Conference Material > Abstract
Arago M, Mangue M, Cumbi N, Zamudio AG, Loarec A, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
WHAT CHALLENGE OR OPPORTUNITY DID YOU TRY TO ADDRESS? WERE EXISTING SOLUTIONS NOT AVAILABLE OR NOT GOOD ENOUGH?
Ototoxicity is an unfortunate side-effect of second-line injectable drugs for drug-resistant tuberculosis (DRTB), including aminoglycosides and peptides. Worldwide, up to 15% of patients on treatment regimens containing these drugs develop a degree of ototoxicity. Patients who experience ototoxicity are generally switched to an oral treatment regimen. Although regular audiological evaluations are recommended for patients receiving these drugs, there is limited access to these services, and few patients with noticeable hearing problems are referred for confirmation and follow-up.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Before the introduction of this digital tool, the MSF DRTB project in Mozambique had to refer patients to the Central Hospital in Maputo. This limited the number of patients screened and referred for testing, curtailing the potential to switch treatment early for those showing mild-to-moderate hearing loss.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
In 2018, the team piloted a way to simplify monitoring of hearing using a clinically approved mobile tablet-based tool that has been found to be comparable with traditional audiometry measurements in children and adults. MSF acquired three kits of CE-marked and FDA-certified iOS-based audiometry kits from SHOEBOX® Audiometry systems. The units were comprised of calibrated headphones and tablet-based software that have acceptable accuracy (±10dB) with 90% sensitivity and specificity. The portable units were deployed in rotation in six health centres over two years; a total of 673 audiometry tests were performed in MSF-supported public health centres in Maputo. Patients were tested at baseline during their first consultation and then monthly while on treatment regimens that included injectable drugs.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
The 2018 Mozambique National TB Committee approved treatment without injectable drugs in patients who had any degree of hearing impairment before the initiation of treatment. Patients screened using the digital tool directly benefitted from switching to oral DRTB treatment if they exhibited any hearing loss, without requiring hospital referral.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We describe the implementation and use of a mobile audiometry system for patients with treatment-related ototoxicity in the MSF DRTB project in Mozambique, and consider its potential for easily assessing hearing deterioration in this cohort.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY
Routinely collected data were evaluated.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
Data were analysed retrospectively from routine records and may not be exhaustive. Separate analysis of baseline and follow-up was not possible.
WHAT RESULTS DID YOU GET?
Of the 673 audiometry tests conducted using the digital tool, 480 (71%) showed normal hearing, 65 (10%) mild hearing loss, 81 (12%) moderate hearing loss, and 47 (7%) severe-to-profound hearing loss.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
This decentralised approach does not need specialised setup, which may lead to increased screening, proper follow-up, and more potential for early switching of drug regimens.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Decreasing the need for hospital referrals improved time and transport costs for patients.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?:
A cost-benefit analysis to compare the mobile audiometry system to referrals would be beneficial for programmatic decisions.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
In December 2019, the project was phased out as there was a protocol change in which injectable drugs were replaced with more potent and fully oral regimens that made monitoring for ototoxicity unnecessary for most patients.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
The tools adapted are clinically approved for screening activities for any programmes that deal with hearing loss.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
The project demonstrates the potential to improve follow-up and detect complications early for patients who take ototoxic medications.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
User-friendly and automated audiometry systems that are mobile and do not require audiologists or sound-insulated booths could be extremely useful to various medical projects using potentially ototoxic drugs such as aminoglycosides. They may also be beneficial for environmental projects with noise and toxic pollutions. The high cost of the license could present a limitation necessitating a cost-benefit analysis before contemplating scale-up.
ETHICS
This description and evaluation of an innovation project involved human participants or their data, and has had ethics oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
Ototoxicity is an unfortunate side-effect of second-line injectable drugs for drug-resistant tuberculosis (DRTB), including aminoglycosides and peptides. Worldwide, up to 15% of patients on treatment regimens containing these drugs develop a degree of ototoxicity. Patients who experience ototoxicity are generally switched to an oral treatment regimen. Although regular audiological evaluations are recommended for patients receiving these drugs, there is limited access to these services, and few patients with noticeable hearing problems are referred for confirmation and follow-up.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Before the introduction of this digital tool, the MSF DRTB project in Mozambique had to refer patients to the Central Hospital in Maputo. This limited the number of patients screened and referred for testing, curtailing the potential to switch treatment early for those showing mild-to-moderate hearing loss.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
In 2018, the team piloted a way to simplify monitoring of hearing using a clinically approved mobile tablet-based tool that has been found to be comparable with traditional audiometry measurements in children and adults. MSF acquired three kits of CE-marked and FDA-certified iOS-based audiometry kits from SHOEBOX® Audiometry systems. The units were comprised of calibrated headphones and tablet-based software that have acceptable accuracy (±10dB) with 90% sensitivity and specificity. The portable units were deployed in rotation in six health centres over two years; a total of 673 audiometry tests were performed in MSF-supported public health centres in Maputo. Patients were tested at baseline during their first consultation and then monthly while on treatment regimens that included injectable drugs.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
The 2018 Mozambique National TB Committee approved treatment without injectable drugs in patients who had any degree of hearing impairment before the initiation of treatment. Patients screened using the digital tool directly benefitted from switching to oral DRTB treatment if they exhibited any hearing loss, without requiring hospital referral.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We describe the implementation and use of a mobile audiometry system for patients with treatment-related ototoxicity in the MSF DRTB project in Mozambique, and consider its potential for easily assessing hearing deterioration in this cohort.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY
Routinely collected data were evaluated.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
Data were analysed retrospectively from routine records and may not be exhaustive. Separate analysis of baseline and follow-up was not possible.
WHAT RESULTS DID YOU GET?
Of the 673 audiometry tests conducted using the digital tool, 480 (71%) showed normal hearing, 65 (10%) mild hearing loss, 81 (12%) moderate hearing loss, and 47 (7%) severe-to-profound hearing loss.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
This decentralised approach does not need specialised setup, which may lead to increased screening, proper follow-up, and more potential for early switching of drug regimens.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Decreasing the need for hospital referrals improved time and transport costs for patients.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?:
A cost-benefit analysis to compare the mobile audiometry system to referrals would be beneficial for programmatic decisions.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
In December 2019, the project was phased out as there was a protocol change in which injectable drugs were replaced with more potent and fully oral regimens that made monitoring for ototoxicity unnecessary for most patients.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
The tools adapted are clinically approved for screening activities for any programmes that deal with hearing loss.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
The project demonstrates the potential to improve follow-up and detect complications early for patients who take ototoxic medications.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
User-friendly and automated audiometry systems that are mobile and do not require audiologists or sound-insulated booths could be extremely useful to various medical projects using potentially ototoxic drugs such as aminoglycosides. They may also be beneficial for environmental projects with noise and toxic pollutions. The high cost of the license could present a limitation necessitating a cost-benefit analysis before contemplating scale-up.
ETHICS
This description and evaluation of an innovation project involved human participants or their data, and has had ethics oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
Conference Material > Video (talk)
Camacho A
Epicentre Scientific Day Paris 2021. 2021 June 10
Conference Material > Abstract
Hein J, Allewaert N, Hoschele A, Massotte G
MSF Scientific Days International 2021: Innovation. 2021 May 20
WHAT CHALLENGE OR OPPORTUNITY DID YOU TRY TO ADDRESS? WERE EXISTING SOLUTIONS NOT AVAILABLE OR NOT GOOD ENOUGH?
During the COVID-19 pandemic, MSF field health promotion (HP) teams in many countries have been faced with limitations caused by lockdown restrictions. To protect populations, in-person meetings were banned, and disseminating information to communities about COVID-19 protection measures and symptoms became complicated. Traditional HP tools, such as health talks or outreach events, were impossible.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Until the pandemic is over, communities worldwide will be faced with varying degrees of restrictions on movement and gatherings. The same is true for MSF teams. While meeting people physically remains restricted, the organisation will need alternative methods of interacting with communities, both on an individual level and in groups.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
Use of social media by MSF has been limited to communications teams. By changing the paradigm and approaching these platforms as tools to disseminate HP information, we are uncovering massive potential. We implemented digital HP through social media platforms (Facebook, Instagram, WhatsApp) in 11 countries.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
Communities served by MSF received relevant and accurate information about COVID-19 prevention and related health information. The communities we targeted were also involved in designing the campaigns, in line with community engagement principles.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We aimed to disseminate relevant information as widely as possible. Where possible, we engaged in one-to-one conversations with community members via messenger applications.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY.
The ‘reach’ of a social media post is defined as the number of individuals who are exposed to that post through their own social media account. We collected information on the number of people reached, total number of views, frequency of views per person, number of comments, number of conversations, and topical breakdown of conversations between June and December 2020.
HOW DID YOU ANALYSE THIS DATA TO UNDERSTAND TO WHAT EXTENT THE INNOVATION ACHIEVED ITS OBJECTIVES? DID THIS INCLUDE A COMPARISON TO THE STATUS QUO OR AN EXISTING SOLUTION?
We reviewed the data globally and by country.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
All data were pertaining to online activities only; we could not reach people in areas of limited data coverage (for example most of South Sudan outside Juba, or the Central African Republic) or people without access to social media. In some cases, our objectives were to promote in-person services, and we struggled to match online data to offline results (number of people accessing services or changing behaviour).
WHAT RESULTS DID YOU GET?
We reached over 21 000 000 people through 14 social media campaigns. We recorded over 106 000 000 views of HP messages, 15 000 one-to-one conversations, and 6 600 comments.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
This is the first example of social media being used for rapid digital HP at this scale and in response to a global emergency. We leveraged pre-existing tools to disseminate critical health-related information in lockdown scenarios. We reached 21 000 000 people in 6 months and therefore consider this pilot a success.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Those who engaged with our campaigns had the opportunity to interact with MSF staff without risking exposure to COVID-19.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?
We would develop an improved system for measuring whether online results accurately reflect population health outcomes.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
Development of indicators and measurable connections to health outcomes are required. Creating referral pathways to different modes of communication will also be important, allowing for more detailed HP support through platforms that are better equipped for two-way communication.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
Social media is used globally, in contexts with mobile data coverage.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
We hope to demonstrate that the use of digital tools and social media are not only for communication teams but can directly contribute to the improvement of health-seeking behaviour. Additionally, this approach should be considered for HP in hard-to-reach populations.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
Other digital HP projects from Lebanon and Zimbabwe have been presented at previous MSF Scientific Days. We have shown that this approach can also be used on a global scale.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
During the COVID-19 pandemic, MSF field health promotion (HP) teams in many countries have been faced with limitations caused by lockdown restrictions. To protect populations, in-person meetings were banned, and disseminating information to communities about COVID-19 protection measures and symptoms became complicated. Traditional HP tools, such as health talks or outreach events, were impossible.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Until the pandemic is over, communities worldwide will be faced with varying degrees of restrictions on movement and gatherings. The same is true for MSF teams. While meeting people physically remains restricted, the organisation will need alternative methods of interacting with communities, both on an individual level and in groups.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
Use of social media by MSF has been limited to communications teams. By changing the paradigm and approaching these platforms as tools to disseminate HP information, we are uncovering massive potential. We implemented digital HP through social media platforms (Facebook, Instagram, WhatsApp) in 11 countries.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
Communities served by MSF received relevant and accurate information about COVID-19 prevention and related health information. The communities we targeted were also involved in designing the campaigns, in line with community engagement principles.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We aimed to disseminate relevant information as widely as possible. Where possible, we engaged in one-to-one conversations with community members via messenger applications.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY.
The ‘reach’ of a social media post is defined as the number of individuals who are exposed to that post through their own social media account. We collected information on the number of people reached, total number of views, frequency of views per person, number of comments, number of conversations, and topical breakdown of conversations between June and December 2020.
HOW DID YOU ANALYSE THIS DATA TO UNDERSTAND TO WHAT EXTENT THE INNOVATION ACHIEVED ITS OBJECTIVES? DID THIS INCLUDE A COMPARISON TO THE STATUS QUO OR AN EXISTING SOLUTION?
We reviewed the data globally and by country.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
All data were pertaining to online activities only; we could not reach people in areas of limited data coverage (for example most of South Sudan outside Juba, or the Central African Republic) or people without access to social media. In some cases, our objectives were to promote in-person services, and we struggled to match online data to offline results (number of people accessing services or changing behaviour).
WHAT RESULTS DID YOU GET?
We reached over 21 000 000 people through 14 social media campaigns. We recorded over 106 000 000 views of HP messages, 15 000 one-to-one conversations, and 6 600 comments.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
This is the first example of social media being used for rapid digital HP at this scale and in response to a global emergency. We leveraged pre-existing tools to disseminate critical health-related information in lockdown scenarios. We reached 21 000 000 people in 6 months and therefore consider this pilot a success.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Those who engaged with our campaigns had the opportunity to interact with MSF staff without risking exposure to COVID-19.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?
We would develop an improved system for measuring whether online results accurately reflect population health outcomes.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
Development of indicators and measurable connections to health outcomes are required. Creating referral pathways to different modes of communication will also be important, allowing for more detailed HP support through platforms that are better equipped for two-way communication.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
Social media is used globally, in contexts with mobile data coverage.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
We hope to demonstrate that the use of digital tools and social media are not only for communication teams but can directly contribute to the improvement of health-seeking behaviour. Additionally, this approach should be considered for HP in hard-to-reach populations.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
Other digital HP projects from Lebanon and Zimbabwe have been presented at previous MSF Scientific Days. We have shown that this approach can also be used on a global scale.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
Journal Article > Short ReportFull Text
Public Health Action. 2015 December 21; Volume 5 (Issue 4); 205-208.; DOI:10.5588/pha.15.0057
Wright V, Dalwai MK, Vincent-Smith R, Jemmy J-P
Public Health Action. 2015 December 21; Volume 5 (Issue 4); 205-208.; DOI:10.5588/pha.15.0057
Many health care workers lack access to clinical support tools in rural and resource-limited settings. To address this gap, the Médecins Sans Frontières (MSF) Clinical Guidelines manual was converted into a static mobile health reference application (app) entitled MSF Guidance. The app's utility and growth was examined, and within 6 months of its launch 150 countries had downloaded the app, with demonstrated retention among new and existing users. With over 3500 downloads and 36 000 sessions amounting to 250 000 screen views, MSF Guidance is a new mobile health platform with widely demonstrated utility, including potential use as an epidemiological tool, where clinical conditions investigated by app users were found to correlate with geographical outbreaks. These findings show that mobile apps can be used to disseminate health information effectively.
Conference Material > Poster
Sethi S, Shrestha U, Aradhya R
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/wb61-jj97
Journal Article > ResearchFull Text
Confl Health. 2022 February 14; Volume 16 (Issue 1); 6.; DOI:10.1186/s13031-022-00437-1
Ibragimov K, Palma M, Keane G, Ousley J, Carreño C, et al.
Confl Health. 2022 February 14; Volume 16 (Issue 1); 6.; DOI:10.1186/s13031-022-00437-1
BACKGROUND
'Tele-Mental Health (MH) services' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format.
METHODS
From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred.
RESULTS
Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure.
CONCLUSION
Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
'Tele-Mental Health (MH) services' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format.
METHODS
From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred.
RESULTS
Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure.
CONCLUSION
Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
Conference Material > Slide Presentation
Arago M, Mangue M, Cumbi N, Zamudio AG, Loarec A, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
Conference Material > Abstract
Wodon S, Voiret I, Acquarone A, Sterk E, Traore K, et al.
MSF Scientific Days International 2020: Innovation. 2020 May 28
INTRODUCTION
The Ebola outbreak in the Democratic Republic of Congo (DRC) has led to over 3300 confirmed cases and caused over 2250 deaths so far. Health promotion is a key component of the Ebola response, however, misconceptions about Ebola and the response are common. CHAMPIONS CONTRE EBOLA is a smartphone app for disseminating health promotion (HP) messages. It uses gamification to let people proactively identify adequate health behaviours. Players are asked simple questions about Ebola and asked to choose between two answers. For each correct answer, the player earns stars which unlocks avatars. Correct messages, consisting of a short text and two illustrations, and certificates showing successful game completion, can be shared on social media. The app, available in French, Swahili, and English, can be downloaded from Google Play or shared via Bluetooth. The game has been developed in a partnership between MSF and Pixel Impact.
METHODS
The first version of the app was tested in Bunia in October, 2019. 75 people in individual and group sessions gave feedback on the app’s messages and user interface. A second version, including a tutorial, improved coherency between stars, certificates, and avatars, and revised messages, was launched in January, 2020 in Bunia during MSF HP sessions. From these group sessions, 75 individuals, including medical team members, key community members, and other age and gender representative community members, agreed to test the application individually. Using a structured questionnaire, data were collected on app perception, understanding, and usability. An observer checklist was used by a supervisor to collect information on the technical reliability of the app during field use.
RESULTS
The app was positively perceived by 99% of respondents, for its capacity to facilitate knowledge improvement (51% of participants), to reach more people with health promotion messages (14%), to reinforce and affirm existing knowledge (14%), to support decision-making (16%), and as a user-friendly game (10%). The game’s design and pedagogical approach were appreciated and motivating for all participants, with 99% motivated to win stars, 97% appreciating the ability to choose avatars, and all participants agreeing with its utility to fight Ebola and likely acceptance by communities. Challenges were identified regarding usability, with 53% of people requiring assistance at the beginning of use, due to difficulty with game initiation (55% of those requiring assistance), fear regarding a new game (28%), and difficulty utilising the options in the game (18%). Additional factors were identified for improvement, including increased competitiveness and intuitiveness.
ETHICS
This innovation project did not involve human participants’ personal data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
CONCLUSION
CHAMPIONS CONTRE EBOLA generated a positive response and has potential as a complement to standard health promotion tools. It is designed to enable participants to engage actively in the learning process and to facilitate sharing of health messages within the community, rather than be passive recipients of health-care messages. Limitations include the lack of assessment of message retention and impact on behavior; further research would be needed to determine these effects. The app has been shared with other Ebola response actors and is available on Google Play.
Conflicts of interest
None declared.
The Ebola outbreak in the Democratic Republic of Congo (DRC) has led to over 3300 confirmed cases and caused over 2250 deaths so far. Health promotion is a key component of the Ebola response, however, misconceptions about Ebola and the response are common. CHAMPIONS CONTRE EBOLA is a smartphone app for disseminating health promotion (HP) messages. It uses gamification to let people proactively identify adequate health behaviours. Players are asked simple questions about Ebola and asked to choose between two answers. For each correct answer, the player earns stars which unlocks avatars. Correct messages, consisting of a short text and two illustrations, and certificates showing successful game completion, can be shared on social media. The app, available in French, Swahili, and English, can be downloaded from Google Play or shared via Bluetooth. The game has been developed in a partnership between MSF and Pixel Impact.
METHODS
The first version of the app was tested in Bunia in October, 2019. 75 people in individual and group sessions gave feedback on the app’s messages and user interface. A second version, including a tutorial, improved coherency between stars, certificates, and avatars, and revised messages, was launched in January, 2020 in Bunia during MSF HP sessions. From these group sessions, 75 individuals, including medical team members, key community members, and other age and gender representative community members, agreed to test the application individually. Using a structured questionnaire, data were collected on app perception, understanding, and usability. An observer checklist was used by a supervisor to collect information on the technical reliability of the app during field use.
RESULTS
The app was positively perceived by 99% of respondents, for its capacity to facilitate knowledge improvement (51% of participants), to reach more people with health promotion messages (14%), to reinforce and affirm existing knowledge (14%), to support decision-making (16%), and as a user-friendly game (10%). The game’s design and pedagogical approach were appreciated and motivating for all participants, with 99% motivated to win stars, 97% appreciating the ability to choose avatars, and all participants agreeing with its utility to fight Ebola and likely acceptance by communities. Challenges were identified regarding usability, with 53% of people requiring assistance at the beginning of use, due to difficulty with game initiation (55% of those requiring assistance), fear regarding a new game (28%), and difficulty utilising the options in the game (18%). Additional factors were identified for improvement, including increased competitiveness and intuitiveness.
ETHICS
This innovation project did not involve human participants’ personal data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
CONCLUSION
CHAMPIONS CONTRE EBOLA generated a positive response and has potential as a complement to standard health promotion tools. It is designed to enable participants to engage actively in the learning process and to facilitate sharing of health messages within the community, rather than be passive recipients of health-care messages. Limitations include the lack of assessment of message retention and impact on behavior; further research would be needed to determine these effects. The app has been shared with other Ebola response actors and is available on Google Play.
Conflicts of interest
None declared.
Journal Article > LetterFull Text
Lancet. 2021 November 27; Volume 398 (Issue 10315); 1962-1963.; DOI:10.1016/S0140-6736(21)02349-7
Boum Y II
Lancet. 2021 November 27; Volume 398 (Issue 10315); 1962-1963.; DOI:10.1016/S0140-6736(21)02349-7
Conference Material > Video (panel)
Chakkalackal M
MSF Scientific Days International 2020: Innovation. 2020 May 20