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Cited by 91Mobile Health and mHealth ApplicationsHealth Promotion and Cardiovascular PreventionICT in Developing Communities

Evaluating the use of mobile phone technology to enhance cardiovascular disease screening by community health workers

Open access
Surka, Sam, Edirippulige, Sisira, Steyn, Krisela, Gaziano, Thomas, Puoane, Thandi, Levitt, Naomi·2014·International Journal of Medical Informatics
DOI 10.1016/j.ijmedinf.2014.06.008PMC PMC4108525
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Abstract

Background Primary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countries. Task shifting to community health workers (CHWs) is being investigated to further scale CVD risk screening. This study aimed to develop a mobile phone CVD risk assessment application and to evaluate its impact on CHW training and the duration of screening for CVD in the community by CHWs. Methods A feature phone application was developed using the open source online platform, CommCare(©). CHWs (n=24) were trained to use both paper-based and mobile phone CVD risk assessment tools. They were randomly allocated to using one of the risk tools to screen 10-20 community members and then crossed over to screen the same number, using the alternate risk tool. The impact on CHW training time, screening time and margin of error in calculating risk scores was recorded. A focus group discussion evaluated experiences of CHWs using the two tools. Results The training time was 12.3h for the paper-based chart tool and 3h for the mobile phone application. 537 people were screened. The mean screening time was 36 min (SD=12.6) using the paper-base chart tool and 21 min (SD=8.71) using the mobile phone application, p=<0.0001. Incorrect calculations (4.3% of average systolic BP measurements, 10.4% of BMI and 3.8% of CVD risk score) were found when using the paper-based chart tool while all the mobile phone calculations were correct. Qualitative findings from the focus group discussion corresponded with the findings of the pilot study. Conclusion The reduction in CHW training time, CVD risk screening time, lack of errors in calculation of a CVD risk score and end user satisfaction when using a mobile phone application, has implications in terms of adoption and sustainability of this primary prevention strategy to identify people with high CVD risk who can be referred for appropriate diagnoses and treatment.

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  • The CommCare platform enables immediate data entry and real-time monitoring, which significantly benefits frontline healthcare workers by reducing average data entry timelines and allowing immediate monitoring of adherence to protocols or identifying needed improvements.

    “The CommCare platform [5] enables immediate data entry and real-time monitoring, which significantly benefits frontline healthcare workers: it reduces average data entry timelines and allows healthcare workers to immediately monitor their adherence to protocols, or identify where improvements were needed [6, 7].”

    From Best practices in scaling digital health in low and middle income countries (2018) · cites this paper as [7]

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  • There is increasing recognition of the importance of studying implementation/process as a way to achieve sustained improvements in health outcomes.

    “There is an increasing recognition of the importance of studying implementation/process as a way to achieve sustained improvements in health outcomes [12, 17, 18, 42–44].”

    From Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study (2016) · cites this paper as [18]

    The Abstract Conclusion and Discussion link evaluation of training, screening time, errors, and user acceptance to the potential sustainability of CVD prevention. They do not establish increasing recognition of implementation/process research generally or show that studying these processes achieves sustained improvements in health outcomes; the Discussion says follow-up and management over time still need evaluation. The supplied copy gives section labels but no page numbers. (LLM, conf=0.82)

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  • Using a mobile phone app version of the CVD screening reduces the time required and improves the cost-effectiveness of the intervention.

    “Using a mobile phone app version of this screening reduces the time required and improves the cost‐effectiveness of the intervention.10, 11”

    From Using mHealth Tools to Improve Access and Coverage of People With Public Health Insurance and High Cardiovascular Disease Risk in Argentina: A Pragmatic Cluster Randomized Trial (2019) · cites this paper as [10]

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2 of the 17 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [14]Leon NS H. MHealth4CBS in South Africa: A review of the role of mobile phone technology for the monitoring and evaluation of community based health services 2012 Medical Research Council and University of Western Cape Cape Town

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Authors
Surka, S., Edirippulige, S., Steyn, K., Gaziano, T., Puoane, T., & Levitt, N.
Affiliations
  • University of Cape Town (ZA)
  • The University of Queensland (AU)
  • Brigham and Women's Hospital (US)
  • University of the Western Cape (ZA)
Corresponding author
Surka, Sam
ORCID
Venue
International Journal of Medical Informatics
Publisher
Elsevier BV
Published
2014-09
Volume
83
Issue
9
Pages
648-654
ISSN
1386-5056 (ISSN-L)
DOI
10.1016/j.ijmedinf.2014.06.008
PMC
PMC4108525
OpenAlex
W2083136545
Cited by
91
References
17
Citations by year
2026: 4 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 5 · 2021: 5 · 2020: 9 · 2019: 5 · 2018: 12 · 2017: 12 · 2016: 9 · 2015: 9 · 2014: 1
FWCI
18.71
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Medical Informatics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Cape Town
  • School of Public Health at the University of the Western Cape
  • South African Medical Research Council
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
Keywords
cardiovascular screening, community health workers, mobile application, primary prevention, task shifting, screening time, developing countries
MeSH terms
Adult, Aged, Cardiovascular Diseases, Community Health Workers, Female, Health Promotion, Humans, Male, Mass Screening, Middle Aged, Pilot Projects, Focus Groups, Cell Phone, Young Adult, Mobile Applications

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