scholarly journals Mobile Health Systems for Community-Based Primary Care: Identifying Controls and Mitigating Privacy Threats (Preprint)

2018 ◽  
Author(s):  
Leonardo Horn Iwaya ◽  
Simone Fischer-Hübner ◽  
Rose-Mharie Åhlfeldt ◽  
Leonardo A Martucci
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Mobile Health ◽  
Data Protection ◽  
Large Scale ◽  
Health Workers ◽  
Careful Consideration ◽  
Mitigation Strategies ◽  
Community Based ◽  
Privacy And Security

BACKGROUND Community-based primary care focuses on health promotion, awareness raising, and illnesses treatment and prevention in individuals, groups, and communities. Community Health Workers (CHWs) are the leading actors in such programs, helping to bridge the gap between the population and the health system. Many mobile health (mHealth) initiatives have been undertaken to empower CHWs and improve the data collection process in the primary care, replacing archaic paper-based approaches. A special category of mHealth apps, known as mHealth Data Collection Systems (MDCSs), is often used for such tasks. These systems process highly sensitive personal health data of entire communities so that a careful consideration about privacy is paramount for any successful deployment. However, the mHealth literature still lacks methodologically rigorous analyses for privacy and data protection. OBJECTIVE In this paper, a Privacy Impact Assessment (PIA) for MDCSs is presented, providing a systematic identification and evaluation of potential privacy risks, particularly emphasizing controls and mitigation strategies to handle negative privacy impacts. METHODS The privacy analysis follows a systematic methodology for PIAs. As a case study, we adopt the GeoHealth system, a large-scale MDCS used by CHWs in the Family Health Strategy, the Brazilian program for delivering community-based primary care. All the PIA steps were taken on the basis of discussions among the researchers (privacy and security experts). The identification of threats and controls was decided particularly on the basis of literature reviews and working group meetings among the group. Moreover, we also received feedback from specialists in primary care and software developers of other similar MDCSs in Brazil. RESULTS The GeoHealth PIA is based on 8 Privacy Principles and 26 Privacy Targets derived from the European General Data Protection Regulation. Associated with that, 22 threat groups with a total of 97 subthreats and 41 recommended controls were identified. Among the main findings, we observed that privacy principles can be enhanced on existing MDCSs with controls for managing consent, transparency, intervenability, and data minimization. CONCLUSIONS Although there has been significant research that deals with data security issues, attention to privacy in its multiple dimensions is still lacking for MDCSs in general. New systems have the opportunity to incorporate privacy and data protection by design. Existing systems will have to address their privacy issues to comply with new and upcoming data protection regulations. However, further research is still needed to identify feasible and cost-effective solutions.

Georeferenced and secure mobile health system for large scale data collection in primary care

2016 ◽  
Vol 94 ◽  
pp. 91-99 ◽  
Author(s):  
Joao H.G. Sa ◽  
Marina S. Rebelo ◽  
Alexandra Brentani ◽  
Sandra J.F.E. Grisi ◽  
Leonardo H. Iwaya ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Health System ◽  
Mobile Health ◽  
Large Scale ◽  
Large Scale Data ◽  
Scale Data

scholarly journals Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Shah ◽  
Q Jamali ◽  
F Aisha
Keyword(s):  
Rural Communities ◽  
Data Collection ◽  
Umbilical Cord ◽  
Rural Areas ◽  
Health Workers ◽  
High Rate ◽  
Cord Care ◽  
Community Based ◽  
Sindh Province ◽  
At Home

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.

scholarly journals HUBUNGAN PERSEPSI IBU BALITA TENTANG POSYANDU DENGAN PEMANFAATAN POSYANDU MAWAR 2 RW 06 KEBAGUSAN JAKARTA SELATAN TAHUN 2015

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Alifa Dinda Septifani ◽  
Apriningsih Apriningsih
Keyword(s):  
Data Collection ◽  
Study Design ◽  
Significant Relationship ◽  
Health Workers ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Chi Square ◽  
Cross Sectional

Posyandu was one manifestation of Health Efforts on Community Based (UKBM). Based on data Posyandu Mawar 2 in February 2015 there were a decreased number of mothers’s visit from 81.25% to 62.5%, so the researchers wanted to know about association of the mother’s perception with the utilization of The Posyandu. This research used cross sectional study design using total sampling (80 mothers). Data collection was done by direct interviews based on the questionnaire and analyzed using Chi Square. The result there’s a significant association between mother’ss perception of the distance to the utilization of Posyandu RW 06 Posyandu Mawar 2 Kebagusan South Jakarta and there’s no significant relationship between education, employment and the knowledge and mothers’perceptions about the completeness of facilities, the attitude of cadres and the presence of health workers. Suggestions for Posyandu is to increase  of  mother’confident to visit Posyandu

scholarly journals Pakistan’s Community-based Lady Health Workers (LHWs): Change Agents for Child Health?

2020 ◽  
Vol 12 (11) ◽  
pp. 177
Author(s):  
Shehla Zaidi ◽  
Maryam Huda ◽  
Ammarah Ali ◽  
Xaher Gul ◽  
Rawshan Jabeen ◽  
...  
Keyword(s):  
Child Health ◽  
Large Scale ◽  
Health Workers ◽  
Information Source ◽  
Child Health Services ◽  
Growth Monitoring ◽  
Continuous Variables ◽  
Maternal Knowledge ◽  
Community Based ◽  
Child Illness

BACKGROUND: In Pakistan’s high child mortality context, a large-scale Lady Health Worker (LHW) Program raises the need to look at whether LHWs are delivering their key mandate as agents of change for child health. This study examines the quantity and quality of LHW interactions with mothers for child health and their impact on mothers' knowledge and child health practices. METHODS: 1,968 mothers of children <2 years (n=1,968) were interviewed through a cross-sectional survey in two rural districts of Pakistan focusing on immunization, nutrition, and early child illness. Data on frequency of LHW’s visits; services provided, specific services related to routine immunization (RI), nutrition and child illness, and maternal knowledge and practices were analyzed using median values for continuous variables and counts and percentages for categorical data. RESULTS: Monthly visits by LHW were reported by only 63% of LHW covered households. During LHW monthly encounters, Oral Polio drops administration was most frequently reported (77%), followed by RI (59%), breastfeeding counseling (20%), child illness management advice (18%), growth monitoring (9.5%), while none reported receiving hygiene counseling. Although LHWs were reported to be the main information source for child health; limited impact of LHW-mother interaction was seen on maternal knowledge and practices: 76% mothers reported receiving ORS packets from LHWs but only 27% knew of correct usage, only 34% washed hands before feeding children, less than a third could correctly recall early signs of pneumonia and awareness of Vaccine Preventable Diseases other than Polio ranged from 42%-9% only. CONCLUSION: Although LHWs are main information source for child health services but infrequent, poor quality household encounters indicate ineffective delivery on the key mandate of community-based child health. Policy debate instead of focusing on scaling up or downsizing the program, should prioritize quality and supervision to improve value for money of a critical community resource.

scholarly journals A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study (Preprint)

2018 ◽  
Author(s):  
Michael McCreary ◽  
Armen C Arevian ◽  
Madeline Brady ◽  
Ana E Mosqueda Chichits ◽  
Lily Zhang ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Program Evaluation ◽  
Data Collection ◽  
Integrated Care ◽  
Clinical Care ◽  
Data Collection Tool ◽  
Community Based ◽  
Care Services

BACKGROUND National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. OBJECTIVE The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. METHODS Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. RESULTS A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. CONCLUSIONS Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. CLINICALTRIAL ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW)

scholarly journals Bringing Community Back to Community Health Worker Studies: Community interactions, data collection, and health information flows

2017 ◽  
Vol 13 (3) ◽  
Author(s):  
Eric Ryan Obeysekare ◽  
Khanjan Mehta ◽  
Carleen Maitland
Keyword(s):  
Data Collection ◽  
Community Health ◽  
Health Information ◽  
Health Workers ◽  
Participant Observation ◽  
Health Resources ◽  
Community Members ◽  
Community Interactions ◽  
Community Based ◽  
Potential Health

Community Health Workers (CHWs) have the potential to be a great resource in the further growth of the fledging healthcare systems that exist in many developing countries. Through their position as community members, CHWs can interact with other individuals in the areas where they live and work and serve as valuable health resources by providing basic health information and referrals up the healthcare chain. However, few studies have examined CHWs from a community-based perspective. This study analyzes the work and relationships of several CHWs working for the Mashavu mHealth venture in Nyeri, Kenya. Through the use of participant observation and interviews, the workflows of these CHWs were investigated with a specific eye towards interactions between CHWs and their communities and how these interactions affect potential health data collection opportunities. This community-based perspective reveals unique insights into the workflows of the CHWs and how technology might be designed to support them.

scholarly journals RADAR-Base: Open Source Mobile Health Platform for Collecting, Monitoring, and Analyzing Data Using Sensors, Wearables, and Mobile Devices

10.2196/11734 ◽  
2019 ◽  
Vol 7 (8) ◽  
pp. e11734 ◽  
Author(s):  
Yatharth Ranjan ◽  
Zulqarnain Rashid ◽  
Callum Stewart ◽  
Pauline Conde ◽  
Mark Begale ◽  
...  
Keyword(s):  
High Resolution ◽  
Data Collection ◽  
Open Source ◽  
Mobile Health ◽  
Large Scale ◽  
Streaming Data ◽  
Security And Privacy ◽  
The European Union ◽  
Wide Range ◽  
Remote Assessment

Background With a wide range of use cases in both research and clinical domains, collecting continuous mobile health (mHealth) streaming data from multiple sources in a secure, highly scalable, and extensible platform is of high interest to the open source mHealth community. The European Union Innovative Medicines Initiative Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) program is an exemplary project with the requirements to support the collection of high-resolution data at scale; as such, the Remote Assessment of Disease and Relapse (RADAR)-base platform is designed to meet these needs and additionally facilitate a new generation of mHealth projects in this nascent field. Objective Wide-bandwidth networks, smartphone penetrance, and wearable sensors offer new possibilities for collecting near-real-time high-resolution datasets from large numbers of participants. The aim of this study was to build a platform that would cater for large-scale data collection for remote monitoring initiatives. Key criteria are around scalability, extensibility, security, and privacy. Methods RADAR-base is developed as a modular application; the backend is built on a backbone of the highly successful Confluent/Apache Kafka framework for streaming data. To facilitate scaling and ease of deployment, we use Docker containers to package the components of the platform. RADAR-base provides 2 main mobile apps for data collection, a Passive App and an Active App. Other third-Party Apps and sensors are easily integrated into the platform. Management user interfaces to support data collection and enrolment are also provided. Results General principles of the platform components and design of RADAR-base are presented here, with examples of the types of data currently being collected from devices used in RADAR-CNS projects: Multiple Sclerosis, Epilepsy, and Depression cohorts. Conclusions RADAR-base is a fully functional, remote data collection platform built around Confluent/Apache Kafka and provides off-the-shelf components for projects interested in collecting mHealth datasets at scale.

scholarly journals Bottlenecks to Intervention Scale Up: Supply and Demand Side Perspectives From a Large, Community-based Trial of Malaria Testing

2021 ◽  
Author(s):  
Joseph Kirui ◽  
Josephine Malinga ◽  
Edna Sang ◽  
George Ambani ◽  
Lucy Abel ◽  
...  
Keyword(s):  
Community Health ◽  
Large Scale ◽  
Health Workers ◽  
Supply And Demand ◽  
Scale Up ◽  
Demand Side ◽  
Endemic Region ◽  
Community Based ◽  
The Impact ◽  
Malaria Test

Abstract Background: Maximizing the impact of community-based programs requires understanding how the supply of and demand for the intervention interact at the point of delivery. We present results from a large-scale community health worker study designed to increase the availability of and demand for malaria diagnostic testing in a rural, malaria-endemic region in western Kenya between 2015 and 2017. Methods: Community Health Workers (CHWs) provided free malaria Rapid Diagnostic Test(mRDT) in the community. Those with a positive malaria test were provided with a discounted first-line antimalarial over-the-counter. We conducted a community-based survey to collect individual study outcomes at 12- and 18-months post-implementation. In addition, we collected monthly testing data from the 244 participating CHWs and also conducted in-depth interviews with a random sample of 70 CHWs. Results: From the survey, 55% (n=948/1738) reported having a malaria test for their recent illness with 38% having been tested by a CHW. Being aware of a local CHW (95% CI:1.10-2.04) and belonging to a wealthy household (95% CI:1.14-2.06) were associated with higher malaria testing uptake from any source. Poorer households were more likely to receive a test from a CHW. School-aged children between 5-17 years were more than twice as likely to be tested by a CHW (95% CI:1.47-4.14). Both confidence in AL treatment (95% CI:1.54-4.92) and perceived accuracy of an RDT performed by a CHW (95% CI:1.12-5.27) were strongly and positively associated with testing by a CHW. In adjusted analyses, specific CHWs attributes were significantly associated with higher testing rates including formal employment (95% CI:0.05-2.70), those serving more than 50 households (95% CI:0.70-2.74) and those serving areas with a higher proportion of positive tests (95% CI:1.05, 3.22). On both the supply side and the demand side, confidence in a test performed by a CHW was strongly correlated with the success of the intervention.Conclusion: Scale-up of community-based malaria testing intervention through CHWs is feasible and effective at reaching the poorest households. In order to maximize the impact of such interventions, it is important to recognize factors that may restrict both delivery and demand for such services.

scholarly journals Using Community Informants to Estimate Maternal Mortality in a Rural District in Pakistan: A Feasibility Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Ali Mohammad Mir ◽  
Mohammad Saleem Shaikh ◽  
Siti Nurul Qomariyah ◽  
Gul Rashida ◽  
Mumraiz Khan ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Large Scale ◽  
Health Workers ◽  
Rural District ◽  
Reproductive Age ◽  
Religious Leaders ◽  
Women Of Reproductive Age ◽  
Community Based ◽  
Capture Recapture ◽  
Elected Representatives

Background.We aimed to assess the feasibility of using community-based informants’ networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan.Methods. We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies.Results. In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births.Conclusion. It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys.

scholarly journals Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

2020 ◽  
Vol 17 (17) ◽  
pp. 6368 ◽  
Author(s):  
Shital S. Muke ◽  
Deepak Tugnawat ◽  
Udita Joshi ◽  
Aditya Anand ◽  
Azaz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Training Programs ◽  
Health Workers ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Course Content ◽  
Face To Face ◽  
Digital Training

Introduction: Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods: Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results: Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content—issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions: This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.

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