Quote of the month: “Information overload is a grim reality making it increasingly difficult for individuals to filter out applicable know-how from the mass of available information” John Miescher, HIFA Member, Switzerland
The number of healthcare apps worldwide has nearly doubled in the last two years, according to research into UK and US digital health trends by the Institute for Human Data Science (IQVIA). At the time of publication in November 2017, 318,000 health apps were available for download from major app stores and, with more than 200 health apps currently being added each day, the IQVIA predicts that – in the US - digital health is “likely to be mainstream for most organizations delivering human health” within a decade.
Our Quote of the Month, posted on the HIFA forum by John Miescher, suggests that the transition to a new digital health paradigm may not be entirely seamless. The information overload of the “app explosion” could reduce the overall impact of digital health tools if potential users are faced with page upon page of healthcare apps, with no means of evaluating whether an app meets their needs or if the information it provides is accurate. Indeed, how many of these apps have an impact on health outcomes? A study by HIFA's Mobile Health project (mHIFA) 'commissioned a survey of 1700 projects of mobile technology for health [and] none of these services provided essential, actionable, offline guidance for direct use by citizens addressing the range of acute health-care situations commonly encountered in low-resource settings, and very few provided any such content at all.'
Kavita Bhatia (HIFA member, independent researcher, Ashavani platform, India) is having difficulty finding an app that meets her needs. “I am looking for a free app for CHWs [Community Health Workers] in India, she wrote on the HIFA forum following publication of the IQVIA findings, “that would help them to give health information/track their work/upgrade their own knowledge”. Kavita already knows that digital technology can make a huge difference to CHWs, who until recently were under-represented on HIFA. Kavita pioneered the approach of bringing CHWs into contact with the global HIFA community through WhatsApp groups, an approach that has been emulated by other HIFA members in India and Uganda. She also encourages CHWs in India – some of whom have a rudimentary knowledge of English - to download the free Hello English app from the Google Play store, which teaches conversational English to native speakers of Indian languages. “It would be wonderful to have a similar app for CHWs, for health care”, she stated on the HIFA forum, “Is there any such possibility?”
This stimulated a rich discussion among HIFA members, many of whom are themselves developing health apps. For example, Alex Little (HIFA member, web developer, UK) described the open-source OppiaMobile (Digital Campus). OppiaMobile delivers rich learning content offline on Android devices. “Although it's all in English”, says Alex, referring to the various implementations now available, “all this content is under Creative Commons License, so is available for anyone to re-use/adapt/translate”.
Kavita herself thought that the mhealth platform Leap, which offers SMS- WhatsApp-based communication, was particularly impressive because, as she stated, “If I want to make an app for India, I would like the mode of communication to be SMS and WhatsApp”. Mia Marzotto (HIFA member, USA) highlighted a potential limitation of SMS – and suggested how to overcome it. “Our experience at Translators without Borders”, she stated, “shows that CHWs as well as their 'patients' must have communications materials and channels in their language”, citing TwB’s study of Ebola-related information in Kenya. Mia explained that messages need to be simple and the format adaptable to a mobile device (an oral language may pose greater challenges). “The most important step would be to simplify the messages and test them with CHWs to make sure they resonate on an SMS platform”, she advised. “Then translate into as many Indian languages as possible. Then test whether that helps”.
Kavita had some further requirements to share with HIFA colleagues. “The CHWs themselves should be able to access a menu of pre-loaded information as needed, in major Indian languages, and it should be freely available through Google Play Store because websites are difficult to navigate on small screen mobile phones. Is this a pipe dream?”
The experience of Will Mapham (HIFA member, South Africa) proved that it wasn’t. “We started a similar process in 2010”, he explained,“which resulted in the launch of Vula Mobile in 2014. Since then over 3000 health workers in 6 Provinces in South Africa have downloaded the app and joined the system.” William reported Vula Mobile had achieved an average 31% reduction in physical referrals to higher levels of care.
In his post to the forum which provided our Quote of the Month, John Miescher also outlined some essential features for the future: “globally applicable; free (for the end user); platform-, provider- and language- independent; facilitate discovery, access and perusal; require only a minimal engineering effort to implement”. A useful addition to that list could be Kavita’s definition of an ideal app for CHWs, based upon the suggestions made by HIFA colleagues: “a ‘fixed’ component of universal knowledge and a ‘flexible’ component of local knowledge”. This could also help to speed progress towards a wider vision. As Kavita suggested, “The HIFA mHealth group is advocating for the political will and the resources for mHealth. Perhaps their task might be easier with a common app for all CHWs?” Indeed, HIFA's mHealth group is currently in discussion with WHO and others about the feasibility of making content such as Hesperian's Where There is No Doctor available to all CHWs - and the general public - on mobile phones.
Over to you: Are you a health professional or citizen who needs help identifying an app which meets your needs? If so, why not join HIFA, share your experiences, and receive informed guidance from our multi-disciplinary community of experts? HIFA also has forums in French and Portuguese, with Spanish to be launched soon.
Metrics: In December 2017 we exchanged 157 from 69 members in 26 countries (Australia, Canada, Colombia, Denmark, Germany, Ethiopia, Gambia, Ghana, Hong Kong, Kenya, India, Iraq, Japan, Mali, Nepal, Nigeria, Philippines, Rwanda, South Africa, Switzerland, Tanzania, Uganda, UK, United Arab Emirates, USA, Zimbabwe). Our top contributors were John Miescher, Switzerland (6 messages) and Kavita Bhatia, India (4). Thank you all for sharing your views and your experience.