Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal (Preprint)

BACKGROUND Populations in low-resource settings with high childhood morbidity and mortality increasingly are being selected as beneficiaries for interventions using passive sensing data collection through digital technologies. However, these populations often have limited familiarity with the processes and implications of passive data collection. Therefore, methods are needed to identify cultural norms and family preferences influencing the uptake of new technologies. OBJECTIVE Before introducing a new device or a passive data collection approach, it is important to determine what will be culturally acceptable and feasible. The objective of this study was to develop a systematic approach to determine acceptability and perceived utility of potential passive data collection technologies to inform selection and piloting of a device. To achieve this, we developed the Qualitative Cultural Assessment of Passive Data collection Technology (QualCAPDT). This approach is built upon structured elicitation tasks used in cultural anthropology. METHODS We piloted QualCAPDT using focus group discussions (FGDs), video demonstrations of simulated technology use, attribute rating with anchoring vignettes, and card ranking procedures. The procedure was used to select passive sensing technologies to evaluate child development and caregiver mental health in KwaZulu-Natal, South Africa, and Kathmandu, Nepal. Videos were produced in South Africa and Nepal to demonstrate the technologies and their potential local application. Structured elicitation tasks were administered in FGDs after showing the videos. Using QualCAPDT, we evaluated the following 5 technologies: home-based video recording, mobile device capture of audio, a wearable time-lapse camera attached to the child, proximity detection through a wearable passive Bluetooth beacon attached to the child, and an indoor environmental sensor measuring air quality. RESULTS In South Africa, 38 community health workers, health organization leaders, and caregivers participated in interviews and FGDs with structured elicitation tasks. We refined the procedure after South Africa to make the process more accessible for low-literacy populations in Nepal. In addition, the refined procedure reduced misconceptions about the tools being evaluated. In Nepal, 69 community health workers and caregivers participated in a refined QualCAPDT. In both countries, the child’s wearable time-lapse camera achieved many of the target attributes. Participants in Nepal also highly ranked a home-based environmental sensor and a proximity beacon worn by the child. CONCLUSIONS The QualCAPDT procedure can be used to identify community norms and preferences to facilitate the selection of potential passive data collection strategies and devices. QualCAPDT is an important first step before selecting devices and piloting passive data collection in a community. It is especially important for work with caregivers and young children for whom cultural beliefs and shared family environments strongly determine behavior and potential uptake of new technology.

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Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

Social Science & Medicine ◽

10.1016/j.socscimed.2017.04.046 ◽

2017 ◽

Vol 183 ◽

pp. 97-105 ◽

Cited By ~ 17

Author(s):

Alastair van Heerden ◽

Danielle M. Harris ◽

Heidi van Rooyen ◽

Ruanne V. Barnabas ◽

Nithya Ramanathan ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Hiv Testing And Counseling ◽

Home Based ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Testing And Counseling

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Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v12i1.2629 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Elsje Scheffler ◽

Robert Mash

Keyword(s):

South Africa ◽

Community Health ◽

Family Caregivers ◽

Community Health Workers ◽

Health Workers ◽

Stroke Survivors ◽

Home Based ◽

Home Based Care

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Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal

JMIR Pediatrics and Parenting ◽

10.2196/12366 ◽

2019 ◽

Vol 2 (1) ◽

pp. e12366 ◽

Cited By ~ 8

Author(s):

Brandon A Kohrt ◽

Sauharda Rai ◽

Khanya Vilakazi ◽

Kiran Thapa ◽

Anvita Bhardwaj ◽

...

Keyword(s):

South Africa ◽

Data Collection ◽

Passive Data ◽

Cultural Assessment

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Smart Phones As a Viable Data Collection Tool in Low-resource Settings: Case Study of Rwandan Community Health Workers

Neuroscience and Biomedical Engineering ◽

10.2174/2213385204666160711155116 ◽

2016 ◽

Vol 4 (2) ◽

pp. 132-139 ◽

Cited By ~ 2

Author(s):

Suzana Brown ◽

Alan Mickelson

Keyword(s):

Data Collection ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Smart Phones ◽

Data Collection Tool ◽

Low Resource Settings ◽

Low Resource

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Post-trial perceptions of a symptom-based TB screening intervention in South Africa: implementation insights and future directions for TB preventive healthcare services

BMC Nursing ◽

10.1186/s12912-021-00544-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nicole Salazar-Austin ◽

Minja Milovanovic ◽

Nora S. West ◽

Molefi Tladi ◽

Grace Link Barnes ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Implementation Strategies ◽

Healthcare Services ◽

Preventive Therapy ◽

Provider Perceptions ◽

Symptom Screening ◽

Study Implementation

Abstract Background Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts. Methods Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants’ experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted. Results Participants’ had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers. Conclusions Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care. Trial registration The results presented here were from research related to NCT03074799, retrospectively registered on 9 March 2017.

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Passive sensing on mobile devices to improve mental health services with adolescent and young mothers in low-resource settings: the role of families in feasibility and acceptability

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01473-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sujen Man Maharjan ◽

Anubhuti Poudyal ◽

Alastair van Heerden ◽

Prabin Byanjankar ◽

Ada Thapa ◽

...

Keyword(s):

Data Collection ◽

Health Services ◽

Mobile Devices ◽

Family Involvement ◽

Mobile Phones ◽

Young Mothers ◽

Audio Recording ◽

Low Resource Settings ◽

Passive Sensing ◽

Passive Data

Abstract Background Passive sensor data from mobile devices can shed light on daily activities, social behavior, and maternal-child interactions to improve maternal and child health services including mental healthcare. We assessed feasibility and acceptability of the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) platform. The StandStrong passive data collection platform was piloted with adolescent and young mothers, including mothers experiencing postpartum depression, in Nepal. Methods Mothers (15–25 years old) with infants (< 12 months old) were recruited in person from vaccination clinics in rural Nepal. They were provided with an Android smartphone and a Bluetooth beacon to collect data in four domains: the mother’s location using the Global Positioning System (GPS), physical activity using the phone’s accelerometer, auditory environment using episodic audio recording on the phone, and mother-infant proximity measured with the Bluetooth beacon attached to the infant’s clothing. Feasibility and acceptability were evaluated based on the amount of passive sensing data collected compared to the total amount that could be collected in a 2-week period. Endline qualitative interviews were conducted to understand mothers’ experiences and perceptions of passive data collection. Results Of the 782 women approached, 320 met eligibility criteria and 38 mothers (11 depressed, 27 non-depressed) were enrolled. 38 mothers (11 depressed, 27 non-depressed) were enrolled. Across all participants, 5,579 of the hour-long data collection windows had at least one audio recording [mean (M) = 57.4% of the total possible hour-long recording windows per participant; median (Mdn) = 62.6%], 5,001 activity readings (M = 50.6%; Mdn = 63.2%), 4,168 proximity readings (M = 41.1%; Mdn = 47.6%), and 3,482 GPS readings (M = 35.4%; Mdn = 39.2%). Feasibility challenges were phone battery charging, data usage exceeding prepaid limits, and burden of carrying mobile phones. Acceptability challenges were privacy concerns and lack of family involvement. Overall, families’ understanding of passive sensing and families’ awareness of potential benefits to mothers and infants were the major modifiable factors increasing acceptability and reducing gaps in data collection. Conclusion Per sensor type, approximately half of the hour-long collection windows had at least one reading. Feasibility challenges for passive sensing on mobile devices can be addressed by providing alternative phone charging options, reverse billing for the app, and replacing mobile phones with smartwatches. Enhancing acceptability will require greater family involvement and improved communication regarding benefits of passive sensing for psychological interventions and other health services. Registration International Registered Report Identifier (IRRID): DERR1-10.2196/14734

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Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

Health Policy and Planning ◽

10.1093/heapol/czaa172 ◽

2020 ◽

Author(s):

Joshua P Murphy ◽

Aneesa Moolla ◽

Sharon Kgowedi ◽

Constance Mongwenyana ◽

Sithabile Mngadi ◽

...

Keyword(s):

South Africa ◽

Qualitative Study ◽

Policy Implementation ◽

Community Health ◽

Resource Constraints ◽

Health Workers ◽

Healthcare Providers ◽

Successful Implementation ◽

Programme Implementation ◽

Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

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Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey

BMC Public Health ◽

10.1186/s12889-018-5927-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Nireshni Naidoo ◽

Jean P. Railton ◽

Sellina N. Khosa ◽

Nthabiseng Matlakala ◽

Gert Marincowitz ◽

...

Keyword(s):

South Africa ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Community Survey ◽

Programme Implementation

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Compensation Models for Community Health Workers: Comparison of Legal Frameworks across Five Countries

10.21203/rs.3.rs-36222/v1 ◽

2020 ◽

Author(s):

Madeleine Ballard ◽

Carey Westgate ◽

Rebecca Alban ◽

Nandini Choudhury ◽

Rehan Adamjee ◽

...

Keyword(s):

South Africa ◽

Public Sector ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Legal Framework ◽

Law Firms ◽

Advantages And Disadvantages ◽

Compensation Mechanisms ◽

Legal Frameworks

Abstract Background Despite the life-saving work they perform, community health workers (CHWs) have long been subject to global debate about their remuneration. There is now, however, an emerging consensus that CHWs should be paid. As the discussion evolves from whether to financially remunerate CHWs to how to do so, there is an urgent need to better understand the types of CHW payment models and their implications. Methods This study examines the legal framework on CHW compensation in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. In order to map the characteristics of each approach, a standardized questionnaire was developed and targeted at local law firms. The questionnaire covered legal structures and requirements for compensation of CHWs, CHW compensation mechanisms, CHW legal protections and benefits, and alignment of national CHW policies with global guidelines. Results The five countries profiled represent possible archetypes for CHW compensation: Brazil (public), Ghana (volunteer-based), Nigeria (private), Rwanda (cooperatives with performance based incentives) and South Africa (hybrid public/private). Advantages and disadvantages of each model with respect to (i) CHWs, in terms of financial protection, and (ii) the public sector, in terms of ease of implementation, are outlined. Conclusions While a strong legal framework does not necessarily translate into high-quality implementation, it is the first necessary step. While certain approaches to CHW compensation - particularly public-sector or hybrid models with public sector wage floors - best institutionalize recommended CHW protections, political will and long-term financing often remain obstacles. Removing ecosystem barriers - such as multilateral and bilateral restrictions on the payment of salaries - can help governments institutionalize CHW payment.

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