Global Public Health and Disasters Course October 2017 Sheana S. Bull, PhD, MPH

Transcription

1 Mobile/Social Media and Global Public Health: Emerging Evidence From The Field and Priorities for the Future Global Public Health and Disasters Course October 2017 Sheana S. Bull, PhD, MPH UNIVERSITY OF COLORADO COLORADO STATE UNIVERSITY UNIVERSITY OF NORTHERN COLORADO

2 Objectives To briefly review achievements in ehealth, mhealth and Public Health To consider examples of how technology has been used in disasters To identify priorities for the field More Evidence! Theory (big T and little t) Hybrid programs Helping Health Workers in low resource settings Scale-up and Dissemination

3 Why Mobile and Social Media Reach can potentially reach many more people with technology than through face to face programs Are they the right people? Can we keep them? Potential for impact While likely smaller effects, they reach more people Population effects and therefore impact has potential to be greater Timing once we reach people, we can do so at times of the day and days of the week that either are more convenient, and/or more relevant or ideal for sending a message

4 Why Mobile and Social Media Standardization the message or program is delivered in the same way each time Easy to adapt or change can use effective content but alter the spokesperson or setting Scalability if we know a technology based program works, it is potentially easy to replicate and disseminate widely in different settings

5 Mobile Phones

6 The use of mobile phones worldwide Mobile phone technology is the predominant mode of communication world wide The average number of mobile phones used per 100 people in Asia, Africa and Latin America and the Caribbean (LAC) increased between 100% and 400% in the first five years of the 21 st Century Rashid, A.T., & Elder, L MOBILE PHONES AND DEVELOPMENT: AN ANALYSIS OF IDRC-SUPPORTED PROJECTS. The Electronic Journal on Information Systems in Developing Countries. 36(2)1-16

7 Mobile phone subscriptions per capita 2011

8

9 What works for mobile phone interventions? Impacts on: Medication adherence Healthy behaviors (e.g. smoking, physical activity, nutrition, sexual health behaviors) Meta-analyses, research syntheses Web-based interventions Text messaging for behavior change Social media interventions Apps

10 What works for mobile phone interventions? HIV Adherence project 538 HIV Patients in Kenya 62% adherent in intervention vs. 50% in controls at 5 months 58% in intervention group had Reduced viral load vs. 48% controls Lester et al., The HAART cell phone adherence trial (WelTel Kenya1): a randomized controlled trial protocol. Trials Sep 22;10:87.

11 What works for mobile phone interventions? Percentages of patients Receiving any vaccination at 4, 12, and 24 weeks Stockwell MS. AJPH 2012

12 CyberSenga A six session computer program for Ugandan youth: Comprehensive sex education Skills building for HIV prevention Focus on decision making, communication and avoidance of coercion Among sexually active youth, those exposed to CyberSenga showed significant declines in sexual activity at a six month follow-up compared to those not exposed

13 CyberSenga Outcomes Abstinent unprotected Intervention+Booster Intervention Control

14 Tanzania-Health Information Technology Step one: HW collects data on their phone (e.g. for pregnant woman) At Rural dispensary(e.g. HIV test data; confirmatory test; CD4 count; viral load) Step two: data transmitted to regional health post: *Data merged with maps in surveillance database; *Health advisor reviews and considers priorities for care Step three: Health advisor Provides follow-up directives To HW via text message Surveillance Step four: Health advisor sends patient text message Call me for Important Test results Health Promotion/Disease Management

15 Tanzania-Health Information Technology

16 The use of social media worldwide Populations increasingly use cell phones to access the Internet Additional services that are not widely used today but anticipated include MMS (sending photos via phone) and using phones to send and receive data Users increasingly access social media via a mobile device 37% in 2001; 46% in % via tablet in 2011; 16% in 2012

17 The use of mhealth in disasters Interactive Emergency Kit list Map of open shelters, disaster recovery centers Preparedness info GIS for posting photos of disaster

18

19 Social media, disaster preparedness and emergency response Twitter feed explorations Identify key words that could indicate an increase in a PH condition Fever, chills, runny nose, joint aches Consider location based on geotags Create maps of hot spots 1&v=HmDIh-YS0GI

20 Priorities for the field More Evidence! Call to action Feasibility and acceptability? More of what works needs to be replicated Cell phone text messaging for adherence Multi session online programs for prevention Social media for prevention Faster, more responsive research: Observational, N of 1, interrupted time series, modeling

21 Priorities for the field Theory Call to action Simply translating behavior change models to the online environment isn t enough Communication theory instructive Message framing; Elaboration Likelihood Model Social Media considerations for Engagement; Sharing Social Networking

22 Theory Contagious: messages work when they: Make you look good Are useful/informative Trigger a response (tip of the tongue/cue to action) Are emotional Can double as a promotion (logos) Tell a story

23 Priorities for the field Helping Health Workers in low resource settings Programs to date haven t evaluated how technologies can be mobilized for care delivery

24 Priorities for the field Scale up and dissemination Replication Scale and Dissemination: RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) Who are we reaching? What proportion of those eligible are enrolling? Does it work as well with these groups? What are factors that facilitate or deter program adoption? Implementation? Maintenance?