In a summary of key quotes from great designers both locally and internationally, I intend to showcase the future of health promotion vocabulary and thinking that is so different from current mode of thinking prevalent in workplaces all over the country. We must change our way of seeing the problem and how we address the issues in order to find a human centered solution and not an organization and bureaucracy centered solution.

In design thinking for health promotion we get the population to create demand for healthy lifestyles and not push messages at the population. We create the opportunity for target populations to participate in the design process so we know how it should work for our clients/patients/grandparents.

Design is not how it looks, but how it works” :-

Monib Mahdavi Creative Director – Monib

 

Design is the method by which we change things. If you’re thinking about changing things, you’re going to use a design method, or its going to be accidental. Accidental may or may not be helpful, but design certainly will be. Design is about making things exactly as you want them”

Bruce Mau – CEO  Bruce Mau Design

 

Design thinking is a collaborative process by which the designer’s sensibilities and methods are employed to match people’s needs with what is technically feasible and a viable business strategy. Design thinking converts need into demand. It is a human centered approach to problem solving that helps people and organizations become more innovative and creative”

Tim Brown, Change by Design -  CEO IDEO

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The Ghana project targets women who do not typically seek help from local health facilities during pregnancy or when giving birth. The expectant mothers receive weekly automated voice or SMS messages on how to promote healthy foetal development and other vital information about pregnancy and birth.

“All they need to receive these messages is an inexpensive mobile phone,” says Jacqueline Møller Larsen of the Grameen Foundation in Ghana.

The weekly messages, designed to be both relevant and entertaining, are meant to encourage expecting mothers in poor rural areas to overcome their reluctance to contact health care professionals. They also receive information on which vaccinations they should take and advice on nutrition.

The objective of the information texted to these pregnant women is to give them confidence in the health care system and to counterbalance advice they may hear that is based on superstition. The text messaging solution is now being tested on nearly 4 000 pregnant women in Ghana.

South Africa leads in mHealth

The latest mHealth service to reach South African shores is FolUp, a mobile and web-based health communication system. Headquartered in the US, the application connects physicians to patients for free and creates a platform for them to collaborate more on their health, symptoms and treatments. It is available for Android and Apple iOS devices.

According to Simon Spurr who is the co-founder and head of operations for Folup, doctors can use the application to track their patients’ symptoms, provide data on how they feel and report about how they respond to medication. The system can also be used for following up on patients after consultations.

“Patients’ identities are kept private,” Spurr says. “However, overall generalised statistics and data of all the users’ information could be sold on to the likes of, for example, research institutes.”

FolUp allows doctors to devote more time to patients and keep track of their wellbeing.

According to Spurr, the FolUp platform could help patients to gain better control over their conditions, boost levels of emotional well-being and accelerate patient healing.

The platform is also part of a network which allows patients to interact with existing forums, medical apps and software. These in turn will connect with other medical apps, peripheral devices and self-help tools.

Through the patients’ charted online history with blogs and diary entries, doctors will have easier access to their information.

“Patients need to take ownership of their health, control over their diseases and manage themselves better,” Spurr says.

He adds that although much has been asked about making FolUp available to people in rural areas, for now the pilot, although free, is only available to individual patients and consumers of mHealth apps.

Mobile technology can help people in less-developed countries manage hypertension

New University of Michigan research evaluated the impact of automated calls from a U.S.-based server to the mobile phones of patients with hypertension (high blood pressure) in Honduras and Mexico. The program was designed to be a low-cost way of providing long distance checkups and self-management education.

Patients were provided with home blood pressure monitors and reported information about their blood pressure, medication use and symptoms during the weekly automated calls. During the calls, they received tailored health information from U-M via a cloud computing system.

Compared to patients receiving usual care, those who received the weekly 12-minute calls for six weeks were more likely to say that they understood how to take their medication, experienced fewer depressive symptoms and were more satisfied with care. Blood pressures decreased significantly, especially among patients with the greatest need for education about their hypertension management.

“What some people may not realize is that the biggest health threats in less-developed countries aren’t just communicable diseases like HIV. Chronic disease and high blood pressure are the biggest killers,” says lead author John D. Piette, Ph.D., professor of internal medicine at the U-M Medical School.

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What the research and industry leaders need to learn from ‘Patients Like Me’ is that patient and industry interests can be aligned through data sharing partnerships. But not all great things in healthcare need to be not for profit or have a doctor sitting in a consulting room. Here the business model of ‘Patients Like Me’ is explained.

• How does PatientsLikeMe make money?

  We take the information patients like you share about your experience with the disease and sell it to our partners (i.e., companies that are developing or selling products to patients). These products may include drugs, devices, equipment, insurance, and medical services.  Except for the restricted personal information you entered when registering for the site, you should expect that every piece of information you submit (even if it is not currently displayed) may be shared with our partners and any member of PatientsLikeMe, including other patients.  We do not rent, sell or share personally identifiable information for marketing purposes or without explicit consent. Because we believe in transparency, we tell our members exactly what we do and do not do with their data.

  By selling this data and engaging our partners in conversations about patient needs, we’re helping them better understand the real world medical value of their products so they can improve them. We are also helping companies accelerate the development of new solutions for patients.

  PatientsLikeMe is a for-profit company (with a not-just-for-profit attitude).  Every partnership we develop must bring us closer to aligning patient and industry interests. Our end goal is improved patient care and quality of life.

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The post Global health promotion scaling up or stagnant? appeared first on Youth Health 2.0.

The following data has been drawn from the Australian Bureau of Statistics website on the 5th of Febuary 2013. The data was collected in 2001 during the Census. There has been no update yet or I have not been able to locate it. If you have current information please share it in the comment section below.

We definitely lack the quantitative figures that  organization like the Pew Internet Research Centre are publishing every year. Maybe there is a need for such an effort in Australia.

The first part of this article focuses on the total Indigenous and non-Indigenous populations (excluding those people for whom Indigenous status was unknown). Overall, there was a marked difference in the use of IT between the Indigenous and non-Indigenous populations in the week preceding the 2001 census (table S23.3), as highlighted by the following statistics:

• home computer use – 18% of Indigenous population, 44% of non-Indigenous population

 

• home Internet use – 9% of Indigenous population, 29% of non-Indigenous population

 

• Internet use overall – 16% of Indigenous population, 39% of non-Indigenous population.

Slightly more Indigenous females (19%) than Indigenous males (17%) had used a computer at home. For the non-Indigenous population, more males (46%) than females (43%) had used a computer at home. This was also the situation with use of the Internet at home or elsewhere, with Indigenous females (17%) having a slightly higher rate of use than Indigenous males (15%).

Indigenous persons living in Very Remote areas were least likely to have used IT. Of the 71,100 Indigenous persons in Very Remote areas:

• 3% had used a computer at home (38% for non-Indigenous persons)

 

• 1% had used the Internet at home (23% for non-Indigenous persons)

 

• 4% had used the Internet overall (33% for non-Indigenous persons).

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Alain Labrique, Ph.D., the founding director of the Johns Hopkins University Global mHealth Initiative, and his team recently conducted a survey of the mHealth studies that were registered in the government’s clinicaltrials.gov database as of November 2012. Labrique writes: ”We identified 215 unique mHealth studies that were registered in the clinicaltrials.gov database, of which 8.4 percent (n=18) were observational in nature while the remaining 91.6 percent (n=197) were interventional. Of the 215 studies, 81.8% (n=176) studies used a classical randomized trial design and 40 new studies were added to the database between May and November 2012 alone. Based on these results, we posit that the field is entering a new ‘era’ where a body of rigorous evaluation of mHealth strategies is rapidly accumulating.”

 Labrique concludes: “The transition into an era of evidence-based mHealth supports our position that innovation in this domain can be evaluated with the same rigor as other public health strategies, attenuating some of the hype previously associated with mHealth.”

From mobihealthnews.com taken from Pharma Geek – January 24, 7:52 PM

Hot Triggers

When we use mobile technology for behavior change, we find that interventions programmed at the opportune moment is best in triggering the desired behavior (BJ Fogg). For example, in order to trigger executing an exercise routine, I would put a reminder on my phone and make sure that my gym bag was prepared the night before. To make a behavior easy to implement and by taking baby steps in the behavior change continuum, the missing link according to Dr. Fogg has been the ability to remind, trigger, push, encourage users because there were no ubiquitous tools to do it with e.g. mobile phones.

With the mobile phone being with you everywhere and all the time, the area of Mass Interpersonal Persuasion (BJ Fogg), is being developed with this specific goal in mind – to change human behavior for the better with a more personalised touch tailored to your needs and specifications. It is contextual.

Connected Health

Reminders, alerts and hot triggers alone are not sufficient strategies for long term behavior change. According to a recent blog post by Joseph Kvedar, we need to be able to provide feedback loops showing progress and data but eventually, people get bored. What he suggests is using contextual messages along feedback loops to sustain the encouraging factors in behavior change strategies. When I use Endomondo as my sports tracker, the voice in the app, provides me with info on speed, distance covered, and distance to goal every kilometer and it has tremendously improved my running. Endomondo can also allow for friends following your running online to post comments that can then be heard over your headphones. This is an example of how hot triggers and feedback loops are strengthened using contextual messages and how it can work to support you and your friends in doing their activity.

These are aspects of health promotion that will change the way preventive and curative approaches are managed from a primary health care standpoint. This inspires me to imagine what the primary health care industry will look like in the next 5 years.

For a great blog post from Jason Berek Lewis, please read HealthyStartups latest articles on:

1. 100 trends that will change healthcare in 2013

2. The Top 10 Health Startups and social media post of 2012

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Concepts of healthcare gamification

According to a Pew Research study which I came across recently on Global Post, neuroscientist are “…discovering more and more about the ways in which humans react to such interactive design elements. Such elements can cause feel good chemical reactions, alter human response stimuli…and in certain instances improve  learning, participation and motivation”.

The CEO (Bonnie Henry) of GameMetrix solutions, a company that draws inspiration from games like Jeopardy and Solitaire have come up with fun platforms for managing chronic illness like diabetes. Henry says, ‘in the healthcare arena, there’s a lot of discussion around patient activation, meaning getting people going (with games) at looking at the change in their engagement levels. This new trend is being dubbed gamification of healthcare because it is about “applying elements and design concepts from games to other contexts that are not themselves games” according to Kevin Werbach. Kevin is the co author of For the win: How game thinking can revolutionize your business, which argues that companies should think and function like game designers when writing their strategies for motivating clients and employees. The same can be applied to health clinic and Aboriginal Medical Services in remote areas when working on the ground with the community.

Whats wrong with traditional social marketing?

It is quite common to see the practice of the occasional sausage sizzle and freebies to attract community members and target group to a certain health issue and then to project a preventive health message. Many times these activities turn over a large number of participants and funnily enough, rarely evaluated for impact and behaviour change. When I used to work department of health, I probably gave away 1000 t-shirts to young people promoting safe sex and getting tested but in the 4 years that I lived in the town, I had never seen anyone wear it.

On the other hand, Werbach, in his book also warns us in being wary of ‘pointification’, the rewarding of points and badges to people who play games. The culture of freebies and sausage sizzles in health promotion is a defunked loyalty program that is not measurable, wasteful, and reduces the importance of the message to a simple marketing gimmick. Werbach goes on to also say that “tangible rewards are potentially very effective, but also potentially very dangerous”. He says “if it signals that this is not really about improving your life” but instead it is all about the incentive then the game was not successful in creating an experience that is totally engaging.

Ideas for innovation in a remote setting

Nike Fuel Band: A simple band that connects with a mobile device and can send data on your level of physical activity. Set a daily goal and share your results with your friends. This can be gamified further with the help of WiFi hotspots and a health promotion officer/coordinator.

Beam Toothbrush: This is an amazing toothbrush that connects via Bluetooth to a mobile device and tracks how long you brush your teeth. It helps improve the length of time you brush your teeth in a fun way and sends the data to your nominated health provider. Once again this is an idea that can be utilised to improve oral hygiene amongst children in a remote community. What we need is WiFI hotspot and a simple device mounted on a wall in the house. It does not need to be a smartphone or a tablet. All it needs is to function with one single app.

Challenges for gamification:

1. Health care providers that want to offer games to their customers must do so without violating federal patient privacy regulations — a requirement that can make it difficult to target games to the patients who will benefit most from them. Even companies that are not subject to those regulations are finding themselves under pressure to protect players’ most personal data.
2.  How can companies make them engaging enough to keep customers interested? “It’s sometimes hard to build a game that’s sufficiently serious and on topic, but also fun,” Werbach says.

Extra information:

The post Gamification in remote aboriginal health appeared first on Youth Health 2.0.

A remote community in Australia very often refers to the traditional homelands of Indigenous Australians. The lands of the Yolngu have been their home for more than 40,000 years. The Yolngu know every river, creek, tree and stone on their land and are connected to them both intellectually, spiritually and materially. An example of a remote community where I live, Birritjimi, is a small area made up of a strip of sealed road about 300 metres long with a row of houses on each side. There is a total of 23 houses (2-3 bedrooms) and an average of 7 family members may reside at any one point in a house.

Is Internet available in remote communities?

Today the 3G network coverage is expanding, especially up here in the Northern Territory. Of course, broadband Internet is only available where there is sufficient commercial revenue. The Indigenous people are still not considered potential customers for post paid and broadband Internet as most of their access is pre-paid mobile Internet via a 3G connection. Facebook has become the main social network for Yolngu. This has become more accessible since Telstra provides free access to Facebook even when on a pre paid account.

Recently I have been able to secure a ADSL 2+ Internet connection to my home in Birritjimi. Before this piece of land returned to Yolngu hands, non Indigenous workers servicing the aluminum refinery lived here. Therefore there were phones lines put in and only thanks to that we have Internet. I now run an Internet connection at speeds of up to 3.7 Mbps and sometimes higher and other times slightly slower (in the evening).

What wireless technology can be used?

1. Blood pressure monitoring: iHealth turns your iPhone via an app into a blood pressure monitor that tracks and graphs the information making it easy to share it with your health provider. Although many Aboriginal Medical Services provide transportation for their clients to the clinic and an outreach service, as a medical doctor I cannot overstress the importance of daily self tracking by patients to improve medication adherence and behavior change.

2. Wireless Glucose Meter: This is a new addition to iHealth’s arsenal where the Smart Glucometer lets people determine their blood sugar using their iPhone

3. Wireless Weight Scale: Withings is famous for their body scale that tracks your weight, syncs with your WiFi network and can even Tweet your results for you if you’re interested in positive peer pressure, community support and gamification for public health purposes.

Conclusion

Companies like Nike, Jawbone and Fitbit produce wearable wireless technology that keep track of your movements and sleep and record this data via an app on your mobile technology device be it a tablet, iPad or smartphone. I think that the young people of today (Indigenous youth living in remote communities) who are rapidly getting their hands on smartphones, and who hang onto their phones better than their parent’s generation, will be eligible and excited to put these wireless technologies to use. Who says that behavior change programs are only educational, in a classroom, on a poster or through TV advertisements. New behavior change programs will incorporate self tracking and mobile technology with an element of gamification.

The post Mobile & wireless technology for health in a remote community appeared first on Youth Health 2.0.

Where do I live and work now?

Welcome to Birritjimi. I live a simple house, just like the my Yolngu neighbors only we are four in a house instead of the common overcrowding that prevails due to lack of proper housing in Yolngu communities. The community is located on the beach, less than a kilometre away from the Rio Tinto Alcan bauxite refinery. There are about 150-200 people living here.  I am fortunate that broadband Internet connection with sufficiently high speeds was recently made available after waiting for almost 2 months. Thus I am finally resuming the blog after a few months of being inactive.

Current status of research work?

These are exciting times for me. My research will kick off in due time as I solidify my relationships and build trust with community members and elders. I plan to provide a wifi hotspot with a ‘bush cafe’ like atmosphere in the tiny carport where people can shelter form the rain.  I expect the wifi hotspot to be popular amongst young people in the  late hours of the night. They will use mobile phones and there are a couple of laptops around too.  So far the response has been positive but it is always important to cross check with traditional owners if this is appropriate.

My research is in partnership with several stakeholders. They are the traditional owners of Nhulunbuy, Miwatj Health Aboriginal Corporation, Office of Youth Affairs (Department of Children and Families) and the Mulka Project. My stakeholders are keen on the research and its methods of research dissemination that make sharing results and analysis simple and accessible. I have conditional ethics clearance which will be upgraded to full within the next month. I hope that this study will contribute to health promotion knowledge in the digital age and open up this field in the Northern Territory.

 My kind neighbors gave me a mud crab and 2 turtle eggs as a welcome gesture and I am learning the language and customs as part of an appropriate participant observation type method of inquiry. Details of my research will be provided as a summary in the MyPhd page above.

As we move into 2013 I will be offering you stories from Yolngu elders and youth especially regarding their high interest in mobile technology. There are many great stories from Yolngu history that I would like to share and make a connection to the current state of innovation in the world.

I hope you will stay with me this year to experience my life, research, and services to the Yolgnu of East Arnhem Land. A big thank you to @DrPieterPeach and @justinavery for the Youth Health 2.0 blog makeover and for hosting it.

The post Health Promotion, Mobile Technology and Research in 2013 appeared first on Youth Health 2.0.

IJPH: Could you tell us the title of your work and what it is about?

Kishan: The title of my research is “The interplay of social media and mobile phones amongst Yolgnu (Aboriginal) youth and its impact on traditional social marketing in Yirrkala.”

My work is focused on Aboriginal Health and the methods that are applied in this work is structured to enhance community participation and highlight the importance of culturally appropriate strategies.

IJPH: How is a typical day on the field?

Kishan: The Yolngu community in Yirrkala are made up of clan leaders, traditional owners of Aboriginal land, artists and the wider community. Working with the community involves the researcher first acquiring some specific knowledge in the history, language, culture and health priorities of the community.

The most important role in my everyday interaction and collaboration with the community is to understand and to apply traditional knowledge systems before even attempting to consolidate my research.

As a new member in the community trying to consolidate himself in the community I had to begin learning Yolngu languages and the kinship systems so I can identify myself with the members of the community and show my respect and appreciation for their culture. I took on the role of assistant to the football coach with responsibilities to provide refreshments to the players during training and matches. I have also taken on a volunteer role with a not for profit organization aiming to eliminate scabies in the region.

My role as a researcher here is then the least important, and this is essential as my purpose is to be useful to the community and not only be there to conduct research. Once a strong relationship is built through trust and mutual respect, then it will be the right time to roll out my research plans, still always consulting with clan leaders and elders whilst they guide the research.

IJPH: What are some challenges and barriers you have to deal with?

Kishan: There are two types of challenges that I am facing and am about to face. First, mobile phone users are not consistent and the life of the mobile phone is quite unpredictable. Phones are lost or given away and therefore phone numbers of people constantly change. This is a challenge when considering mobile health intervention design and program planning. Giving out phones have been tried and has not been successful.

Financial resources from individuals are scarce for projects like texting health messages (SMS) to take off. Most sharing of media content is done through Bluetooth. Evaluation in this setting becomes cumbersome as privacy and confidentiality must be taken into account.

The other challenge is in finding accommodation on site. Many researchers have done work in this community and are on ‘fly in fly out’ basis. I think that this approach will not yield good relationships and subsequently good research data and results that are beneficial to the community. It takes time and opportunity to build relationship and Yolngu knowledge systems with direct impact for behavior change can only be harnessed at ‘opportune’ moments. Therefore living in the community and experiencing community life is essential.

IJPH: Have you thought about research dissemination and how you are going to implement it for your project?

Kishan: One of the reasons why research is abhorred in Yolngu communities is because of the lack of authentic community consultation, collaboration and most importantly sharing of results post research with an aim to improve public health programs.

Research is definitely not disseminated well. Researchers need to consider how people receive and convey information, their levels of literacy and whether print or multimedia format needs to be used in the dissemination strategy.

For my research, I have prepared a special section on my blog called Youth Health 2.0 (www.youthhealth20.com) where the public can access in plain language and less than 750 words, updates from my analysis and community/stakeholders consultations. I hope that I will receive comments and feedback from the community to improve on my understanding as well as enable public health programs to improve on their health communications strategy and content development in real time instead of waiting 3 years for my thesis to be published.

The challenge in this approach, from my examiners will be interesting but this is an equitable and respectful way for researchers in the future. I do not own the knowledge and therefore the analysis must be fed back in the correct space of time for it to be useful.

IJPH: What do you think about the use of social media in public health, especially when it comes to research dissemination?

Kishan: I started using social media in my work, because of its advantage in spreading information and engaging the public. Many Aboriginal communities and their youth are active users of digital technology. Especially when young people live in remote locations, social media becomes their source of knowledge and entertainment.

Through the use of blogs, Facebook, Twitter and YouTube, I would be able to engage and deliver information about my research to the community in written and video format which could overcome barriers like low literacy. Disseminating research in an engaging video co created with research participants not only makes the information more valid but also empowers and gives importance to the role the community plays in the research process.

Through Twitter, I will be able to hold discussions with research colleagues from around the world who are interested in working with hard to reach populations in a resource poor setting.

IJPH: Tell us a few final words!

Kishan: I hope that the process of engagement and consultation with the Yolngu community can be enhanced with, state of the art processes in research dissemination, so that public health research will gain renewed acceptance from the community and enable future collaborations.

The post The future of research depends on its transparent dissemination appeared first on Youth Health 2.0.