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mBaby: Making Information Actionable

To date, neonatal mHealth SMS programs have taken two forms: reminders sent to expectant mothers, and reporting done by certified health workers. mBaby asks the question - what if we combined the two, making the reminders actionable? Real-time reminders and concrete calls-to-action will help health workers get a clearer picture of their patients' well-being and habits. In addition, these actionable reminders will ensure mothers get quality information and concrete steps to keep themselves - and their babies - healthy.

Photo of erika johansson
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With 5 billion cell phone subscriptions and counting - the global community needs to step up our game with regards to mHealth. Programs often rely heavily on trained health-workers to collect the data we need to ensure every pregnant woman and newborn is safe and healthy. But the fact is: there aren't enough health workers to go around. We have to develop a solution that is simple, useable, and scalable to meet the needs of expectant mothers on the ground.

mBaby is a reminder app and a datagathering app all in one. Instead of relying on the health-workers for a heavy lift, mBaby asks mothers themselves to report back on their habits, their health choices, and their environment. As an August 2009 study commissioned by the Grameen Foundation asserts, 70% of neonatal deaths can actually be prevented – if the right precautions are taken. (1) This is why it's important not just to remind mothers what they should be doing, but to ask for confirmation as well.

Initial registration for mBaby kicks off a 12-month series of automated calls-to-action for expecting and new mothers. These actions can range from quitting smoking, to sleeping under mosquito nets, to breastfeeding their newborns. Women are invited to share whether or not they are taking these measures via SMS. This paperless solution offers women an easier way to keep track of their health data - in the digital mBaby database.

Then, when a woman actually does visit a health worker, she can give them her cell phone number and grant them access to her mBaby records through a web portal. After SMS verification, her archived data can then be pulled up for review. Detailed information on issues (such as a woman's access to clean water and her eating habits) can have an incredible impact on pregnancy, and help drive more specific recommendations from the health worker.

By educating mothers and empowering them to make healthy choices, Oxfam and Nokia can spark behavioral change and accountability - leading to strong and stable families, worldwide.


Citation:
(1) MoTECH: mHealth Ethnography Report, prepared by Patricia N. Mechael and the Dodowa Health Research Center for The Grameen Foundation http://bit.ly/1HaUeA

What is the minimum level of mobile technology needed for this concept?

We need the ability to send texts and collect data via return SMS. Nokia has already developed a version of this technology for their Dengue Fever DataGathering initiative in Brazil. All that would be needed is a modification that enables each user to submit to their own personal record. ///

In addition, we would need to develop a web-portal, accessible via a secure SMS password. This portal could be used by the health-worker for tracking and alerts. ///

Based on feedback during the refinement phase, it would also be great if we could provide a way for local NGOs to offer their services through the text-reminders. For example, if a mother responded that she had not vaccinated her baby, the immediate text feedback could provide information on which local NGO was providing free vaccinations for babies and a number to call to make an appointment. ///

In addition, it would be ideal if a number of unsatisfactory responses to the actionable reminders (i.e. answers that aren't conducive to good health) could ping a local doctor or CHW to let them know that a local mother was in trouble. This way, the (already) limited time and resources of local health workers could be concentrated on the mothers who need them the most.

How could this work in a low-literacy context?

As an alternative to SMS data collection, we can provide the reminders and calls-to-action in audio form – most of the answers will fall into a “Yes” / “No” category – making this type of data collection simpler. ///

By providing an open translation interface in the back-end of the web portal, we can scale the translation across borders.

Which partners could help realise and deliver this solution?

  • Oxfam
  • Nokia
  • Mobile operators
  • NGOs
  • Government

Concept Builds

For some reason, these text boxes don't accept paragraph breaks, so (for readability purposes) paragraphs are broken up using three slashes. ///

Thanks to OpenIDEO for choosing my idea and congratulations to the other 19 finalists! ///

I've addressed many of the suggestions and comments in the comments section below but I've drawn heavily on two of them: 1) Siri Johansson's once-per-month routine check-up concept fits perfectly into the prompt and answer format of the original concept - thanks for the tip @IDEO! Taking inspiration from Siri, I've additionally included a couple new slides (13 & 14) that talk about how the mBaby software will deal with unsatisfactory answers*** during the monthly health-checkup and the actionable reminders. I also incorporated a graphic from Siri's concept - a sample userflow that acts kind of like a quiz, asking users Y/N questions to zero in on the root cause of their symptoms (the graphic is from http://FamilyDoctor.org). Self-diagnosis will enable us to give/collect more information (and send help, if needed) if unsatisfactory answers are provided. 2) I also incorporated some great feedback from Maia Smith (slide 15) about involving local and national services (i.e free transportation to clinics, vaccination, health-care, etc.) with the mBaby text flow. This kind of local customization will require the mBaby software to be adapted on a regional level, but standardizing the types of services offered (help with vaccination, transportation to clinics, provision of mosquito nets) should help with scalability. ///

There are currently many datagathering systems that are using this type of text and response mechanism - like Ushahidi and CJ (below) referred me to http://opendatakit.org/about/tools The fact that these systems can be easily adapted (I say adapted because of the necessity for a back-end translation system) from current off-the-shelf options only reinforces my feeling that this idea is definitely technologically feasible.

Also, per OpenIDEO's feedback, see slides 9-11 for further examples of questions that can be posed to the mother during and post- pregnancy. These are just starter questions, but they give a rough idea of the types of issues mBaby would cover - from current health status, to nutrition choices, and prompts to improve personal health habits. ///

Although I don't have additional sides for them, Joe, Marie, and Nancy also brought up the idea of having a mother-to-mother group chatting functionality. Group chats would facilitate strong ties between the mothers on a local level, and provide an alternative support system for them. I do believe, however, that the group chats should be (at least) monitored by a doctor or a CHW to ensure that the information going around is factually correct. (see comments on http://openideo.com/open/maternal-health/concepting/low-cost-internet-free-forum/ for similar concerns about information quality). This is why I hesitated to incorporate it in the mBaby scheme; in order to make mBaby as simple and scalable as possible, I wanted to avoid -to the extent possible- the necessity for human moderation. That said, group chat functionality is very very easy to build and actually already exists in off-the-shelf solutions like http://group.me - implementation would be simple and available immediately. Great idea, guys! ///

Thanks everyone for your comments and support. This experience has been incredible and invaluable. It just shows how much can be achieved if we put our heads together (across tables, as well as borders) to solve the world's most pressing crises! ///

***unsatisfactory answers are answers that imply that the mother is taking actions that may have a detrimental effect on the life of her or her baby or suffering from complications - i.e. a "NO" answer to the question "Do you have access to clean water?" or a "YES" answer to the question "Have you felt sharp pain in your pelvic area?"

Virtual Team

Collaborators:
Siri Johansson http://openideo.com/profiles/siri/
Maia Smith http://openideo.com/profiles/maia/
Iyobosa Ekhato http://openideo.com/profiles/iyo2011/
Robyn Sneeringer http://openideo.com/profiles/639439597/
Josh Nesbit http://medicmobile.org/team/

Other inspirations: Crystal Nelson http://openideo.com/profiles/camnel/
Paul Wood http://openideo.com/profiles/paulmwood/
Nancy Smith http://openideo.com/profiles/nancysmith/
Marie Leznicki http://openideo.com/profiles/leznicki/
Joe Rubinstein http://openideo.com/profiles/1050877290/

awesome post-refinement input from:
CJ Adams http://openideo.com/profiles/adamscj/

and thank you to Open IDEO http://openideo.com/profiles/admin/ for the suggestions!

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Photo of Laura

Hi Erica,

What a great idea to use mobile technology, which is so prevalent, to spread educational information! I wanted to add a comment about the language and phrasing of the questions which mothers are asked to answer. In the examples, the question is preceded by a factual statement (i.e. Pregnancy increases your change of contracting malaria. Do you sleep under a mosquito net?). My first thought looking at the questions was could people who are not sleeping under a net (for example) feel pre-judged before answering the question? The statement makes it fairly obvious what the "correct" answer is. I think this could have a few different problems. First, women who figure out the "correct" answer might chose yes even if the answer is no, especially if they know that sometime in the future the information is going to be seen by a doctor. This would first and foremost be a danger to the mother because she might not get appropriate counsel from her healthcare provider. It could also pose a problem if the answers are going to be complied and used for research purposes- if people are pushed towards one answer or another the data would be invalid. Another issue that could arise is if a mother feels in any way "judged" for her answer, she might be less willing to continue with the program.

What about having the question be short and straightforward, without extraneous information in the first interface (i.e. Do you sleep under a mosquito net?) and then include the factual information in both of the answers, with appropriate corrective advice for a "No" answer? I think especially if one goal is to be able to aggregate the data for use in policy, advocacy, or research, it would be important to have someone familiar with survey design look over the application to make sure there is no bias implicit in the question design.

Overall though, I think you have a fantastic idea that could provide a lot of people with a lot of needed information! Best of luck!

Photo of Dianna

Great comments, Laura. I agree that it's worth the time and effort to think carefully about how the questions and responses are crafted to ensure that mothers are responding honestly and accurately. Your suggestion to flip the order to question first, then fact is a great solution.

Photo of erika

That's a great idea, Laura. The order of the statements in the SMS messages are absolutely flippable. I wouldn't want the women to feel judged at all.

Photo of Xing

It's really great comment! Laura, you really think people behaviour! Good job!

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