The Technology and the Debate        Technologies such as the smartphone, crowd sourcing tools, remote diagnostics and oth...
with each other. These innovations have had a positive impact on society but these tools werealso conduits for yellow jour...
prevention of further violent outbreaks.7 Other instances using the Ushahidi platform have beenduring the earthquake in Ha...
surrounding the magnitude of the problem. Data tends to be limited as many women do notreport or seek medical services imm...
throughout the world regardless of social, economic or religious divisions. In looking at specificrisk factors women who t...
in garnering this type of support. In Senegal, the organizations Tostan and UNICEF launchedthe Jokko Initiative. By way of...
alone.27 MyWay Village, a social network installed in nursing homes, allows residents to connectwith new people and share ...
violence is heating up and interrupt to calm the situation down. With Ushahidi,FrontlineSMS:Medic and PopTech, the project...
Self-Directed Violence        Lastly, violent acts that one inflicts upon himself or herself are classified as self-direct...
Overarching Gaps and Trends       Through the program implementation cases above several arching gaps and trends beginto e...
patients and report on their health status. This information is sent to a central web baseddashboard which can then provid...
However, a larger issue                                                            remains, which is the exchange of      ...
3. Develop common metrics for monitoring and evaluation    With the ever pressing need to know if these technologies are m...
13    "Sexual Assault Statistics." National Center on Domestic and Sexual Violence. Web. Oct. 2011.<
46   World Report on Violence and Health. WHO, 2002.47   Jody Ranck, Health Information and Health Care: The Role of Techn...
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Role of Information Communication Technologies in Violence Prevention


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Background Paper for "mPreventViolence: Communication and Technology for Violence Prevention - A Workshop" held by the Institute of Medicine.

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Role of Information Communication Technologies in Violence Prevention

  1. 1. THE ROLE OF INFORMATION COMMUNICATIONS TECHNOLOGIES IN VIOLENCE PREVENTION Cathryn Meurn Introduction Violence is a global problem that exceeds cultural and socio-economic boundaries. Fromcollective to interpersonal and self-inflicted typologies, the impact of violence on health issubstantial. Overall violence is one of the leading causes of death worldwide for people between15-44 years of age.1 However, the actual cost and extent to which violence occurs is difficult tomeasure. Countless violent acts happen out of public view in offices, homes or even publicinstitutions. Violence can be prevented and this assertion has been proven true within the field ofpublic health. Along with violence prevention, there have been numerous methods and programsthat have reduced the impact of violence itself. Action has been undertaken from the local andcommunity level up through to the international system. Methods have ranged from the level of Defining Violence: primary prevention, aiming to prevent a violent act before it occurs, to the tertiary level, which “The intentional use of physical force encompasses approaches that focus on long-term care. or power, threatened or actual, against oneself, another person, or The goal of this background paper is to provide against a group or community, that a brief introduction to the current and potential role that either results in or has a high information and communication technologies (ICTs) likelihood of resulting in injury, death, can play in the prevention and reduction of violence. psychological harm, maldevelopment First and foremost this paper is by no means an or deprivation” extensive study on the intersection of ICTs and violence WHO 2002 prevention. There is a plethora of projects that exist anda deeper landscape analysis is recommended. In addition, the use of ICTs in the field of publichealth is in its early stages. Much of what is cited in this paper can be classified as pilot projectsand, to date, there is no in depth measurement of their impact. Therefore what has been written inthis paper is for the sole purpose of introducing the potential of the space and for encouragingcollective action forward. The paper will begin with a brief introduction to ICTs and their rise in usage withinhealth programs, with reference to the debate that surrounds them. Then specific programs andcase examples, segregated by typology, will be discussed. Lastly we will look at someoverarching trends and examine gaps that will conclude with a series of proposedrecommendations.The responsibility for the content of this article rests with the author and does not necessarilyrepresent the views of the Institute of Medicine or its committees and convening bodies.
  2. 2. The Technology and the Debate Technologies such as the smartphone, crowd sourcing tools, remote diagnostics and othertechnological innovations have proliferated over the past decade or so, and many have shiftedover to mainstream use. With this technological expansion, debate has also risen over thepositive and negative impacts these innovations have within communities and worldwide.Information and communication technologies can be defined as a set of technological tools andresources used to communicate, create, disseminate, store, and manage information. This caninclude video, radio, television, Internet programs, social media platforms and mobile phones.Distinctions are emerging between “old” and “new” forms of media and technology; that is,between the use of television, radio and other forms of traditional media that have beenemployed for decades and newer forms of media including social media and the use of themobile phone. Particularly for thedeveloping world, adoption of the Mobile cellular subscriptionsmobile phone creates a new avenue by level of developmentfor combating against longstandingproblems. With currently over 5billion mobile subscriptionsworldwide, phone ownership hasexploded. Two-thirds of thesesubscriptions are in developingcountries and it is predicted thatsoon 90 percent of the world’spopulation will be within the ITU 2010 2coverage of wireless networks.Unique users active on social networks are also up nearly 30 percent globally, rising from 244.2million to 314.5 million as reported by the Nielsen Company in 2010.3 There are over 800million users on Facebook, Twitter is estimated to be beyond 200 million users, and more videocontent is uploaded to YouTube in a 60-day period than what three major U.S. television networks created in 60 years.4 Teens are texting at monthly records and areas such as eLearning, remote diagnostics, and mServices are growing steadily. Still technology is not a panacea for the problems we face today. Despite the hype, these are simply tools that can be used either for social good or for harm. As with the invention of paper, the printing press, and the telephone – all changed the way in which we interact 2
  3. 3. with each other. These innovations have had a positive impact on society but these tools werealso conduits for yellow journalism and mass media campaigns against ethnic groups and certainminorities. In addition, technology is only a small part of any solution. As seen in the diagram tothe left by Ushahidi, there is a lot of other “stuff” that goes along with making any project orprogram successful. In the case of today, these new forms of communication and new technologies have leadto some fantastic outcomes, as discussed in the next section. Contrarily they have also elicitednew intricacies within the struggle to prevent and reduce violence. Trends in cyberbullying,losses in privacy and security, and stories of perpetrators targeting victims through social mediasites, all weigh ominously when we speak of using these tools for social good. Program and Intervention DesignsCollective Violence Often receiving a high level of international, public and political attention, collectiveviolence is perhaps the most visible type of violence. Whether arising from violent intra-stateconflicts that account for the majority of conflicts today, the flow of displaced persons, acts ofterrorism or genocide, the associated affects can be immense. Impact from violent conflictsaffect the civilian society profoundly in regards to health via increased mortality, morbidity anddisability. The WHO has defined collective violence: the instrumental use of violence by people who identify themselves as a member of a group – whether this group is transitory or has a more permanent identity – against another group or set of individuals, in order to achieve political, economic or social objectives.5 However with the rise of new media, advances in technology and increased access,opportunities exist in which violence can be further prevented. One of the most popular forms ofprogram implementation using mobile phones is through the utilization of short message service(SMS) messaging, or better known as text messages. SMS has been used most frequently foreducational awareness via one-way messaging, such as Amnesty International’s SMS urgent-action appeals campaign in The Netherlands. This campaign raised the awareness of torturevictims through text campaigns and in turn enabled the agency to collect “signatures” whenimmediate action from supporters was necessary.6 One of the most cited cases, exemplifying the potential of SMS past simple awarenesscampaigns, was during the Kenyan 2007 election. Although initial results indicated theopposition candidate Raila Odinga was in the lead, incumbent President Mwai Kibaki wasannounced as the official victor. Six weeks of violence ensued where the influential role ofmobiles became apparent. Through the Ushahidi platform, those with mobile phones were ableto send texts to a specific number to report on human rights abuses and incidents, which werethen mapped geographically on a website. This utilization of both texts and online tools not onlyenabled the reporting of events in real time but also aided the mobilization of groups around the 3
  4. 4. prevention of further violent outbreaks.7 Other instances using the Ushahidi platform have beenduring the earthquake in Haiti, and more recently in the Egypt protests and the crisis in Libya.8Nevertheless it is important to note that this mode of communication can also make it cheap andeasy for others to spread hateful messages to insight additional violence as it did in the case ofKenya. Outside of the recent trend of crowd sourcing information, traditional uses of informationcommunication technologies, such as phone networks, radio and television should not beneglected. Radio and television have been used in many forms since their invention. With theutilization of phone networks, one project of note is by Interaction Belfast, which created amobile phone network to prevent outbreaks of violence between warring neighborhoods inBelfast. Volunteers in both Protestant and Catholic communities are given mobile phones toenable communication with their counterparts when potentially violent crowds gathered or whenrumors of violence started to spread in order to resolve the issue. Technologies provide not only increased communication but also increasedaccountability and transparency.9 The organization Witness works to use the power of videoadvocacy by documenting and sharing human rights abuses via cameras. By working withconstituents on the use of video as a medium to shed light on certain atrocities, they have helpedshed light on the repression of ethnic minorities in Burma and help prosecute recruiters of childsoldiers in the Democratic Republic of Congo.10 In addition, training includes information onhow to use video safely, which is important given the complexities this type of intervention cangive rise to. Lastly, particularly in the developing world, a unique opportunity that deserveshighlighting is the increasing role of the health worker. As task shifting continues to progress inthese countries, community health workers can help to draw attention to indications of violence.With multiple programs now using these health workers for community outreach, data collectionand reporting via the use of ICTs and mobile phones, opportunities exist to leverage.Interpersonal Violence Moving towards the category of interpersonal violence, opportunities for leveragingtechnology still exist. Interpersonal violence is differentiated from collective violence asviolence that is inflicted by another individual or small group of individuals.11 Within thiscategory, this includes sexual violence, intimate partner violence, elder abuse, youth violenceand child abuse. Sexual violence Sexual violence is defined as “any sexual act, attempt to obtain a sexual act, unwantedsexual comments or advances, or acts to traffic, or otherwise directed, against a person’ssexuality using coercion”.12 Research suggests that at least one in four women in the UnitedStates have experienced sexual violence.13 Sexual violence is a universal problem and it can havea deep impact on both physical and mental health including injury, stigmatization, and evendeath. One continuously noted aspect of this type of violence is the lack of information 4
  5. 5. surrounding the magnitude of the problem. Data tends to be limited as many women do notreport or seek medical services immediately in incidents of violence. To further complicatematters, data comes from varying sectors, such as clinical settings, NGOs and the police. Following upon the previous example of the Kenyan elections, the use of SMS andgeocoding can be applied to the prevention of interpersonal violence as well as collectiveviolence. In Egypt, Frontline SMS, a text messaging based system, in conjunction with the Ushahidi platform have been used in a project called Harassmap. In Egypt 83 percent of women are exposed to sexual harassment.14 The basis of the program is that if a woman is sexually harassed she can send an SMS to the Harassmap number with corresponding details of the incident. This information will then be mapped on the website, allowing for “hot- spots” of harassment to become identified. They also provide help and information for victims.15 This program aims to help break through the silence that surrounds this issue. Harassmap 2011 Another program aiming to break through some cultural barriers is the Mobile CinemaFoundation. This program travels to various soldiers’ camps and exposes soldiers to theconsequences of rape through short films. These films seek to educate the soldiers of Congo’sNational Army through victim’s testimonies and discussions that are held after the viewing. Thisform of digital storytelling can be a powerful tool both for empowering the victims andeducating offenders on the effects their actions can elicit. Other programs center on confidential hotlines, such as the National Sexual AssaultHotline in the United States where victims can call in for help. Relating this method to sextrafficking we can point towards the International Organization for Migration who partnered withUkrainian mobile phone service providers in 2007, allowing victims to dial a certain number toreceive information and advice on migration and trafficking issues.16 Often it is an intimate partner that commits sexual violence, making sexual violencedovetail closely with intimate partner violence. Many interventions then can relate to both areasincluding programs that promote gender equality, additional awareness campaigns, andmicrofinance programs for women and support networks. Intimate Partner Violence Intimate partner violence is one of the most common forms of violence against women.This categorization refers to any “behavior within an intimate relationship that causes physical,psychological or sexual harm to those in the relationship”.17 Intimate partner violence occurs 5
  6. 6. throughout the world regardless of social, economic or religious divisions. In looking at specificrisk factors women who tend to be uneducated, of low income and lack support often fall victimto this behavior.18 Again conventional forms of technology and media can play a role in the prevention ofintimate partner violence. This includes hotlines and awareness campaigns through bothtraditional and new media. Bell Bajao, or Ring the Bell, campaign is a series of public serviceannouncements urging men and boys to stand against domestic violence. The idea is that if one ishearing violence in progress to ring the bell and ask a simple question, such as “Can I borrow acup of sugar?” It is likely the perpetrator recognizes the person has heard the violence and thiswill interrupt the action. The organization also hosts a blog for victims to voice their experiencesand offers information and guidance.19 Domestically, the company Liz Claiborne initiated a Love Is Not Abuse program, whichprovides information and tools for men, women, and children including teens to learn more aboutthe issue of domestic violence. In August of 2011 they launched the Love Is Not Abuse iPhoneapplication that helps teach parents about teen dating abuse and demonstrates how technology,such as text messages, emails and phone calls, can be conduits for committing abuse. Parentsreceive real-time communication mimicking the abusive and controlling behaviors teens mightface in their relationships.20 This program illuminates the negative role technology can take on. However, texting also can be used as a cheap and effective way to prevent intimatepartner violence, as demonstrated by a case in Ohio where a texting service allowed victims toreport incidents silently via a simple SMS message and make contact with a crisis interventionworker or police without making an actual phone call. The total cost of the program set-up,which used the FrontlineSMS platform, was about $380.00. FamilyFirst, as it was termed,processed between 6,000 to 8,000 texts per month during the first year and helped convict 18abusers which victims were able to report confidentially.21 Outside of these programs, technology can play a role in helping to transform some of theunderlying causes of intimate partner violence. Enabling access for women to both economic andsocietal support such as through the Village Phone project by Grameen Phone Foundation canlead to positive outcomes. The Village Phone model was based on providing a small loan and a“business in a box” enabling the aspiring entrepreneur to provide customers with access to amobile phone and sell mobile airtime. By March 2011, the program claims that 85% of the 6,876entrepreneurs who had been recruited into the network are women.22 This notion of womenhaving access to a mobile device is further echoed by the report Women & Mobile: A GlobalOpportunity published in 2010. This report states 9 out of 10 women surveyed felt safer, and85% of women felt more independent, because of their mobile phone.23 With the rise of mobilepayments and mobile money, or mFinance, and increasing access to mobile devices – women arebeginning tap into economic independence in places they traditionally have not been able to. Lastly, social support for women in domestic violence situations is an important factor. Inthe developed world, this may be derived from in-person working groups or community groupsand can extend through social media platforms and the Internet, allowing women to connect andshare their experiences. However in the developing world, mobile phones can play a unique role 6
  7. 7. in garnering this type of support. In Senegal, the organizations Tostan and UNICEF launchedthe Jokko Initiative. By way of SMS technology the program allows community members tosend out messages on topics including information on vital events, service announcements andincome-generating activities.24 It allows women the opportunity to promote their goods and getinformation out about events they organize. Not only does this provide a chance for women toconnect with each other and provide support, but the program is also tied into Tostan’s literacyand math program. Elder Abuse Elder abuse has received the least public attention, having historically been defined as a“private matter.” Today it is seen as an important problem likely to grow due to the rise in agingpopulations in many countries. It is agreed that elder abuse is defined as “either an act of commission or of omission”, and that it may be either intentional or unintentional.25 The elderly can experience violence physically, sexually or psychologically and they are also susceptible to economic abuse. Again we see the use of hotlines and the Department of Economic and Social Affairs Population Division 2009 sharing of information via the Internet as integral todealing with this type of violence. The National Center on Elder Abuse has state resources suchas helplines and hotlines listed directly on its website in addition to listing where to reportnursing home abuses and information about Adult Protective Services. There are also NationalElder Abuse Awareness public service announcements that call attention to the issue. Some sources cite that a key prevention tactic could be the further use of interventionprograms in hospital settings, which are lacking due to an absence of training in this area.26Recently there has been a rise in electronic checklists within the hospital setting regardingsurgical procedures. The incorporation of certain elements such as signs and symptoms of abusecould be integrated into these checklists. As more move towards the use of tablets and electronicrecords, this opens up a unique opportunity to start progressing to a more holistic approach inhealthcare. Additionally with the ability to train remotely, technology can be used to keep thosein the healthcare industry abreast of proper diagnosis of elder abuse and what to do about it. Lastly, the role of social media should be highlighted here. Social media platforms suchas Facebook and Twitter, along with communications tools such as Skype, allow thosetraditionally cut off from the outside world the means to connect with family as well as a widercommunity. According to a 2009 study from AARP, about one-third of people 75 and over live 7
  8. 8. alone.27 MyWay Village, a social network installed in nursing homes, allows residents to connectwith new people and share their memories and experiences. Equipped with training sessions, it iseasy to pick up and residents can send friends messages, play games and most importantly notfeel like they are isolated.28 Youth Violence Youth violence is closely linked with other forms of violence as youths who are exposedto other types of violence, have an increased propensity towards committing violent actsthemselves. Adolescents and young adults are often both victims and perpetrators of youthviolence. WHO notes that violence involving youth greatly adds to the costs of welfare andhealth services, decreases productivity and even “undermines the fabric of society”.29 Technology, particularly the role social media can play, frequently is viewed as having anegative effect on youth. From online bullying to violent YouTube videos and video games,these are often cited as leading to increased violence amongst youth. Even a term has beenassigned to the type of harassment that occurs through e-mail, instant messaging, and websites orvia the mobile phone: “electronic aggression”.30 Regardless of the potential harm, youth are increasingly using social media and there areways in which it can be used positively. With the increase in use of mobile phones by teens, thisopens a unique window to reach each one on an individual basis. loveLife, a program in SouthAfrica launched a web-based mobile program called MYMsta. This mobile social networkenables the youth population to access information about HIV, employment opportunities,scholarships and other tips to improve their lives.31 It also allows them to talk about concernsrelating to sexual health and get responses from trained counselors. loveLife implores other services to reach youth such as their call-back service whichoffers users free mobile connectivity to a counselor. Users send a message to the service saying,‘Please Call Me’ and the automated system calls them back and links them to an availabletrained counselor.32 Texting in this regard is also used domestically in the United States. TheNational Dating Abuse Helpline recently made its services available via text message byallowing teens to text “loveis” to 77054 and receive help from trained peer advocates.33 In another effort to reach out to teens, particularly in reference to intimate partnerviolence or dating violence, Futures Without Violence developed the online campaign That’sNot Cool. That’s Not Cool encourages teenagers to decide for themselves what’s okay, or notokay, in their relationships by incorporating videos, interactive games, and an online forum forteens to share their stories and receive advice. That’s Not Cool recently launched an avatarapplication where teens can create their own personalized mobile phone character in response toanimated videos addressing digital dating abuse. Using text-to-speech technology, the characterspeaks the teen’s response and the result is a speaking avatar video that can be posted and sharedwith their peers on Facebook & Twitter.34 In relation to youth gangs, an innovative partnership has emerged in relation to a Chicagobased organization CeaseFire which combines science and street outreach to track where 8
  9. 9. violence is heating up and interrupt to calm the situation down. With Ushahidi,FrontlineSMS:Medic and PopTech, the project PeaceTXT will look at how mobile tools, such asthose used by other crisis mapping organizations, and mobile messaging can accelerateCeaseFire’s success already in decreasing deaths.35 Child Abuse Child abuse takes the form of infanticide, mutilation, abandonment and other forms ofphysical and sexual violence.36 It is a universal problem and often increases the likelihood ofadult forms of illness and disease. There is also a unique cultural aspect to child abuse as thestandards and expectations of proper parenting can range in different countries and societies.More often than not, the term technology when combined with the idea of child abuse conjuresup images of child porn on the Internet and other negative ways in which recent innovations havefurther harmed children. As with all forms of violence, technology also offers unique ways inwhich to prevent this type of abuse. One underlying risk factor cited for a parent’s proclivity towards committing child abuseis a lack of education on the expectations of their child’s development.37 There has been a recentrise in health text messaging programs geared towards reaching traditionally underserved groupswith important health information. For instance, in the United States the Text4Baby programpiloted by the Department of Health and Human Services (HHS) is a public-private partnershipthat provides pregnant women and new mothers with free health text messages. The messagesrange from tips on how to care for your baby as well as information on what to expect duringpregnancy. Evaluations of the program are scheduled to be available in 2013 and the model isalready being taken abroad with IVR technology (the use of voice instead of text). Another textprogram HHS is due to roll out next year is Text4KidsHealth. Through the Health Resourcesand Services Administration (HRSA) text messages will be developed on nutrition and physicalactivity to be used for future programs targeting the parents of children 1-5 years of age.38 The mobile phone can act as a reporting tool for cases of child abuse. As seen earlier inrelation to collective violence, there is power is capturing images of typically ignored issues andbringing them to light in the mainstream media. Using one’s mobile phone in combination withcommunity reporting is an easy way for stories to hit the Web and be shared across masses ofpeople through YouTube, blogs and other social media channels.39 One can do a simple googlesearch online and find numerous online campaigns, blogs and other videos calling for action andattention to the issue of child abuse. The traditional hotlines available to children, such as the National Child Abuse Hotlinerun via Childhelp, offer another medium of help and prevention. Childhelp also has informationon its website to help children in discerning if they are being abused and what action they cantake.40 In addition, health professionals play a key role in identifying any signs of child abuse intheir patients. Incorporating this as part of their training, or including information and prompts inthe tools they use such as checklists or reminders could help in preventing additional cases ofabuse. 9
  10. 10. Self-Directed Violence Lastly, violent acts that one inflicts upon himself or herself are classified as self-directedviolence. This includes both suicidal behavior and self-abuse. In the United States,approximately over 35,000 commit suicide every year. This doesn’t even take into considerationsuicide attempts or self-abuse. Additionally the most recent state-by-state data available is fromprior to the 2008 economic crisis.41 Annually more than 1 million people attempt to take theirown lives and approximately 60 million Americans experience a mental health disorderincluding posttraumatic stress disorder (PTSD) and depression, in any given year.42 The WHO cites proper diagnosis of mental disorders is important, but in addition so issupport for those who are contemplating such destructive acts. Again Telehelp lines and callcenters are influential. There are numerous lifelines, hopelines and other crisis services outthere. Opportunities now also exist for easy access to information and therapies online. The riseof online support groups also allows for those suffering to reach out and connect with othersensuring that they know they are not alone. The more awareness and access to services permitsmany to move past the social stigma often attached to depression and suicide. On the mobile platform there has been some debate over the creation and use of suicideprevention applications. To have the applications verified and appropriate for the user in additionto the possibility of producing any impact is contested. The QPR Institute released an Androidapp that turned the book “The Tender Leaves of Hope, Helping Someone Survive a SuicideCrisis” into a digital booklet in hopes of reaching more families and individuals.43 Some mobileapplications let users track their moods and experiences, providing supplemental information forthem as well as their therapists. An app called “mobile therapy” has a "mood map" that pops upon a users screen where the user can then indicate how they are feeling. In response the app thenoffers “therapeutic exercises" ranging from "breathing visualizations to progressive musclerelaxation" and ways on how to disengage from a stressful situation.44 Again there are risks involved. Often blame is placed on technology and media forsuicide, particularly teen suicide in relation to the rise of cyberbullying. It is difficult todetermine how much media and technology play a role in these deaths. Some instances becomesensationalized such as the case of a Florida teenager in 2008 that posted a live stream video ofcompleting the act of suicide online, encouraged by others he was chatting with online at thetime.45 With over 87 percent of teens (ages 12-17) using the Internet and 19 million teens sharingtheir lives through text messages, this is definitely a cause for concern. As much as mobilephones, chat rooms and other forms of communication can help teens work through their issues,they can also push teens in the opposite direction. 10
  11. 11. Overarching Gaps and Trends Through the program implementation cases above several arching gaps and trends beginto emerge, many similar to others using these tools in differing fields. In this section we willexamine some of these gaps and what we can do about them.Data Collection and Surveillance A common problem in the field is the collection and distribution of valid, useful andanalyzed data. As cited in the first WHO World Report on Violence and Health, countries aroundthe world are at different stages of capacity for collecting data.46 There is a lack of quality andlack of uniformity in the data itself. In addition, the problem of only knowing “the tip of theiceberg” remains, as many instances of violent acts remain undetected and unreported. The use of ICTs can create certain efficiencies in Elements of a Well Designeddata collection as well as in its quality and associated Information System: 1. A streamlined data entryinformation flows.47 Currently, partly due to the need for processdonor reporting, data collection is fragmented and siloed. 2. The direct digital capture ofParticularly through the use of mobile phones in the laboratory test results ordeveloping world, opportunities to increase the collection clinical diagnosesand access to data and health information have increased. 3. Efficient data mergeElectronic capture of data can decrease human error and capabilities from multiple dataincrease the speed of analysis. sources Talk about the use of unique identifiers, such as 4. Automated data quality checksbiometric data, and the use of electronic health records to 5. Rapid search, retrieval, andtrack patients have become increasingly commonplace. visualization capabilitiesThis type of data capture and storage can create better 6. Early warning alerts forcoordination across health systems to share data potential disease threats andhorizontally.48 Having access to broader data could lead disease different actions and outcomes. Additionally the use of Ranck 2011ICTs and mobiles could aid health professionals, fromdoctors to community healthcare workers, in accessing and retrieving information. EpiSurveyor and Commcare are examples of tools that have just started to breech intothis area. EpiSurveyor allows anyone to create an account, design forms and download them totheir mobile phone to collect data for free. Commcare is free and open-source software that aidscommunity healthcare workers (CHW) in case management through their mobile phone. Thesoftware contains registration forms, checklists, danger sign monitoring, and educationalprompts and is designed to help manage enrollment, support, and tracking of all of the CHW’sclients and activities. The data that is collected is sent to the cloud for easy analysis and retrieval. Another project ChildCount+ is a platform designed and used by the Millennium VillagesProject. ChildCount+ uses SMS text messages to assist and coordinate the activities ofcommunity based health care providers such as CHWs. CHWs can use text messages to register 11
  12. 12. patients and report on their health status. This information is sent to a central web baseddashboard which can then provide a real-time view of the current status of the community.49There are also other numerous software kits being used in the developing world such as EpiInfo,OpenXdata, Open Data Kit, Open Dream, Open MRS, OpeneLIS, Open-Clinica, District HealthInformation System (DHIS), Managing News, Sahana, Geo-Chat, Riff/Evolve, Mesh4x,Ushahidi, and Epidefender.50Research and Evaluation Along with the needs listed above for data collection and surveillance, common metricsfor monitoring and evaluation especially for programs using ICTs and mobile devices arelacking. There is serious gap in vigorous evaluation of the many pilot programs that are utilizingthese new mediums of communication and determining their overall impact.A unique factor around the use of ICTs is the possibility for real time evaluation. In addition,linking data from one program to others could lead to a clearer view of where the field is andwhere it is heading. This could be quite impactful. However issues remain over a lack ofunderstanding of the capabilities and realities around the use of ICTs, a lack of common datastandards that support interoperability and the creation of information-sharing policies.51Conversations around the “enterprise architecture”, or rather the “plumbing” of systems, are inthe early stages. We have yet to have hit a point where projects are no longer functioningindependently in siloes, but sharing data leading to a leveraging of each other’s results. Thiselement of “interoperability”, or the ability to share data quickly and accurately across differentapplication and through the health system, will be an important barrier to overcome in thecoming years if large-scale impact regarding ICTs and mobile devices is to be realized. Lastly, and related to sharing data across silos, are concerns over privacy and security.Unease over the ability for users’ to retain anonymity, especially given the nature of collectiveviolence or intimate partner violence, is understandable and should remain at the forefront of anyproject implementation. Data ownership remains a concern as well if projects continue to strivefor scale in implementation or begin to share data is between programs or with the health systemat large.Dissemination and Implementation In the implementation of violence prevention programs, ICTs can play a pivotal rolethroughout the program and intervention design section. Multiple modes of telecommunicationsexist, but mobile explosion both within the United States and globally provide additionalopportunities for impact. Common elements of program implementation can include the use ofelectronic forms and checklists, remote training for healthcare professionals, the use of crowdsourcing and social media platforms, the use of SMS and video or television. 12
  13. 13. However, a larger issue remains, which is the exchange of information and lessons learned throughout not only the violence prevention community but the public health field at large. In this capacity, online platforms can aid in the dissemination and sharing of knowledge. Although not widely instituted yet, GHD Online and the mHealth Alliance’s Healthunbound platforms offer a peek into what is possible. With the rise of webinars and remote access to meetings, and the ability to share presentations online through websites such asslideshare, avenues for information sharing and collaboration have increased. Lastly, institutions should not overlook these platforms for supporting their advocacycampaigns and ability to raise funds for the implementation of programs. Multiple programs nowuse e-cards and online petitions, or request advocates to share program information with theirsocial networks. Text campaigns have become particularly popular over the past few years,allowing individuals to donate to certain causes via their mobile phones. Eight days after theearthquake in Haiti in 2011, the American Red Cross had raised approximately $22 million viatext messaging. Donors texted the word “Haiti” to 90999 and a $10 pledge was automaticallyadded to the person’s phone bill.52 Recommendations1. Undertake a full landscape analysis of the use of ICTs in violence prevention Time and resources should be dedicated to a full landscape analysis on the intersection between ICTs and the field of violence prevention, with particular emphasis on the mobile phone in relation to the developing world.2. Learn from other fields and each other Particularly the mServices and mHealth space can have a lot to offer in terms of uses of new innovations and lessons learned. Conversations around the employment of electronic health records, interoperability and development of common metrics to evaluation are being explored. Additionally, the typologies of violence outlined in this paper are repeatedly interrelated and interdependent. Using new platforms for information sharing and collaboration, as well as the possibility of sharing data and lessons learned with each other, could greatly push the field forward. 13
  14. 14. 3. Develop common metrics for monitoring and evaluation With the ever pressing need to know if these technologies are making a positive impact, the development of common metrics for monitoring and evaluation is important. With the ability for near real time analysis of data and given the nature of the infancy in this space, collaboration around metrics and the actual evaluation of programs will be vital in knowing what works and what does not.4. Further explore privacy issues Given the sensitivities that exist around certain types of violence, such as intimate partner violence, the need for anonymity takes precedence. Issues around user privacy, the sharing of data, reporting and so forth need to be further explored. The technologies themselves also must be investigated to make certain they are not leaking sensitive information to a wider public, for example via GIS mapping or forums on the internet.5. Address development factors – move beyond intervention Emphasis must be made on many of the underlying development factors that can lead to the instigation and continued perpetration of violence. Factors such as poverty, lack of access to the healthcare system, lack of access to education and economic inequality can make any person or society ripe for violence. ICTs can be pivotal in addressing these issues such as the use of mFinance in addressing poverty, tools for CHWs to help expand access to healthcare and education through the use of computers or even mobile phones.ENDNOTES1 Krug, Etienne G., Linda D. Dahlberg, James A. Mercy, Anthony B. Zwi, and Rafael Lozano, eds. World Report onViolence and Health. Rep. Geneva: World Health Organization, 2002.12 Krug, mHealth Alliance. 2010. Web. James A. <>. About Etienne G., Linda D. Dahlberg,Oct. 2011.Mercy, Anthony B. Zwi, and Rafael Lozano, eds. World Report onViolence and Health. Rep. Geneva: World Health Organization, 2002.2 About mHealth Alliance. 2010. Web. Oct. 2011. <>.3 Grove, Jennifer V. "Social Networking Usage Surges Globally [STATS]." Mashable Business. Mashable, 19 Mar.2010. Web. Oct. 2011. <>.4 Elliott, Amy-Mae. "YouTube Facts: 10 Things You May Not Have Known." Mashable Business. Mashable, 19Feb. 2011. Web. Oct. 2011. <>.5 World Report on Violence and Health. WHO, 2002.6 "WK 214 Mobile Phones: Communicating for Action." New Tactics in Human Rights. Center for Victims ofTorture. Web. Oct. 2011. <>.7 Harvard Humanitarian Initiative. Disaster Relief 2.0: The Future of Information Sharing in HumanitarianEmergencies. Washington, D.C. and Berkshire, UK: UN Foundation & Vodafone Foundation TechnologyPartnership, 2011.8 "Mapping The Egypt Protests and Libya Crisis." The Ushahidi Blog. Ushahidi, 07 Apr. 2011. Web. Oct. 2011.<>.9 World Report on Violence and Health. WHO, 2002.10 "What We Do." Web. Oct. 2011. <>.11 World Report on Violence and Health. WHO, 2002.12 Ibid 14
  15. 15. 13 "Sexual Assault Statistics." National Center on Domestic and Sexual Violence. Web. Oct. 2011.<>.14 Heatwole, Anneryan. "HarassMap: Tracking Sexual Harassment in Egypt with SMS." 23 Feb.2010. Web. Oct. 2011. <>.15 Ibid16 Verclas, Katrin. "Human Trafficking Hotline: Mobile Phones in the Fight Against Slavery |" MobileActive Corp, 07 Aug. 2007. Web. Oct. 2011. <>.17 World Report on Violence and Health. WHO, 2002.18 Ibid19 "My Cause." BellBajao: Bring Domestic Violence to a Halt. Breakthrough. Web. Oct. 2011.<>.20 "iPhone App." Love Is Not Abuse. Liz Claiborne Inc. Web. Oct. 2011.<>.21 Papillon, Anthony. Developing a Text Messaging Based Community Domestic Violence Response System UsingFrontlineSMS. Rep. Advanced Data Concepts. Web. Oct. 2011.22 "Mobile Livelihoods." Grameen Foundation. Grameen Foundation. Web. Oct. 2011.<>.23 Vital Wave Consulting. Women & Mobile: A Global Opportunity. Rep. Cherie Blair Foundation, Feb. 2010. Web.Oct. 2011.24 Ibid25 World Report on Violence and Health. WHO, 2002.26 Ibid27 Clifford, Stephanie. "Online, ‘a Reason to Keep on Going’." The New York Times. The New York Times, 01 June2009. Web. Oct. 2011. <>.28 Ibid29 World Report on Violence and Health. WHO, 2002.30 Hertz MF, David-Ferdon C. Electronic Media and Youth Violence: A CDC Issue Brief for Educators andCaregivers. Atlanta (GA): Centers for Disease Control; 2008.31 Ngcobo, Njabulo. "Mobile LoveLife Goes Global." Daily Sun. 01 Nov. 2010. Web. 06 Nov. 2011.<>.32 "What We Do." LoveLife. LoveLife. Web. Oct. 2011. <>.33 Pritchard, Sarah. "ICTs and Violence Prevention." Message to the author. 07 Oct. 2011. E-mail.35 Meier, Patrick. "Launching PeaceTXT." The Ushahidi Blog. Ushahidi, 29 Oct. 2010. Web. Oct. 2011.<>.36 World Report on Violence and Health. WHO, 2002.37 Ibid38 "HHS Text4Health Projects: Open Government at HHS." United States Department of Health andHuman Services. Web. Oct. 2011. <>.39 Nyirubugara, Olivier. "Unmasking Child Abuse with Mobile Phones - Articles." Voices ofAfrica Media Foundation, 05 Dec. 2010. Web. Oct. 2011.<>.40 National Center for Health Statistics. "Facts and Figures." American Foundation for Suicide Prevention. Web.Oct. 2011. <>.42 "Election 2010: Will Candidates Address the Facts? Check out State Suicide Rates and New ObamaAdministration Numbers; Unemployed Persons and Veterans Are Especially at Risk." National Alliance on MentalIllness. 14 Sept. 2010. Web. Oct. 2011. <>.43 "Suicide Crisis Support - Android Market." Apps - Android Market. Web. Oct. 2011.<>.44 Trudeau, Michelle. "Mental Health Apps: Like A Therapist In Your Pocket : NPR." National Public Radio. 24May 2010. Web. Oct. 2011. <>.45 Friedman, Emily. "Florida Teen Live-Streams His Suicide Online." ABC News, 21 Nov. 2008.Web. Oct. 2011. <>. 15
  16. 16. 46 World Report on Violence and Health. WHO, 2002.47 Jody Ranck, Health Information and Health Care: The Role of Technology in Unlocking Data and Wellness – ADiscussion Paper, (Washington, D.C.: United Nations Foundation & Vodafone Foundation TechnologyPartnership), February 2011.48 Ibid49 Ranck, 2001.51 Ibid52 Heath, Thomas. "U.S. Cellphone Users Donate $22 Million to Haiti Earthquake Relief via Text." The WashingtonPost. 19 Jan. 2010. Web. Oct. 2011. <>. 16