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Pragati - A Mobile Based Virtual Reality (VR) Platform to Train and Educate Community Health Workers
Abstract
Accredited Social Health Activists (ASHAs) are essential link to healthy communities in resource-constrained environments. However, they are insufficiently trained to solve community health challenges. In this paper, we present Pragati - a mobile-based Virtual Reality (VR) platform to train and educate ASHAs in rural Assam, India. Mobile based VR platform was chosen due to its ability to increase focus, attention and learnability among users. We developed 3 modules on maternal and child healthcare. Modules were presented via audio-visual interface in local Assamesse language. This paper presents the design of Pragati, user interactions, technology implementations and future directions of our study.
KeywordsICT in social development - interaction design for developing regionsTechnology in healthcareVirtual realityMedical trainingCommunity health workers
... Capacity building: Induction, skills development, mentoring, and coaching Competency-based training Frequency of training Training modules aligned with roles Formalisation and structure post-in-service training [27,28,32,47,48] Changes to education, training, and certification CHW technical-retained competency The formality of CHWs' qualifications Comprehension of theoretical health and mHealth concepts Correlation of pre-existing capacities and roles with training amount and type [9,[44][45][46][49][50][51] Workplace design and organisation structure Continuous supervision Physical learning environment Discrepancies between practice and training theory Internet and virtual social networks Comprehension of training content [6,33,[52][53][54] Training strategies ...
... Primary school education: minimal entry-level requirement Historical experiences Individual readiness for learning Personal health beliefs Health status of CHWs Motivational factors at the interpersonal level Financial incentives [6,7,20,37,48,56] Competency-based task/role assignment-related factors ...
Background: Globally, community health workers (CHW) are increasingly viewed as an integral part of the health system as opposed to simply being an extension of it. Given this view, most low- or middle-income countries (LMICs) have refocused their efforts on reorganising CHW initiatives to maximise their impact. The ongoing endeavours to augment the practice of community health workers using technological solutions are characterised by as many challenges as opportunities. In low- and middle-income countries, including South Africa, information and communication technology (ICT) has become a promising development in the enhancement of the equitable coverage of health services by community health workers. However, there has not been a wide-scale implementation and adoption of ICT; most technology initiatives fail to scale up during the implementation stage, which is attributable to human and context-related factors. Although there has been an effort to develop solutions to address ICT infrastructure and technical barriers, conceptualising an evidence-based understanding of the contextual and user-related factors that influence the efficacy of technology adoption by CHWs within their multidimensional system remains critical. Objective: The purpose of the study is to conceptualise the social factors to consider when implementing a bespoke ICT solution suited to the specific demands of CHWs in primary healthcare in developing contexts, with a particular focus on the South African context. Methodology: The methodology involves synthesizing, extracting, and consolidating the findings of a systematised scoping review into concepts and factors. The review adapts Arksey and O’Malley’s scoping review approach to the study and incorporates 59 relevant articles. Results: Although the knowledge base on CHWs is extensive, there is a considerable gap in addressing structural challenges within the community system, which contributes significantly to the overall performance of CHW programs. Factors promoting policy adaptations, common practice within the health system, CHW competencies, a community’s development in terms of knowledge and economic advancement, safety and security, the environment, and the socio-cultural context all play a significant role in facilitating or impeding the success of health interventions from the individual to the national level. Conclusions: Within several practical limitations, the study shows that despite the efforts of various developing countries to promote technology adoption, the barriers to ICT adoption outweigh the benefits gained in developing countries. The paper argues that addressing these challenges before and during implementation is critical. The authors conclude with some essential concerns about assisting CHWs towards realising the desired health outcomes through ICT.
Immersive Virtual Reality (VR) has shown to be effective in general training and learning applications, but whether it has potential in understanding and learning complex topics is not well researched. In addition, the role of users’ expertise in VR-based learning is not really understood.
Here we present findings from our purpose-designed immersive VR system and investigation on whether experts with theoretical knowledge in a certain domain can develop deep non-verbal comprehension beyond pure understanding. Mathematically educated experts as well as non-experts are asked to interact with four-dimensional cubes projected into three-dimensional VR space (hypercubes)—an intentional task not found in real life.
In the first of two studies, we validate the feasibility of the principle subject matter, apparatus, and proposed measurements with 22 participants. This study is based on a seminal study proposal from the 1970’s. We use the results of this first study to inform a second study based on a philosophical thought experiment known as Mary’s Room. With 70 participants we investigate experience, interaction, and prior knowledge, in an immersive VR learning environment.
We can show that both experts and non-experts benefit from the immersive interaction with hypercubes. Both groups develop a non-verbal comprehension of this theoretical construct. Surprisingly though, experts, with prior theoretical knowledge, benefit stronger.
Our findings have implications for immersive VR learning environments and open a future research space on the importance of and relationships between immersive VR, interaction, understanding, comprehension, and constructivist learning.
The study presented in this paper demonstrates how nurse midwives used video on mobile phones to support patient education in a maternal and child health project in rural India. The main goals of the study were to understand how the technology impacted the workflow of the nurses and to assess the acceptability of the use of video during patient encounters. The study was based on interviews of the midwives, observation of patient visits, and an analysis of logs from the mobile devices. The overall results were positive; the midwives accepted use of mobile video as part of the workflow for postnatal care examinations. Using video changed the process of patient education, in some cases making it a more focused activity. The use of video also led to midwife multitasking, which was enabled by the technology. The study suggests that the midwives felt that their authority was enhanced by the use of video.
Mobile health (mHealth) describes the use of portable electronic devices with software applications to provide health services and manage patient information. With approximately 5 billion mobile phone users globally, opportunities for mobile technologies to play a formal role in health services, particularly in low- and middle-income countries, are increasingly being recognized. mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children sick with diarrhea, pneumonia, and malaria.
Our aim was to conduct a thematic review of how mHealth projects have approached the intersection of cellular technology and public health in low- and middle-income countries and identify the promising practices and experiences learned, as well as novel and innovative approaches of how mHealth can support community health workers.
In this review, 6 themes of mHealth initiatives were examined using information from peer-reviewed journals, websites, and key reports. Primary mHealth technologies reviewed included mobile phones, personal digital assistants (PDAs) and smartphones, patient monitoring devices, and mobile telemedicine devices. We examined how these tools could be used for education and awareness, data access, and for strengthening health information systems. We also considered how mHealth may support patient monitoring, clinical decision making, and tracking of drugs and supplies. Lessons from mHealth trials and studies were summarized, focusing on low- and middle-income countries and community health workers.
The review revealed that there are very few formal outcome evaluations of mHealth in low-income countries. Although there is vast documentation of project process evaluations, there are few studies demonstrating an impact on clinical outcomes. There is also a lack of mHealth applications and services operating at scale in low- and middle-income countries. The most commonly documented use of mHealth was 1-way text-message and phone reminders to encourage follow-up appointments, healthy behaviors, and data gathering. Innovative mHealth applications for community health workers include the use of mobile phones as job aides, clinical decision support tools, and for data submission and instant feedback on performance.
With partnerships forming between governments, technologists, non-governmental organizations, academia, and industry, there is great potential to improve health services delivery by using mHealth in low- and middle-income countries. As with many other health improvement projects, a key challenge is moving mHealth approaches from pilot projects to national scalable programs while properly engaging health workers and communities in the process. By harnessing the increasing presence of mobile phones among diverse populations, there is promising evidence to suggest that mHealth can be used to deliver increased and enhanced health care services to individuals and communities, while helping to strengthen health systems.
Health workers in the developing world are starved of the information that is the lifeblood of effective health care.1 2 As a direct result, their patients suffer and die. In the words of the late James Grant, former executive director of Unicef, “The most urgent task before us is to get medical and health knowledge to those most in need of that knowledge. Of the approximately 50 million people who were dying each year in the late 1980s, fully two thirds could have been saved through the application of that knowledge.”2
Providing access to reliable health information for health workers in developing countries is potentially the single most cost effective and achievable strategy for sustainable improvement in health care. Cost effective because the …
The use of collaboration technology to allow community health workers, who provide care in patients' homes, to be supported by remote expert clinicians can enhance the quality of home care services. We have explored the design of two collaboration tools to enable a health worker to discuss patient details with a remote clinician and to be guided by the clinician when performing a physical examination of a patient. One of the tools is hand-held tablet-based and designed to support real-time communication and information sharing, shared annotation on patient data as well as recording of rich media annotations for asynchronous review after the home visits. The second tool is a wearable unit consisting of a computer, a camera and a near-eye display and enables a clinician to use hand gestures to remotely guide a health worker in physical examinations. In this paper we describe our design considerations and outline our design approaches.
Health education in rural communities is one of the main ways in which developing countries are addressing prevalent health issues like maternal and child mortality, HIV/Aids, tuberculosis (TB) and malaria. In many rural villages, Community Health Workers (CHWs) act as proxies through which health education information is spread in their communities. In this paper, we discuss important principles to consider when designing solutions for creating and distributing digital health content in rural communities, based on previous work in the area of health education and the training of CHWs. We then introduce our model of content creation and distribution, which involves providing tools that allow rural health professionals to independently create health content from within their local communities. We also present the lessons learned from our deployment of this model in Lesotho - highlighting the opportunities presented by the use of locally produced hence locally relevant digital content in health education.
In this paper, we present the design, implementation, and deployment of a tool developed to help rural health trainers to create digital training content for low-literate Community Health Workers (CHWs) in Lesotho; the digital content being mobile videos created from combining images, voice-over, and/or video clips. Our results show that when health professionals who are based in rural areas were empowered by the tool to create their own content, they were able to supplement nationally and globally produced health training materials with more locally relevant content that addresses unique information needs within their communities. We discuss other lessons learned from an eight-months deployment of this tool in Lesotho, and conclude with recommendations on how a similar project can be implemented in other developing regions.
There is some evidence that Virtual Reality (VR) can contribute to raise interest and motivation in students and to effe ctively support knowledge transfer, since the learning process can be settled within an experiential framework. However, the practical potential of VR is still being explored: understanding how to use Virtual Reality to support training and learning activities presents a substantial challenge for the designers and evaluators of this learning technology. This chapter has the main aim of discussing the rationale and main benefits for the use of virtual environments in education and training. A number of key attributes of VR environments will be described and discussed in relationship to educational theory and pedagogical practice, in order to establish a possible theoretical basis for VR learning. Significant research and projects carried out in this field will be also presented, together with suggestions and guidelines for future development of VR learning systems. However, further research is required, both on technological side and on key issues such as transfer of learning, appropriate curriculum implementation, elements of effective VR design, and the psychological and social impact of the technology use.
Educational uses of virtual reality technology. Institute for Defense Analyses
- C Youngblut