Posts tagged ‘digital campus’

OppiaMobile presentation at TelSpain

On Friday I gave a presentation about OppiaMobile to the TelSpain conference in Madrid. At the conference I meet several colleagues from projects and work I was doing at the Open Uni over 5 or 6 years ago, so was great to meet them again. My presentation was video recorded, so will post up a link to the full video once it is available.

Digital Content Developer for Primary Healthcare

Cross posted from the Digital Campus website:

Through our recent funding from DFID, we are looking to recruit a Digital Content Developer for Primary Healthcare to work with us on this project. A brief overview of the role:

  • You will be working with our medical and technical team to create and source high quality primary healthcare training content, activities and assessment for rural health workers in their continuous professional development activities.
  • You will ensure that all the training material is prepared to the highest standards of presentation, accuracy and educational value.
  • The ideal candidate will have excellent organisational skills and an ability to keep to tight deadlines. Proven experience of instructional design and teaching is essential.

and the key details:

  • Contract: 2 year fixed term contract
  • Hours: Part-time (20 hours p.w./0.5 FTE)
  • Location: Remote (home-based)
  • Salary: £26,600 to £28,700 p.a. (pro-rata)
  • Closing date: 13 September 2013

You can download the full job advert here: http://digital-campus.org/docs/ad-005.pdf and the job description here: http://digital-campus.org/docs/jd-005.pdf

To apply please send a copy of your CV with a supporting statement and details of 2 references to alex@digital-campus.org. References will not be taken up until after a job offer has been made.

New mQuiz and mobile learning app released

I’ve just released the new version of mQuiz. For those of you who have previously signed up to mQuiz and/or the mobile learning app, the key change is that you will need to reset your password (the new version of mQuiz uses a more secure way of storing passwords) and upgrade the mobile learning app on your Android phone.

To reset your password, go to: http://mquiz.org/profile/reset/, enter your email/username and a new password will be emailed to you. Once you log in, you can reset your password to something more memorable. If you are using the mobile learning app, after you upgrade the app, you will need to log in using your updated password.

The key changes to mQuiz are:

  • Quiz creation/editing. You can now add different question types (not only multiple choice) and add feedback to give to the user.
  • Rewritten in Django application framework. This should make the app faster, more robust/stable and easier to add new features.

The key changes to the mobile learning app are:

  • Improved interface
  • Better management for media/video files
  • more info and screenshots here

Finally, I should add that this is all still a work in progress, there are many, many more features and improvements I’m looking to make. If you find anything isn’t working as expected, or if you have any comments/suggestions then please either post a comment below or email me.

Updated mobile learning app – sneak preview…

Alongside updating mQuiz into Django, I’ve also been updating the Digital Campus mobile learning app. Rewriting mQuiz into Django has been going really well, it’s almost there now and hopefully I should be able to get this released live before Christmas. For the API side I’ve been using TastyPie, which has made it much simpler for creating the API for the mobile app.

The main changes to the mobile learning app include:

  • Better user interface and navigation: the old app was rather text heavy and you couldn’t jump directly into a particular activity. With the new app, when exporting the course/module from Moodle you can specify icons for each activity/section/module, or just use the default icons in the mobile app. I’m not sure I’ve got the default icons exactly right yet, but to me, the layout and navigation looks much better than before.
  • Downloading media files: I’ve been avoiding including media files within the download packages to keep the filesize down, but until now I’ve not had a good way for users to know where to get the media files from, or how to download onto their phone. All the media file info (including download link) is now included in the module package, so I’m now building into the app a media checker/manager, so users can see straightaway which video files are missing and can download them much more easily.

A few screenshots of the updated app:

New research paper: Knowledge and performance of the Ethiopian health extension workers

Araya has just had his second paper published: “Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study”. The full paper is available from Human Resources for Health, provisional abstract:

Background

In recognition of the critical shortage of human resources within health services, community health workers have been trained and deployed to provide primary health care in developing countries. However, very few studies have investigated whether these health workers can provide good quality of care. This study investigated the knowledge and performance of health extension workers (HEWs) on antenatal and delivery care. The study also explored the barriers and facilitators for HEWs in the provision of maternal health care.

Methods

In conducting this research, a cross-sectional study was performed. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Descriptive statistics was used and a composite score of knowledge of HEWs was made and interpreted based on the Ethiopian education scoring system.

Results

Almost half of the respondents had at least 5 years of work experience as a HEW. More than half (27 (54%)) of the HEWs had poor knowledge on contents of antenatal care counseling, and the majority (44 (88%)) had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructures like water supply, electricity, and waiting rooms for women in labor. On average within 6 months, a HEW assisted in 5.8 births. Only a few births (10%) were assisted at the health posts, the majority (82%) were assisted at home and only 20% of HEWs received professional assistance from midwives.

Conclusion

Considering the poor knowledge of HEWs, poorly equipped health posts, and poor referral systems, it is difficult for HEWs to play a key role in improving health facility deliveries, skilled birth attendance, and on-time referral through early identification of danger signs. Hence, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their knowledge and competencies, while creating appropriate working conditions.

mHealth: Patient Identification Issues

Patient identification is still proving to be quite an issue with the records that Health Workers are submitting, making it difficult to be sure that a record for a follow up visit is attached to the right patient.

As not everyone has an id number we can use, originally we asked health workers to identify patients by the id number they enter in their log book. This, we thought, had the advantage that we could easily then match up the database records to the paper records. The combination of this and the health post name (selected from a text list in the form, but stored as code number in the database) should have given us a unique identification for each patient. Only the first registration form contains the full name, on the other visit forms, we just ask for the health post name and the id number, plus the year of birth and age to use as checks for the data.

Using the year of birth and age checks we can identify where patient ids may have been entered incorrectly, but we are seeing quite a lot of errors. In theory rectifying these errors shouldn’t be very time consuming or difficult, assuming that follow up calls to the HEWs are made soon after the error is made. Unfortunately, delays to following up these errors, mean that now it will be quite difficult to fix all the errors.

On each patient visit form, we recently also added the patient first name, as an aid to matching errors back to their correct registration forms.

Some of the problems we have come across include:

  • Two (or more) patients being registered with the same ID number
  • Patient visit forms being entered with the wrong ID – and so getting matched to the wrong patient registration record
  • Patients being re-registered with a new id number, especially when they may attend a visit at a different health post, or in a health centre. HEWs issue a registration card to each patient when they are first registered. If the patient later visits a different facility, the health post name and id from the card should be used, but seems this is not always happening and patients are getting re-registered. This makes it very difficult to track whether patients are following up on referral advice.
  • Some health post have restarted the numbering in their log books (the new year in the Ethiopian calendar started in September), so we are starting to see the same id number being re-used for new patients (although this wasn’t meant to happen)

Given the lack of reliable identification numbers, it was probably inevitable that we would have experienced some errors with correctly matching records up. I would have hoped that with quick follow up to rectify errors, the health workers would have soon got used to taking extra care when entering patient id information.

There are other options we could have taken for patient identification, but these may have also had their own drawbacks. For example:

  1. pre-registering all patients in a given area – though this seems like substantial work; or
  2. providing a set of pre-generated bar codes or numbers (with check digits), which the HEWs can issue when the see a new patient. A check digit mechanism, would have really helped ensure mistakes in entering id numbers were minimised – though it may not have avoided the same numbers being reused for different patients. In retrospect I think this is the approach we should have taken.

Another factor which may have contributed to this problem is that we’re forcing ODK to do something that it probably wasn’t really designed for. ODK is a general data collection tool, each form is an independent entity, not necessarily designed to link up records entered from different forms. Some other recent mHealth tools, have a front-end so the user needs to click on a particular patient to enter the a visit record. But this requires some form of synchronization of the data between the phone and the main database, to ensure that all the patients a health worker may visit have their records already stored on the phone, otherwise it may lead (again) to patients being re-registered.

In Ethiopia, there seem to be some efforts to resolve this identification issue, for example the national Health Management Information System (HMIS) or Family Folder system, but these aren’t fully rolled out to all the health posts we’re working in, so we wouldn’t be able to take advantage of these. It seems to me that for these types of mHealth tools to work well and generate good quality reliable data, then a reliable and consistent system for patient identification is required, but hopefully this will be coming soon in Ethiopia.

Update on Ethiopia Visit

Have just returned from another visit back to Ethiopia, a week in Mekelle to see how the Health Workers are getting on, followed by a few days in Addis, mainly in meetings and catching up with friends.

The new batch of Health Workers who started with us in the last 3 months are doing really well, and we updated their phones with the latest version of the mobile learning app, along with the video content. The research program is due to run until April next year, and we’re looking at ways in which Health Workers can transition over to the new national mHealth program. This national program has started recently and the pilot area in Tigray (there are other pilot areas in other regions) overlaps with where we’ve been working and the HEWs are already familiar with the phones.

Although the national pilot is focused on maternal care, so the forms/protocols and technology used should be very similar, I think there are some differences in the implementation. I’m not sure the details have been finalised, but the information I currently have is that there will be one phone per health post (so 1 per 2 HEWs) and the phones will have some restrictions on which apps can be accessed. I’m not sure how the HEWs who have been working on our research program will react to this, as is more restrictive than what they have become used to. I think one of the reasons that our project has been relatively successful is because we tried to encourage the HEWs to take real ownership of the phones, they have one each and we allow them to use any of the apps on the phone (or even install apps themselves). I think this ownership explains why we’ve had such a low level of loss/breakage (only one phone was stolen, but then later recovered) and we’ve had very few technical issues (accidentally deleting apps/files etc). There will be much more information on all this once we get the feasibility and technical papers finalised and published in the coming months.

Whilst in Mekelle I also visited the Health Sciences campus and the lab we set up there over 3 years ago now. The lab is still (just about) running, surprising given the very low level of maintenance it has had for the last couple of years. The Health Sciences college has been investing a huge amount in improving student computer access. They’ve recently purchased over 300 Macs, most people don’t believe me, until they see the photo, so here it is:

Mac lab at Ayder campus

Although it wasn’t quite up and running when I visited, they’re just waiting for the wireless network to be set up, the lab looks really impressive and is almost certainly the most number of Macs in one room in Ethiopia! I should also mention that these Macs weren’t from a donor, but purchased directly by the college. I hope the students can make really full and effective use of this resource. I believe the college also has plans to buy large numbers of Galaxy Notes, for students to be able to loan from the library in the same way they loan books. These new Macs are in addition to a smaller Mac lab (approx 50 machines) which has been established for a while now.

Back in Addis in the last week, we’ve had lots of meeting with various NGOs and technology companies here, as there is now a lot of interest here in mHealth, specifically around using smartphones. So hope our research project in Tigray can provide a lot of information and lessons learned to contribute to the success of any new projects. But I still get the feeling that mHealth is seen as the silver bullet rather than just the tool. I think mHealth by itself is unlikely to solve many underlying problems of low level of training, lack of motivation etc.

I also met up with Ahmed, a masters student from Addis Uni, who recently contacted me about porting our mobile learning application to run on J2ME phones. He has made excellent progress and it looks really good, but still a few areas to get finished off. I’d originally thought he was doing this as part of his masters project, but seems not, he’s just doing this because he’s interested and wants to move into programming/computing after he finishes his masters.

Here are the rest of the photos I took:

Demo site for patient management tools

We’ve just set up a demonstration site of our analytics and mobile site for the patient management tools. Previously if someone wanted to test out the tool for themselves, we could really only give them the mobile application and the protocols to look at, but we didn’t have a demo area for the server side. The only demo was on my laptop, and we can’t give access to the live site as it has real patient cases. I took this opportunity to look at using Amazon Web Services (EC2) for setting up the demo server – it all worked out really well and very easy to use.

You can log into the analytics/scorecard site at:

http://odk-demo.digital-campus.org/scorecard/ (username/password is demo/demo)

and the mobile version is at:

http://odk-demo.digital-campus.org/scorecard/mobile (same username/password)

The demo user has supervisor privileges, so is able to see all the data entered, usually health workers logging in would only get to see the data directly related to their patients.

If you would like to see the whole process, from entering the protocols on the smartphone, all the way through to seeing the cases on the analytics scorecard and mobile site, I also set up a demo ODK Aggregate server for submitting protocols. To set this up:

  1. Download and install on your phone our version of ODK
  2. start the app and enter the following settings (go to menu > change settings):
    • Server: http://odk-demo.digital-campus.org/ODKAggregate (note that this is case sensitive)
    • Username: demo
    • Password: demo
  3. Go to ‘get blank form’ – this should connect to the server and show all the available protocol forms – select and download the ones you would like to try out
  4. Enter and submit a few protocols from your phone
  5. You will then be able to see the forms you have entered on the analytics scorecard, and the mobile version – note that the forms don’t appear instantly on the scorecard or mobile site, it may take a couple of hours, as we have some caching running, to make the site run more quickly

Please let us know how you get on – especially if I need to add some more info to the instructions above.

Updated mobile learning app on Google Play

I’ve just made the updated training application available on Google Play, you can get it from here: https://play.google.com/store/apps/details?id=org.digitalcampus.mobile.learning.

As before, when you first start the app you’ll be asked to login or register and then you can install some of the modules to test out (once logged in you’ll see the link to ‘install modules’). For initially logging in and installing the modules, you’ll need a data/wifi connection, but after this the app will work fully offline.

Also (and as before), the video content is not included in the module packages (mainly to keep the download size down). For trying out the videos, you can download them from here (all the .m4v files): http://alexlittle.net/blog/downloads/heat/ – just copy these files directly into the /digitalcampus/media/ directory on your phone SD card.

If you have any problems/comments etc then please leave a message below.

Patient Management Tools Video

Just posted on the Digital Campus blog:

Video demo of the patient management tools currently being used by Health Extension Workers on our project. This video shows the mobile protocols (using ODK), the mobile scorecard and analytics dashboard.

Since my camera broke the other day (I’m waiting for a new one to arrive), I used a flip camera for filming this, unfortunately it doesn’t focus well in close up, so the images of the mobile screen don’t show up well on this video, once my new camera arrives, I’ll refilm the video, to better capture the mobile screen.