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Mobile health: How it can enhance cervical cancer health with and independently of the POCkeT colpos

Updated: Sep 5, 2019

Avni Mehta

Background:

mHealth is the general term for the use of mobile phones and other wireless technology in medical care. mHealth has the potential to transform the face of health delivery across the globe for a myriad of reasons. In the past few years, rapid advances have been made in mobile technology and applications, coverage of mobile networks, and affordability of mobile phones and technology, resulting in the new opportunities for the integration of mobile health into existing healthcare systems. Currently, there are over 5 billion wireless mobile phone users and 70% of them live in low and middle income countries. Wireless signals cover over 85% of the world’s population. In fact, more people have access to mobile phones than to clean water, electricity and toilets. mHealth is particularly relevant in LMICs, where the shortage of healthcare workers constricts access to cervical cancer screenings and any routine medical procedure or screening. Even where physicians and hospitals are not widely accessible, patients can consult professionals across the country or even abroad with a few swipes on their phone. These factors make mhealth, the ability to reach people no matter where they are in the world and deliver healthcare services to them, a very attractive and feasible opportunity across the globe, but especially in LMICs.

The WHO has explored fourteen categories of mHealth: health call centres, emergency toll-free telephone services, managing emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support systems. In addition to this, mobile health can also be used as a training platform for health care providers.


How can mHealth enhance the functionality of the colposcope?

The POCkeT Colposcope has been proposed as a low-cost, easy to use, low-resource friendly device. One of the benefits of the pocket colposcope is that it can interface with a mobile phone for image capture of the cervix. This makes it a good candidate for mHealth applications. The ways in which mHealth can enhance the functionality of the POCkeT Colposcope within the WHO categories are outlined below:

Mobile Telemedicine: Applying telemedicine to the POCkeT Colposcope, physicians can remotely guide community healthcare workers through the colposcopy procedure. It will help eliminate distance barriers to cervical cancer screening that would otherwise not be consistently available in distant rural communities.

Mobile Patient records: Images taken by the POCkeT Colposcope can be saved and identified with a patient’s name, medical record number, and other identifiers. The image capture and storage of patient information will enable consistent record keeping, keeping track and management of patient health information. Since most hospitals in low and middle income countries do not have medical record databases (MRB), the POCkeT colposcope is a means of introducing this technology to current healthcare systems. However, since patient information must be protected it is essential to have an approved, encrypted MRB.

Patient monitoring: Storage of images from the POCkeT Colposcope will enable physicians to track the progression of cervical cancer. Comparing images before and after treatment will help physicians to determine whether the treatment was effective or the cancer’s progression.

Decision support systems: Decision making algorithms that can process visual inspection colposcopy images from the POCkeT Colposcope will enable expert physician interpretation in community health settings or in areas where there lack trained physicians. A computer will be able to determine the presence of a precancerous or cancerous lesion and recommend the patient for further testing and treatment. The algorithm the computer applies to the images will be developed from many hundreds to thousands of analyses from physicians. Image analysis software will require less training for community based cervical cancer screening and also empower community health workers to make confident, accurate screening decisions.

Self-Screening: Using an mHealth model, women may be able to self-screen in the comfort of their own home and send the acquired images to a physician over a mobile application. Self-screening should increase women’s comfort and bypass any stigma associated with receiving a pelvic exam.

What value can mHealth add independently to the colposcope?

Independently of the colposcope mHealth still has value for the cervical cancer screening process. Some of the ways in which mHealth can achieve this are:

Training Platform:

The introduction of a new device requires training of health practitioners and other affiliated staff members. MHealth could be useful in providing an instruction guide to proper equipment use and training platforms to test knowledge of the POCkeT colposcope key functions. Additionally, mHealth could be used with the colposcope to signal proper usage by the implementing party (whether that be the patient or the health practitioner). Perhaps the mhealth platform could signal to the implementing party when the device has been used properly or even guide the implementing party through the image capture process.

Furthermore, expanding the knowledge and awareness of healthcare workers, and equipping them with the skills necessary to work in the space of cervical cancer, are critical elements of reducing the impact of this disease. Given the penetration of smartphones in lower income countries, an mHealth platform could prove to be an effective medium in transmitting and making available this information for healthcare workers. Points or reward systems could be implemented within the platform to incentivize their use.

Appointment reminders: One of the greatest challenges in treating cervical cancer in LMICs, and a key contributing factor to the disparity in the burden of disease between higher and lower income countries, is the loss of patients to follow-up. Leveraging a mobile health system to provide reminders for patients who have appointments could help to reduce the loss of patients between appointments.

Community mobilization and health promotion: mHealth applications can be used to mobilize communities to make use of the health resources available, or to increase involvement in campaigns. For instance, in Peru, private and public healthcare providers use mobile health clinics to provide services to populations that do not have ready access to healthcare. This comes in the form of a van equipped with basic clinical facilities, and is often in a given location only for about a week. A mobile health application could assist in mobilizing communities to make use of this resource while it is available through centrally-disseminated alerts, and also through notifications that friends or neighbors are utilizing the service.

Treatment compliance: The archetypal example for the use of mHealth to improve treatment compliance would be in the case of diabetes, where dietary intakes can be logged by an application and feedback provided for the user to adjust their behavior. If we enter the self-screening paradigm for cervical cancer, or if alternate treatment options become viable, such a scheme could become relevant for cervical cancer as well.

Information access: An mHealth platform could provide a space where pertinent information regarding cervical cancer is consolidated and easily accessible. Contextual information regarding local community services and contact details for healthcare practitioners could also be provided.

Health surveys and data collection: Since mHealth applications are connected to the internet, they serve as a useful, effective, and organized system for data collection. They can be used to collect data from various populations and regions, and have all the information stored in a single, easily-accessible database. This slashes a lot of the overhead involved in paper surveys. Another prime advantage of using applications instead of paper surveys is that there is also a simple return mechanism to provide feedback to the user based on the data collected, since every application would be connected to a server. Data collection for specific diseases that aren’t as widely known or that are gender-specific can be beneficial to raise awareness specifically to the government of that country. Sometimes governments are unaware of certain diseases or are unaware of how many people suffer from that ailment, especially in rural areas so this platform could keep track of how many patients are being treated/added daily.

Mobile Payments and Microinsurance: Around 28.6% of health expenditures in Peru are out-of-pocket (1) and two out of every 10 Peruvians have access to a bank account (2). As such, mobile payments could be very helpful in providing out-of-pocket payers with access to capital to pay for health services and create efficiencies in the provision of care.

Challenges

It should be noted that despite its popularity, higher income countries practice the use of mHealth more than lower and middle income countries, with European countries currently the most active and African countries least active. There may be therefore challenges in acceptance and implementation of mHealth devices. Both physicians and patients will require training on the use of the device and its benefits. There is also the problem of getting the platform recognized and used by patients in middle and lower-income countries where there is less infrastructure.

The inherent nature of the mobile device allows for data storage, information sharing and portability. Although these qualities carry various positive attributes, there are several key considerations for integrating mhealth services; it is important to anticipate the potential for data leakage, misinterpretation of information and connectivity issues. However, if key participants in mhealth activities plan accordingly, it will be easier to mitigate the risks associated with these events and therefore, the overall effectiveness of mhealth platforms will be increased. Especially since smartphones are becoming more easily accessible than medical care, a person who is able to use an app to track their medical records would be very beneficial.

(1) http://wdi.worldbank.org/table/2.15

(2) http://www.worldbank.org/en/news/feature/2014/08/25/peru-donde-la-gente-vive-sin-ban cos


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