I posted a youtube video of Cecelia Adah, Ghana's First CHPS nurse, talking about how MoTeCH could be used to increase compliance of Intermittent preventive treatment (IPT) of malaria in pregnancy, using a drug called SP.
It is recommended that pregnant women living in areas of high malaria transmission take 3 doses of SP during their second and third trimesters of pregnancy to reduce the impacts of the malaria parasite on the mother and baby, resulting in a healthier pregnancy and healthier baby. In the Upper East, many women get their first dose of SP, but compliance drops off a lot for the second and third doses. With MoTeCH, we can proactively remind the nurses to follow up on pregnant women who are overdue for their next dose of SP, hopefully increasing the proportion of women who receive all 3 recommended doses.
Sunday, January 31, 2010
Friday, January 22, 2010
Nurses' Phone Survey
A survey of nurses’ phones was conducted in order to ascertain the proportion of those with java-enabled phones. This information informs us as to the feasibility of nurses being able to use a java application on their phones. Data regarding telco operator use is also informative as a proxy indicator for network reliability in the area, pricing, and popularity. Information regarding handset manufacturer shows us something about which handsets nurses might easily and quickly adapt to, should new phones be introduced to them. Raw data is accessible here.
Main findings:
- 89% of nurses have MTN lines
- 60% of nurses have Nokia phones
- 20% of nurses have java-enabled phones
Full Report
Sample
95 nurses in KND and KNDW
Results
Java
For 76 of the nurses surveyed we were able to ascertain if their phone is java-enabled. Of those 76, 20% have java-enabled phones, 80% do not.
Lines
89%: MTN
7%: Vodafone
1%: Tigo
1%: Stolen
1%: No phone
Make
For 85 of the nurses surveyed we were able to ascertain phone make and model. 60% of the sample had Nokia phones, making it the most popular by far. The Vodafone promotion phone was the second most common make (11%). Breakdown of nurses phones by make are as follows:
| Make | % |
| Nokia | 60 |
| Multimex (Vodafone promo) | 11 |
| Motorola | 6 |
| Acatel | 4 |
| Sony Ericsson | 4 |
| NEC | 2 |
| Blackberry | 1 |
| G-Tide | 1 |
| Hamer | 1 |
| Huawei | 1 |
| J-man | 1 |
| LG | 1 |
| Sagem | 1 |
| Samsung | 1 |
| Seimens | 1 |
| Tecno | 1 |
| Toshibo | 1 |
| ZTE A20 | 1 |
Thursday, January 7, 2010
SMS Model Testing
We recently did a field testing to ascertain the appeal of using SMS for PP app messages. We hear time and again that the literacy issues in Ghana are such that sending messages by voice is crucial to the success of our work here. Yet, supporting SMS is cheaper and in some ways technically simpler than voice. Plus, literacy stats rarely give indication of level of proficiency in a language, or indications of local language literacy. This small field exercise aimed to shed some light on this. The exercise is by no means scientific but gives us some indications to work from.
Summary of findings:
- 50% of people approached could not read either English or local languages
- 86% of those who were literate chose to read English rather than local languages
- Participants’ level of understanding of written messages was accurate in all cases, but often only the main message was deduced, with some details missing.
Implications:
- Illiteracy is prevalent amongst our target demographic in UER so there is value in supporting IVR
- Literacy mainly relates to English (local languages are oratory in origin and rarely written)
- The level of understanding of written messages may be more rudimentary than for audio messages, although it is difficult to draw conclusions on this without a direct comparison with voice.
Full Report
The SMS model testing exercise took place on the 3rd of December, 2009 in two local communities in UER, Pungu and Doba. The exercise intended to assess the accuracy of people’s understanding of written messages, in order to attempt to reach a decision regarding the value of investing in audio messages for users of the Pregnant Parents’ application in addition to making these available by SMS.
Respondents
- Respondents were selected from all age categories
- 14 randomly selected participants (mostly over 40 years old) were approached but were unable to take part as they could not read in either English or local languages.
Language Preference
- Kassim: 2 respondents chose to read messages written in Kassim and provide verbal explanations of their interpretations of the messages in Kassim
- English: 12 respondents preferred to read messages written in English. 4 provided verbal interpretations of the meaning of the messages in Kassim or Nankam, the remainder provided their explanations in English.
- Nankam: no one from the Nankam community could read Nankam
Comfortability Reading Messages
- Most of the women could not fluently read text messages and missed out some words in some of the messages.
- 2 respondents needed us to display text on the PC instead of a phone because they did not have their reading glasses with them and so we had to increase the font size for them to be able to read the messages.
- Many pregnant women were not able to take part in this exercise as they were not able to read any language.
Interpretations
Respondents who could read were mostly able to understand the main points in the messages. In several cases more in-depth information was missed. Those who read messages in Kassim seemed to have a more detailed understanding of the messages.
Message Shown
Regularly attend ANC even when you don’t feel sick because things can change without you knowing. No matter how busy you are, make time for it. A minimum of 4 ANC visits is recommended. The first visit should take place as soon as you suspect you are pregnant and you should make three visits after quickening (first noted movement of the baby your womb.) This will enable the midwife help detect and solve any problems that may arise as well as help you deliver a healthy baby.
- Lady 23 years (read in Kassim)
This means it is good that when you are pregnant or realize that you are pregnant, you start attending ANC all the time and you should attend at least 4 times before you deliver. This will enable the nurses detect any problem in your pregnancy and help you and your baby be healthy so that you can deliver safely or deliver a healthy baby.
Analysis: captured the main points accurately.
- Lady 24 years
It’s like if you are pregnant, you should always be going to the ANC even whether you are sick or not.
Analysis: correct. Main point understood but lots of detail missing.
- Pregnant lady about 20 years old
They are trying to tell me that even if I am not sick, I should attend antenatal.
Analysis: correct. Main point understood but lots of detail missing.
- Young lady 28 years
I understand it as if you are pregnant, you should try as much as possible to attend antenatal clinics, and it can help you deliver safely. Secondly, when you give birth, it will help you look after the child well so that it will not be getting sick all the time.
Analysis: Main point understood.
Message Shown
It is good to feed well during pregnancy. Meat, fish and poultry give you essetral (essential) protein which makes the body grow. If you are vegeltations (vegetarian) or do not want to eat meat, eat a fistful of nuts every day. Foods like beans, nuts and peas are also good. Drink lots especially water and fruit juices e.g. coconut, oranges but do not drink too much of packaged fruit juice as it has a high sugar content.
- Lady 50 years
It means the kind of food a pregnant woman should eat like I have red meat, fish and coconut that will make her healthy.
Analysis: correct. Main point understood but lots of detail missing.
- Lady 35 years
Respondent could not explain the content or meaning of the message she read either Kassim or Nankam.
Analysis: no understanding
- Lady 27 years
That it is good to feed well especially when you are pregnant. It helps you to grow and it helps the baby too. The vegetarians too don’t want to eat meat. Fish meat and fruits and it help you to grow.
Analysis: main points understood. Misunderstanding of some text.
- Lady 18years
It is trying to tell us that if you are pregnant, we should eat protein foods like meat, Beans which can help the baby to grow well and have healthy heart to the pregnant woman. You can eat sugar but not too much because it can cause danger to the baby inside.
Message Shown
Missing your period is a sign of pregnancy but a test will be required in the clinic by the midwife /doctor to confirm. Your health and that of your baby is very important. To ensure that you are starting your pregnancy on a good note and to avoid possible complications during pregnancy, including miscarriage and stillbirth, consult a health care provider as soon as you are pregnant.
- Lady 22 years
I will simply tell her to go to the hospital for a test. May she does not know she is pregnant and if she goes and confirms that she is pregnant, the she will go for ante natal care.
Analysis: main points understood
- Nursing mother 36 years old (read in Kassim)
The message means that, if you miss your period, it means you are pregnant but you need to go for test at the clinic to confirm that you are really pregnant. If that is confirmed, you would have to go for ANC for regular check up to ensure a healthy pregnancy and keep your baby healthy. To me it’s trying to say that it’s a must to go for ANC when you realize you are pregnant for it is good for you and very good for the healthy growth of your unborn baby.
Analysis: good understanding of meaning
- Lady 25 years
The message is saying that if you miss your period and don’t know what is happening, you go to the hospital so that the doctor will confirm.
Analysis: main point understood
- Nursing Mother 19 years
Respondent says that, she would give it some one to explain the meaning of the message to her but she doesn’t know what it means.
Analysis: no understanding
- Nursing mother 29 years
It is trying to explain that, if you miss your period, you may be pregnant but you can go and confirm that by a test at the clinic. It is also telling us what to do during the pregnancy to stay healthy.
Analysis: main point understood. Reporting of some information which is not given.
- Lady 20 years
What I understand is that if you miss your period, it means you are pregnant but it’s better to see your doctor to confirm and if it is pregnancy, you have to ask the important things you will do for the pregnancy to stand well.
Analysis: good understanding
Registration Field Testing
REPORT FOR REGISTRATION EXERCISE AT PUNGU CARRIED ON THE 24TH OF NOVEMBER, 2009.
Aims
This exercise aimed to ascertain how people give their personal information. The exercise was a test of the ease of obtaining information for the fields required from users, rather than the registration process itself. Learnings from this exercise will inform the technical specifications for patient registration in MoTeCH. The exercise took a randomly selected group of participants through a simulated registration exercise face-to-face in the field.
Participant Profiles
27 people took part
- Ages:
o 19-30: 48%
o 31 – 50: 41%
o 50+: 11%
- Gender:
o Male: 44%
o Female: 56%
Learnings By Field
Name
- 89% gave 2 names
- 7% gave 3 names
- 1 person chose to give just one name
- When asked their “preferred name”, for 37% of respondents, that name they stated did not match any of those provided when simply asked their “names”.
TECHNICAL IMPLICATION: needs to be a space for at least 3 names (possibly 4) and searches need to check all name fields. The name people use more frequently (presumably preferred name) often differs from official names, which may introduce inconsistency into the names people report (and thus make search complex). Collecting preferred name at registration and also enabling search on this field could help.
Date of Birth
- 48% knew their date of birth
- 52% used the DoB on their NHIS or voter ID card
- None tried to guess their date of birth
TECH IMPLICATION: people know their date of birth so this can be used as one of the fields used to uniquely identify a patient.
Location Data
- 96% knew their home address
- 4% did not know their home address
- 98% of registrants knew the name of their nearest CHPS compound
TECH IMPLICATION: people generally know how to describe where they live. A free text is required to capture this. Most people know their nearest CHPS compound, but a drill down menu to help ascertain this would be helpful.
Phone Access
- 67% of registrants had phones which they have access to for use at any time.
o 56% personally own a phone
o 11% use shared household phones
o No one reported using a phone in their community (though perhaps the wording of the question was not appropriate here)
TECH IMPLICATION: Many people do not have access to a phone / their own phone, so enabling access through a shared phone is crucial.
Time of Day for MoTeCH Messages
- 37% said they would prefer to receive messages in the evening
- 33% wanted messages to be sent in the morning
- 30% wanted reminders to be sent in the afternoon
Explanations for Certain Times of Day
Evening
- Some who cannot read said there would be literates at home by evening to read and interpret text messages to them
- Some men said they would be at home by evening to read and interpret messages to their wives.
Morning
- Help them keep the clinic in mind and make preparations for it in the day time.
Afternoon
- People who preferred afternoon reminders were mostly traders who said their husbands would be around afternoon to take care of the shop in the afternoon so they can go to the clinic.
TECH IMPLICATION: Very useful to let people choose when they can receive messages – good if people can choose times when both the expectant mother and father are present.
Day of Week for MoTeCH Messages
- 37% preferred to receive reminders a day before the clinic visit is due
- 15% preferred to have reminders on the day of the clinic in the morning or afternoon
- 11% wanted reminders on Monday because it’s the beginning of the week and therefore would set their minds to it till the day of the clinic
- 11% wanted reminders sent on Friday because it is a day they are less busy and can easily go to the clinic
- Just one person wanted to receive reminders on Wednesday with the reason that he would be back home by then to remind his wife to go for the clinic.
TECH IMPLICATION: lots of different takes on this. Need more information to make a conclusion on when to send reminders.
Comfortability giving Maternal Health Information
- Interestingly, none of the registrants were pregnant but there were 3 nursing mothers.
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