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Hi Everyone,

Isaac here—some of you know me as one of the founders of Medic Mobile, and more recently I’m also pursuing research projects through a Gates Cambridge scholarship in management studies and as a fellow at the University of Edinburgh’s Global Health Academy. One of my main projects at Edinburgh is to develop a masters-level online mHealth course and I’m posting here to 1) start a conversation about different approaches to pursuing the aim of capacity building, and 2) solicit feedback and invite contributors and participants.

It seems that in the last year or two, resources for mHealth and ICT4D projects have been proliferating. I’m talking about PATH’s ICT Toolkit, Plan’s ICT4D guide, TechChange’s Mobile Phones for Public Health course (in which I’ve been an instructor twice), the Stanford mHealth MOOC, conversations at GHDOnline and the growing pool of resources at mhealthknowledge.org to name a few. Personally I’ve found some of these resources very helpful, and I’d like to push these efforts forwards.

mHealth projects typically call for interdisciplinary teams, but too few people have the crosscutting expertise to bring together teams of engineers, designers, clinicians and managers. As a result, studies demonstrating important impacts of mHealth interventions have often evaluated built-from-scratch technologies that are insufficiently robust to merit widespread adoption, while the designers and implementers of successful mHealth projects often lack the skills to robustly evaluate their impacts. With the Edinburgh course we’re trying to address the challenge of interdisciplinary capacity in two ways. First, here’s the basic course summary:

mHealth in high and low resource settings is a 10-credit online course offered by the University of Edinburgh’s Global Health Academy, in partnership with the non-profit technology company Medic Mobile. This interdisciplinary overview draws on rich insights from established fields such as eHealth, public health, engineering, development studies, participatory design and management. By comparing and contrasting examples of mHealth deployments in a range of global settings, we will challenge you to think beyond the technology to the functions it is serving and to consider the socio-technical issues that shape how mHealth projects are designed, implemented and evaluated. In a new and complex field, where practitioners and policy makers struggle to understand why some interventions are so much more effective than others, nothing could be more pragmatic than grasping key frameworks for analysing new projects and designing your own more effectively. The ten weeks of the course are titled:

 

· mHealth in Global Context

· mHealth Opportunities: key use cases, software and hardware

· Common Pitfalls

· Interpreting the Evidence Base for mHealth

· Why is it so hard to replicate and scale successes?

· Designing Effective mHealth Interventions

· Operations, Project Management

· Conducting mHealth Research

· Sustainable Financial Models for mHealth

· mHealth Policy

 

So, we’re drawing heavily on the academic literature in fields that have seen less play in the ICT4D and mHealth fields, and we’re emphasizing a theoretical toolkit or framework for bringing these diverse perspectives together and making them actionable. I'd also welcome feedback on the more thorough intro here: http://bit.ly/1qQhLAX

 

Here are my questions for you:

1) What sorts of activities do you see as most important or helpful in fostering interdisciplinary capacity for our field?

2) Of the existing resources out there, have any really proven game-changing for you or your team? Or have you mostly learned from conversations and experiences in the field?

3) For this sort of academic coursework—do you see it as most useful for younger students, or do you think mid-career professionals who are new to the mHealth space might benefit from taking a course like this?

4) Are there any projects or guest-experts that we should feature in the course? We’re particularly interested in interviewing more guest experts and academics from low-income country institutions (feel free to reach out on or off-list).

Thanks for the opportunity to post, and I’d love to discuss this with all of you. Many thanks to Joaquín for encouraging me to post here in addition to the more niche ICT4CHW mailing list!

cheers,
Isaac

 
Soojin Jun
Replied at 5:31 AM, 3 Jul 2014

Hello, Isaac. My name is Soojin and I am a pharmacist in integrated healthcare system in Wisconsin, USA. I am in this group because of my interest in global health delivery by connecting bilingual healthcare workers to patients with language barriers. Believe it or not, even in most high-resourced country like USA, patients with language barriers can be in a situation as bad as patients in low income countries without resources. They are more like isolated islands of low resources within the resource-rich pool of mhealth. And this happens more and more as people move around the globe. More on this later... Thank you for your intro and reaching out for feedback for your project. Here are my answers for your questions:

1. Always keeping patients in mind in design. Remembering patients are the most important component of mhealth. Always questioning where patients are in the design. For example, designers make a great tool to use and doctors agree with the greatness. But do patients agree to this? What are the barriers of patients? How do pain points align with users AND patients? For example, let's say there is a tool for dosing reminder of medication. Designers and doctors agree this is a great tool. Patients have capabilities, phones, and everything ready to go but don't use the tool. Why? This can be due to a variety of reasons or combo of reasons: age, gender, fear of using technology or not knowing where to start, not understanding the disease or importance of medication, tool not fitting in with lifestyle and work schedule, no follow-up with doctors in assessment of effectiveness, etc.

2. Social media groups (For example, LinkedIn group) and listserve/forum/posts like this are most helpful for me to learn about different resources and opportunities and this leads to conversations and sharing experiences. It is hard to find experts nearby with multidisciplinary mind unless I attend conferences and network with people. Conferences are often too expensive and hard to arrange.

3. I am bit split about this question because I almost feel like the course has to be designed separately for the two groups you have mentioned. However, I feel midcareer professionals will definitely benefit from the course as many may not be familiar with the field.

4. I do not know anyone to recommend but I would reach out to fip.org for any pharmacy related effort for low income countries for any suggestions. They have an annual meeting coming up and this is their technology section: https://www.fip.org/bangkok2014/?page=&mod=congress&congress=program&program_... Whether patients come from high or low income countries, patients generally have somewhat same issues to tackle: forgetting to take meds, not believing the meds will work, costs, etc. Feedbacks regarding pharmacy and from pharmacists are often not considered by designers and practitioners, in my opinion, whereas many approach nurses and doctors.

Good luck with your project and I can be reached at for further discussions outside of this thread, if you like.

Best,
Soo

Isaac Holeman
Replied at 8:38 PM, 29 Jul 2014

Hi Soo, and thank you for this feedback!. I didn't see your comment initially because I thought ghdonline would email me if there were any updates, but it seems I had my profile settings wrong. Anyhow, I couldn't agree more about the importance of incorporating patients in the design process. The participatory design or co-design tradition has some very good tools and techniques for this and we will be reviewing these in the course. I met Liam Bannon at a workshop a few weeks ago--he has written some very helpful papers on the topic (I'm attaching an article of his in case you're interested).

Attached resource:

Soojin Jun
Replied at 4:02 AM, 30 Jul 2014

Thank you for sharing the article, Isaac. See the highlights I have marked that I think will be important in your course and in any innovation overall. Mr. Bannon's argument in example #1 is something I have tried and how I have ended up being in SXSW student competition with the idea. It is quite funny though that my idea has had the component of home monitoring but also sharing the experience with caregivers/friends/pharmacists as a collaborative team approaching the care of the patient. The feedbacks I have received from many people have been that I am unrealistic and too idealistic. Well, how about that if my idea was generated from my direct experience as a caregiver for my dad? My idea was a solution for all the things that I had to go through as a caregiver who had to take care of my dad in the darkness of healthcare in US. As I have mentioned before, patients with language/cultural barrier can be isolated within resource-rich country like US. After myriads of healthcare nightmares, my dad decided to pursue care in his country, S.Korea; he passed away a week before his flight due to complication from an adverse event of a medication. That is how I have become a pharmacist. I was an interactive multimedia major prior to his passing and perhaps that was why it was quite natural for me to think of the idea, combining pharmacy and multimedia background of mine.

You see, my idea may be complex and hard to understand to others, but to me, all needed to be there to solve the problems I had. My idea involved universal access of data from different parties involved in patient care, ease of data transmission/sharing from different parties, ability to record the physician-patient interaction, ability to counsel pharmacist/physician at any time, ability to share how patients felt that day, etc. At hindsight, I agree with the comments I have received; however, after reading the article you have shared, perhaps the comments may be viewed as shortsighted in patients/caregivers' perspectives.

After attending SXSW, I attended a Health 2.0 event in Silicon Valley and realized that I was shortsighted too in a way. I realized that there were almost no innovation that would reach the LEP (limited English proficiency) population, one other factor that mattered in my dad's case. I realized this as a problem when I myself couldn't describe subtle symptoms I was experiencing to my physician (before attending pharmacy school); I did not have problem communicating in English otherwise. I didn't know the terms to describe the health condition as I did not know some of the names of the body parts in English and words to describe the symptoms. If this component was to be added to the solution, then there would be one other party to be involved--an interpreter!

I hope my comments help you brainstorm. When you create context for the section "mhealth in global context", I want you to think about my case. If someone like my dad, a foreigner who is more comfortable in his language when it comes to describing symptoms and health terms, is to use the mhealth tool provided, how is that going to work? Maybe I am complicating your viewpoint...but this is the real problem I had in my case (See www.victimsofmedicalerrors.org 8/5/13 blog for full story, if interested). That is why I am in this forum...as I think solution from the problem I have experienced (if there is one) can perhaps be a global solution.

Re: your question #1 from the original post, I like to add having a space (either physical or virtual) involving the organizations' different disciplines is a must-have in order to make any interdisciplinary effort to happen. For example, even within an integrated healthcare model I practice, each individual discipline practices as a separate entity and does not communicate with other disciplines necessarily. Yes, there is a connected Epic system in place, but what good is it if we don't look at or don't have access to the document? This is a huge problem and there's no way of knowing what sorts of problems other entities deal with. For patients, however, they experience our healthcare system as a whole! We have no idea what patients go through when they go to other disciplines as they are navigating within our system. There is a huge incentive in health data integration in US and if the data integration doesn't translate to integration of practice, the effort will be a waste. Does having data (or whatever the innovation is trying to achieve) translate to serve direct values in patient experience? It is the question to be answered in any mhealth innovation.

Attached resources:

Gonzalo Bacigalupe
Replied at 3:09 PM, 30 Jul 2014

This course looks extremely compelling. I think a missing part of the curriculum, in thinking about interdisciplinary work and the application of emerging technology to complex healthcare and health challenges, are the developing of skills related to how to have collaborative dialogues or conversations. The emphasis on the technology distracts us from some of the core barriers (as well as potentials) of interdisciplinary conversations. How to develop trust and an ear for listening deeply. Another aspect I think that needs addressing is the discussion of successes or what lot of us would call positive deviance (google the term for a vast literature related to positive deviance approaches to health. In sum, pay attention to the skills that may help overcome to political and policy barriers that may be at the core of the problem rather than focus solely on the wonders of the technology. I think the question of health literacy, raised in previous post, is also central and often an after thought in implementation of mhealth for ict4d.

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