mHealth for Better Routine Immunization Data in Honduras (2017-2018)

Background

Vaccinations are a highly cost-effective public health intervention. They prevent over 2.5 million childhood deaths each year. Despite the availability of these life-saving interventions through national routine immunization programs, children in resource-limited settings remain susceptible to preventable infections due to delays in, refusal to accept or lack of access to vaccinations.

National routine immunization programs need strategies to rapidly identify and reach under-immunized or unimmunized children. This includes development of robust data systems that collect and manage vaccination data for surveillance, record-keeping, resource allocation and performance-tracking.

Project Description

This Bass Connections project builds on a previous team’s comparative analysis of routine immunization programs in Ghana and Honduras. In response to findings, the 2017-2018 team will focus on creating an mHealth (mobile health) system for better routine immunization data in Honduras.

The growing pervasiveness of mobile technologies has made it possible to improve the quality and speed of health data collection and use. Such mHealth applications focusing on childhood vaccinations have been implemented in many countries. The previous Bass Connections team’s research found high acceptability among partners in Honduras for deploying and using these technologies for data collection and coordinating activities, including tracing and reminding defaulting families about upcoming vaccinations for their children.

The project’s objectives are to:

  1. Conduct a structured needs assessment to inform an mHealth system for capturing and managing vaccination data in Roatan, Honduras
  2. Evaluate technology options that are appropriate for the Honduran context and meet the needs identified in the assessment
  3. Develop and implement the mHealth system with help from local partners, Clinica Esperanza and Offices of the Secretariat of Health in Roatan.

Sub-team 1 will focus on mHealth system design and development. Team members will be primarily responsible for designing, developing and deploying the mHealth system.

Sub-team 2 will focus on monitoring and evaluation and will bear primary responsibility for assessing system feasibility for implementation in Honduras, acceptability among end users and effectiveness in capturing routine immunization data.

Related Courses

Required for sub-team 1: COMPSCI 408 – Delivering Software: From Concept to Client (Duvall, Azhar) (Fall 2017)

Required: GLHLTH 590S – Introduction to mHealth in Low and Middle Income Countries (Vasudevan) (Spring 2018)

Anticipated Outcomes

mHealth system developed and scaled for use by the routine immunization program in Roatan; summary of lessons learned and key barriers in the implementation of the mHealth system; abstracts submitted to global health/mHealth conferences; manuscript(s) submitted to peer-reviewed journals; preliminary data for inclusion in grant proposals

Student Opportunities

This team will include six student team members (four undergraduates and two graduate/professional students or residents/postdocs). Team members will be selected based on strong interest in global health, vaccines and/or mobile technologies from a variety of backgrounds such as global health, computer science, engineering, humanities, biostatistics or medicine. Previous research experience in Honduras is a plus. Intermediate to advanced proficiency in Spanish is preferred. Team members interested in being part of sub-team 1 will be required to complete the prerequisites for COMPSCI 408 prior to Fall 2017. Students will be required to enroll in GLHLTH 590S in Spring 2018.

Student team members will receive training in the following areas through didactic and experiential learning opportunities: global health needs assessment, technology evaluation, software programming and implementation; research methods (quantitative and qualitative); childhood vaccination programs and policies, Spanish language skills, and working in a global low-resource setting (Honduras).

Evaluation criteria include attendance at team meetings, participation in teamwork and quality of deliverables.

Timing

Spring 2017 – Fall 2018

  • Spring 2017: Selected team members will attend organizational meetings wherein project activities and deliverables will be described, time and effort expectations will be clarified, responsibilities and tasks will be assigned and team communication/project management protocols will be established; sub-teams will be established
  • Summer 2017: Team leaders will organize team building activities; team members will read and discuss the book Scarcity: Why Having Too Little Means So Much with a specific lens on how poverty affects uptake of vaccinations; team members will participate in group dinners and virtual meetings with key stakeholders to gather system requirements as well as understand current infrastructure for deploying the mHealth system; sub-team 1 will focus on developing a systems requirements specification document as well as storyboards describing system work and information flows; sub-team 2 will systematically evaluate available technology options
  • Fall 2017: Sub-team 1 will enroll in COMPS 408 and work on developing the mHealth system; sub-team 2 will support the work of sub-team 1 by providing Spanish language support and content for the mHealth system, and will work on developing the study design and questionnaires for assessing system feasibility and acceptability, then submit the study protocol to the Duke University IRB; sub-teams 1 and 2 will collaborate to develop training materials to acquaint end users with the system and provide information related to troubleshooting
  • Spring 2018: In early January, two student team members and a team leader will travel to Roatan to train end users and deploy the mHealth system in Clinica Esperanza for a 10-day pilot study; team will conduct a system demonstration for the routine immunization program members in Roatan to collect further feedback; sub-team 1 will continue to refine and update the system for use by the routine immunization program in Roatan; sub-team 2 will analyze the data from the focus group discussions
  • Summer and Fall 2018: The team will work with health workers form the routine immunization program to scale up the system to the activities in Roatan (training, setting up the necessary infrastructure and supporting the health workers through the initial period of using the application); sub-team 2 will conduct focus group discussions with the health workers to assess the acceptability of and satisfaction with the mHealth system

Crediting

Independent study credit available for fall and spring semesters; summer funding

See earlier related team, Interculturally Competent Analysis of the Uptake of Routine Vaccination (2015-2016).

Faculty/Staff Team Members

Dennis Clements, School of Medicine - Pediatrics - Infectious Diseases*
Robert Duvall, Trinity - Computer Science
Richard Lucic, Trinity - Computer Science*
Lavanya Vasudevan, Duke Global Health Institute*

Community Team Members

Multiple Contributors, Clinica Esperanza, Honduras
Multiple Contributors, Offices of the Secretariat of Health, Roatan, Honduras

* denotes team leader

Status

Active