Nothing Special   »   [go: up one dir, main page]

skip to main content
10.1145/2909609.2909652acmotherconferencesArticle/Chapter ViewAbstractPublication PagesictdConference Proceedingsconference-collections
research-article
Public Access

Closing the Feedback Loop: A 12-month Evaluation of ASTA, a Self-Tracking Application for ASHAs

Published: 03 June 2016 Publication History

Abstract

Accredited Social Health Activists (ASHAs) have been shown to have a positive impact on health outcomes of the households they visit, particularly in maternal and neonatal health. As the first line of the public health system in many countries, they are a critical link to the broader public health infrastructure for community members. Yet they do this all with minimal training and limited support infrastructure. To a pregnant woman, an ASHA is a trusted ally in navigating the health system---information gathered is returned by appropriate advice and counseling. To the health system, the ASHA is a key channel of valuable householdlevel information for the public health system, yet she generally receives minimal guidance in return. In this paper we present ASTA---the ASHA Self-Tracking Application---a system that provides ASHAs with timely, on-demand information regarding their own performance compared to their peers. Using ASTA, ASHAs access comparative performance data through both a web-based and voice-based interface on demand. We evaluated ASTA through a 12-month deployment with 142 ASHAs in Uttar Pradesh, India, assessing the impact of providing feedback on ASHA performance. We find that ASHAs with access to the ASTA system made significantly more client visits, with average monthly visits 21.5% higher than ASHAs who had access to a control system. In addition, higher ASHA performance was correlated with increased usage of ASTA. However, the performance improvement was front-loaded, with the impact of the system decreasing toward the end of the study period. Taken together, our findings provide promising evidence that studying and incorporating tools like ASTA could be cost effective and impactful for ASHA programs.

References

[1]
Uttar Pradesh State Profile. http://nrhm.gov.in/nrhm-in-state/state-wise-information/uttar-pradesh.html.
[2]
Census of India. http://censusindia.gov.in/2011-prov-results/paper2/data_files/UP/7-pop-12-22.pdf, 2011.
[3]
Baseline Study Summary: ReMiND. Technical report, Catholic Relief Services, 2013.
[4]
S., J. Walley, E. Katabira, S. Muchuro, H. Balidawa, E. Namagala, and E. Ikoona. Using mobile phones to improve clinic attendance amongst an antiretroviral treatment cohort in rural Uganda: a crosssectional and prospective study. AIDS and behavior, 14(6):1347--1352, 2010.
[5]
A. H. Baqui, S. El-Arifeen, G. L. Darmstadt, S. Ahmed, E. K. Williams, H. R. Seraji, I. Mannan, S. M. Rahman, R. Shah, S. K. Saha, et al. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. The Lancet, 371(9628):1936--1944, 2008.
[6]
M. Berg, J. Wariero, and V. Modi. Every child counts: The use of SMS in Kenya to support the community based management of acute malnutrition and malaria in children under five. Columbia University, 2009.
[7]
E. Borkum, A. Sivasankaran, S. Sridharan, D. Rotz, S. Sethi, M. Manoranjini, L. Ramakrishnan, and A. Rangarajan. Evaluation of the Information and Communication Technology (ICT) Continuum of Care Services (CCS) Intervention in Bihar. Technical report, Mathematica Policy Research, May 2015.
[8]
C. Bourne, V. Knight, R. Guy, H. Wand, H. Lu, and A. McNulty. Short message service reminder intervention doubles sexually transmitted infection/HIV retesting rates among men who have sex with men. Sexually transmitted infections, 87(3):229--231, 2011.
[9]
B. DeRenzi, L. Findlater, J. Payne, B. Birnbaum, J. Mangilima, T. Parikh, G. Borriello, and N. Lesh. Improving Community Health Worker Performance Through Automated SMS. In Proceedings of the Fifth International Conference on Information and Communication Technologies and Development, ICTD '12, pages 25--34, New York, NY, USA, 2012. ACM.
[10]
B. DeRenzi, N. Lesh, T. Parikh, C. Sims, W. Maokla, M. Chemba, Y. Hamisi, M. Mitchell, and G. Borriello. e-IMCI: Improving pediatric health care in low-income countries. In Proceedings of the SIGCHI conference on human factors in computing systems, pages 753--762. ACM, 2008.
[11]
B. DeRenzi, C. Sims, J. Jackson, G. Borriello, and N. Lesh. A framework for case-based community health information systems. In Global Humanitarian Technology Conference (GHTC), 2011 IEEE, pages 377--382. IEEE, 2011.
[12]
J. F. Florez-Arango, M. S. Iyengar, K. Dunn, and J. Zhang. Performance factors of mobile rich media job aids for community health workers. Journal of the American Medical Informatics Association, 18(2):131--137, 2011.
[13]
B. Fogg and E. Allen. 10 uses of texting to improve health. In Proceedings of the 4th International Conference on Persuasive Technology, Persuasive '09, pages 38:1--38:6, New York, NY, USA, 2009. ACM.
[14]
M. S. Iyengar, J. F. Florez-Arango, and C. A. Garcia. GuideView: a system for developing structured, multimodal, multi-platform persuasive applications. In Proceedings of the 4th International Conference on Persuasive Technology, page 31. ACM, 2009.
[15]
N. Jain, N. Srivastava, A. Khan, N. Dhar, S. Manon, V. Adhish, and D. Nandan. Assessment of functioning of ASHA under NRHM in Uttar Pradesh. Health and Population: Perspectives and Issues, 31(2):132--140, 2008.
[16]
M. Kay. Cran - package artool. https://cran.r-project.org/web/packages/ARTool/, 2015. {Online; accessed 12-November-2015}.
[17]
G. Kidane and R. H. Morrow. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. The Lancet, 356(9229):550--555, 2000.
[18]
P. Klasnja and W. Pratt. Healthcare in the pocket: mapping the space of mobile phone health interventions. Journal of biomedical informatics, 45(1):184--198, 2012.
[19]
V. Kumar, S. Mohanty, A. Kumar, R. P. Misra, M. Santosham, S. Awasthi, A. H. Baqui, P. Singh, V. Singh, R. C. Ahuja, et al. Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. The Lancet, 372(9644):1151--1162, 2008.
[20]
U. Lehmann, D. Sanders, et al. Community health workers: What do we know about them? World Health Organization, 2:1--42, 2007.
[21]
N. Mahmud, J. Rodriguez, and J. Nesbit. A Text Message-based Intervention to Bridge the Healthcare Communication Gap in the Rural Developing World. Technol. Health Care, 18(2):137--144, Apr. 2010.
[22]
I. Medhi, S. Patnaik, E. Brunskill, S. N. Gautama, W. Thies, and K. Toyama. Designing Mobile Interfaces for Novice and Low-literacy Users. ACM Trans. Comput.-Hum. Interact., 18(1):2:1--2:28, May 2011.
[23]
T. Oluoch, X. Santas, D. Kwaro, M. Were, P. Biondich, C. Bailey, A. Abu-Hanna, and N. de Keizer. The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: A systematic review. International journal of medical informatics, 81(10):e83--e92, 2012.
[24]
N. Patel, K. Shah, K. Savani, S. R. Klemmer, P. Dave, and T. S. Parikh. Power to the Peers: Authority of Source Effects for a Voice-based Agricultural Information Service in Rural India. In Proceedings of the Fifth International Conference on Information and Communication Technologies and Development, ICTD '12, pages 169--178, New York, NY, USA, 2012. ACM.
[25]
S. Patnaik, E. Brunskill, and W. Thies. Evaluating the Accuracy of Data Collection on Mobile Phones: A Study of Forms, SMS, and Voice. In Proceedings of the 3rd International Conference on Information and Communication Technologies and Development, ICTD'09, pages 74--84, Piscataway, NJ, USA, 2009. IEEE Press.
[26]
D. Ramachandran, J. Canny, P. D. Das, and E. Cutrell. Mobile-izing Health Workers in Rural India. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI '10, pages 1889--1898, New York, NY, USA, 2010. ACM.
[27]
P. M. Rothwell. Factors that can affect the external validity of randomised controlled trials. PLoS Clin Trials, 1(1):e9, 2006.
[28]
A. Rowe, D. Desavigny, C. Lanata, and C. Victora. How can we achieve and maintain high-quality performance of health workers in low-resource settings? The Lancet, 366(9490):1026--1035, 2005.
[29]
J. Sherwani, N. Ali, S. Mirza, A. Fatma, Y. Memon, M. Karim, R. Tongia, and R. Rosenfeld. Healthline: Speech-based access to health information by low-literate users. In Information and Communication Technologies and Development, 2007. ICTD 2007. International Conference on, pages 1--9. IEEE, 2007.
[30]
J. Stekelenburg, S. Kyanamina, and I. Wolffers. Poor performance of community health workers in Kalabo District, Zambia. Health policy (Amsterdam, Netherlands, 65(2):109--118, 2003.
[31]
D. Thea and S. Qazi. Neonatal mortality--4 million reasons for progress. The Lancet, 371(9628):1893--1895, 2008.
[32]
K. Toyama. Geek heresy: Rescuing social change from the cult of technology. PublicAffairs, 2015.
[33]
A. Vashistha, E. Cutrell, G. Borriello, and W. Thies. Sangeet Swara: A Community-Moderated Voice Forum in Rural India. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems, CHI '15, pages 417--426, New York, NY, USA, 2015. ACM.
[34]
P. Winch, K. Gilroy, C. Wolfheim, E. Starbuck, M. Young, L. Walker, and R. Black. Intervention models for the management of children with signs of pneumonia or malaria by community health workers. Health Policy and Planning, 20(4):199--212, 2005.
[35]
J. O. Wobbrock, L. Findlater, D. Gergle, and J. J. Higgins. The Aligned Rank Transform for Nonparametric Factorial Analyses Using Only Anova Procedures. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI '11, pages 143--146, New York, NY, USA, 2011. ACM.
[36]
J. O. Wobbrock, L. Findlater, D. Gergle, J. J. Higgins, and M. Kay. Artool. https://depts.washington.edu/aimgroup/proj/art/, 2015. {Online; accessed 12-November-2015}.
[37]
S. Yadav. A study of treatment seeking behaviour for malaria and its management in febrile children in rural part of desert, Rajasthan, India. Journal of vector borne diseases, 47(4):235--242, 2010.
[38]
D. Zurovac, R. K. Sudoi, W. S. Akhwale, M. Ndiritu, D. H. Hamer, A. K. Rowe, and R. W. Snow. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. The Lancet, 378(9793):795--803, 2011.

Cited By

View all
  • (2024)A mixed methods evaluation of the impact of ECHO® telementoring model for capacity building of community health workers in IndiaHuman Resources for Health10.1186/s12960-024-00907-y22:1Online publication date: 23-Apr-2024
  • (2024)"If it is easy to understand then it will have value": Examining Perceptions of Explainable AI with Community Health Workers in Rural IndiaProceedings of the ACM on Human-Computer Interaction10.1145/36373488:CSCW1(1-28)Online publication date: 26-Apr-2024
  • (2024)A Pilot Mobile App to Collect South African Child Language DataImplications of Information and Digital Technologies for Development10.1007/978-3-031-66982-8_22(313-327)Online publication date: 1-Aug-2024
  • Show More Cited By

Recommendations

Comments

Please enable JavaScript to view thecomments powered by Disqus.

Information & Contributors

Information

Published In

cover image ACM Other conferences
ICTD '16: Proceedings of the Eighth International Conference on Information and Communication Technologies and Development
June 2016
427 pages
ISBN:9781450343060
DOI:10.1145/2909609
Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than the author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected].

In-Cooperation

  • Google Inc.
  • Microsoft: Microsoft
  • University of Michigan: University of Michigan

Publisher

Association for Computing Machinery

New York, NY, United States

Publication History

Published: 03 June 2016

Permissions

Request permissions for this article.

Check for updates

Author Tags

  1. HCI4D
  2. ICT4CHW
  3. ICTD
  4. mHealth

Qualifiers

  • Research-article
  • Research
  • Refereed limited

Funding Sources

Conference

ICTD '16

Acceptance Rates

Overall Acceptance Rate 22 of 116 submissions, 19%

Contributors

Other Metrics

Bibliometrics & Citations

Bibliometrics

Article Metrics

  • Downloads (Last 12 months)68
  • Downloads (Last 6 weeks)10
Reflects downloads up to 01 Oct 2024

Other Metrics

Citations

Cited By

View all
  • (2024)A mixed methods evaluation of the impact of ECHO® telementoring model for capacity building of community health workers in IndiaHuman Resources for Health10.1186/s12960-024-00907-y22:1Online publication date: 23-Apr-2024
  • (2024)"If it is easy to understand then it will have value": Examining Perceptions of Explainable AI with Community Health Workers in Rural IndiaProceedings of the ACM on Human-Computer Interaction10.1145/36373488:CSCW1(1-28)Online publication date: 26-Apr-2024
  • (2024)A Pilot Mobile App to Collect South African Child Language DataImplications of Information and Digital Technologies for Development10.1007/978-3-031-66982-8_22(313-327)Online publication date: 1-Aug-2024
  • (2022)Imagining Caring Futures for Frontline Health WorkProceedings of the ACM on Human-Computer Interaction10.1145/35555816:CSCW2(1-30)Online publication date: 11-Nov-2022
  • (2022)Counting to be Counted: Anganwadi Workers and Digital Infrastructures of Ambivalent CareProceedings of the ACM on Human-Computer Interaction10.1145/35551776:CSCW2(1-36)Online publication date: 11-Nov-2022
  • (2022)Invisible Work in Two Frontline Health ContextsProceedings of the 5th ACM SIGCAS/SIGCHI Conference on Computing and Sustainable Societies10.1145/3530190.3534814(139-151)Online publication date: 29-Jun-2022
  • (2022)Embodied Negotiations, Practices and Experiences Interacting with Pregnancy Care Infrastructures in South IndiaProceedings of the 2022 CHI Conference on Human Factors in Computing Systems10.1145/3491102.3501950(1-21)Online publication date: 29-Apr-2022
  • (2022)Towards Equitable Futures in Frontline Health:Design of Intelligent Systems for Supporting (Gendered) Care Work in Resource-Constrained SettingsExtended Abstracts of the 2022 CHI Conference on Human Factors in Computing Systems10.1145/3491101.3503808(1-5)Online publication date: 27-Apr-2022
  • (2021)Detecting Data Falsification by Front-line Development Workers: A Case Study of Vaccination in PakistanProceedings of the 2021 CHI Conference on Human Factors in Computing Systems10.1145/3411764.3445630(1-14)Online publication date: 6-May-2021
  • (2021)“It cannot do all of my work”: Community Health Worker Perceptions of AI-Enabled Mobile Health Applications in Rural IndiaProceedings of the 2021 CHI Conference on Human Factors in Computing Systems10.1145/3411764.3445420(1-20)Online publication date: 6-May-2021
  • Show More Cited By

View Options

View options

PDF

View or Download as a PDF file.

PDF

eReader

View online with eReader.

eReader

Get Access

Login options

Media

Figures

Other

Tables

Share

Share

Share this Publication link

Share on social media