Evaluating mHealth Interventions Using Service Design Strategy: A Case of Kenya Presenter: Danny Nyatuka Faculty of Information Technology(FIT) Definitions of Concepts • mHealth: medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices (WHO, 2011) • Underserved context: communities of lower socio- economic status (SES) hence resource constrained and specifically in low-and middle-income (LMIC) settings (Botts et al, 2011; Stowell et al, 2018) Study Background • Mobile phones & smartphones continue to become cheaper and more accessible globally (Mushamir et al, 2015) • Subscription of mobile phones in Africa had been projected to go up to 412 million from 79 million between 2012 and 2018 (Lodhia, 2016). • Due to associated benefits including increased mobility, efficiency, improved quality of care, reduced healthcare costs and enhanced governance structures across health systems (Njoroge et al., 2017) • Has led to increased mHealth interventions particularly in Sub- Saharan Africa in efforts to strengthen health systems Kenya included (Lodhia et al., 2016; Njoroge et al., 2017) • However, underserved communities continue to bear the greatest burden of disease globally, and hence they exhibit the poorest health outcomes due to inadequate infrastructure and healthcare coverage (Lade et al., 2014) Study Background cont’d • As at 2017 49 out of 69 e-health projects in the Kenya were mobile-based, most of which focused on HIV/AIDs and primary care (Njoroge et al 2017) Mobile Subscriptions as at Kenya (Dec 2016-2017) Fig.1: Mobile Subscriptions in Kenya during financial year 2017/2018 (Communications Authority of Kenya ,2017) Study Background cont’d Fig.2: Kenya’s national e-Health Framework (Ogara, 2012) Challenges facing mHealth in Kenya Despite mHealth having been incorporated into the national e-health strategy, some key challenges are being experienced:  No clear scale-up strategy to guarantee sustenance of mHealth projects  Lack of consensus among stakeholders on the requirements for designing these interventions  Donor syndrome  Over-reliance on mobile apps on smart phones  Unstable power supply  Dominated mHealth control by private entities  Illiteracy & language barrier,  Interoperability and compatibility issues  (Kenya Healthcare Federation, 2016, Tomlinson et al., 2013, Kariuki & Okanda, 2017) Research Gaps • Existing evaluation frameworks are not context-specific and thus poor adoption of mHealth interventions • The frameworks are insensitive to the role of stakeholders in the design and evaluation of mHealth interventions • The frameworks are mainly designed for post- implementation evaluation without the pre aspect hence they are unilateral rather than bilateral (Amoako & Rivett, 2015) Research Question • How can a robust framework be designed to guide design evaluation of mHealth services in an underserved context as a healthcare service facilitated by technologies that incorporate mobile technologies? Specific Objectives 1. To engage relevant stakeholders 2. To establish design considerations for desired situations 3. To design context-specific solutions, 4. To evaluate new services in-practice. Research Approach: SDR Strategy Fig. 3: Value Creation for Stakeholders (Design Council, 2015) SDR emphasize on creation of purposeful and context-specific innovations for maximum impact (Moritz, 2005) Stakeholder Theory A stakeholder is “any group or individual who can affect or is affected by the achievement of the organization’s objectives”, and that different stakeholders may have either limited or significant influence on a project’s expected outcomes (Chung & Crawford, 2016 ) Service Design Research • The focus of SDR approach is to design new and or improve the current situation i.e. existing services in order to make them more useful, efficient and effective for organizations Stakeholder Theory cont’d Fig. 4: Value Creation for Stakeholders (Chung et al., 2016) Theoretical Framework Fig.4 :Proposed Research Model In doing this, the study extends and complement existing mHealth evaluation literature and thus contributes to existing body of knowledge regarding designing of healthcare services in an underserved context. Validation of the model Participative evaluation (Carcary, 2010) was used to determine the empirical validity of the new model with fifteen (n=15) participants (academic experts, ICT manager, healthcare consumers, health professionals and mHealth developers). Table 1: mHealth success dimensions and parameters Validation of the Model cont’d Table 2: Validation Scores Validation of the Model cont’d Table 3: Scorecard validation Validation Results • The average validation result was 3.84 hence ‘Satisfactory’ hence the proposed model Meets Expectations • This imply that the model has potential to achieve sustained performance to meet organizational goals References Amoako, G., and Rivett, U. 2015. Towards the develop-ment of sustainable ICT projects in Africa–A Review and Synthesis of Evaluation Frameworks. In Proceedings of the 2015 ACIST Conference (Accra, Ghana). Botts Carcary, M. 2010. 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