to switch (audio), but looking at mobile designs that could result in the best of outcomes.