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Parichaya - APCHI 2013, 25th September, Bangalore Parichaya - APCHI 2013, 25th September, Bangalore Presentation Transcript

  • © Himanshu seth   Parichaya A Low-Cost Device to Increase Adherence Among Tuberculosis Patients in Rural Assam Himanshu Seth and Keyur Sorathia APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   1# INTRODUCTION Some Statistics about Tuberculosis WORLD | INDIA | ASSAM | KAMRUP | DOTS IN INDIA
  • © Himanshu seth   Statistics WORLD   Tuberculosis is world’s leading cause of death from a single infectious disease.   http://en.wikipedia.org/wiki/File:Mycobacterium_tuberculosis.jpg [TB INDIA 2012, Revised National TB Control Programme, Annual Status Report] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Statistics WORLD   8.8 million   As per the WHO Global TB Report 2011, there were an estimated 8.8 million incident cases of TB globally in 2010….   [TB INDIA 2012, Revised National TB Control Programme, Annual Status Report] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Statistics INDIA   India contributes to one-fifth of the global burden of Tuberculosis.   [TB INDIA 2012, Revised National TB Control Programme, Annual Status Report] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Statistics INDIA   In 2009, out of the estimated global annual incidence of 9.4 million TB cases, 2 million were estimated to have occurred in India.   [TB INDIA 2012, Revised National TB Control Programme, Annual Status Report] APCHI-13, Bangalore | 26th September, 2013 1   = 470000 people  
  • © Himanshu seth   Statistics ASSAM & KAMRUP   Tuberculosis has been identified as one of the major diseases prevalent in Assam. [Indranee Dutta, Shailly Banwari, Health and Healthcare in Assam: A Status Report, 2007 ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Statistics ASSAM & KAMRUP   8%   Kamrup registered 8% growth in “suspects examined per smears positive case diagnosed” in 2010 compared to 2009   [RNTCP Case Finding and Treatment Outcome Performance, 1999–2010] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Introduction DOTS IN INDIA   The antibiotics for curing TB are available free of cost in India.
  • © Himanshu seth   Introduction DOTS IN INDIA   7 pills for 6/8 months (Cat.-I/Cat.-II) 3 times a week
  • © Himanshu seth   Introduction DOTS IN INDIA   Patients are supposed to visit nearest DOTS center for ingestion of medicines under direct supervision.
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   Introduction DOTS IN INDIA     Based on interviews with healthcare workers
  • © Himanshu seth   2# STUDY A Contextual Enquiry in the Rural Kamrup District in Assam OBJECTIVE | DEMOGRAPHICS | PARTICIPANTS | CONCLUSIONS
  • © Himanshu seth   Study GOALS   •  •  Understand existing situation of incoherence of DOTS •  APCHI-13, Bangalore | 26th September, 2013 Investigating problems faced by TB patients Patient-professional relationship
  • © Himanshu seth   Study GOALS   •  •  APCHI-13, Bangalore | 26th September, 2013 Access to diagnosis and treatment Social and family dynamics, technology usage and Literacy among the TB patients
  • © Himanshu seth   Study OBJECTIVE   The study was performed to gain insights in order to propose new ICT interventions for empowerment of TB patients. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study DEMOGRAPHICS   Moriyapati Health Center A in Amingaon NGPHC in Collegenagar GMC in Guwahati APCHI-13, Bangalore | 26th September, 2013 Bishnuram Medhi Community Health Center in HAJO
  • © Himanshu seth   Study PARTICIPANTS   `   The study consisted of 15 participants (comprising a mix of healthcare workers, ASHA members, patients and family members) at 3 community health centers and 1 sub-center. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   BLISHED   U NDINGS P FI Findings and analysis of qualitative user study of tuberculosis patients in rural Assam, India Himanshu Seth, Keyur Sorathia
  • © Himanshu seth   Study CONCLUSIONS   Small, advised breaks of around 5 minutes, prior to the ingestion of every pill APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   Small, advised breaks of around 5 minutes, prior to the ingestion of every pill Idle waiting time at health centers APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   Small, advised breaks of around 5 minutes, prior to the ingestion of every pill + Idle waiting time at health centers Opportunity for indulging the patients in serious information knowledge sessions for spreading awareness about the disease.   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   No-low literacy level among the patients and their family members APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   No-low literacy level among the patients and their family members Lack of information mediums in the health centers   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   No-low literacy level among the patients and their family members + Lack of information mediums in the health centers   Introducing interventions for increasing information awareness about the disease, ideally using regional languages   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   Role of peers/social groups and the social importance of ASHA members   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   Role of peers/social groups and the social importance of ASHA members   Lack of basic knowledge about the disease   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Study CONCLUSIONS   Role of peers/social groups and the social importance of ASHA members   Lack of basic knowledge about the disease   Insufficient time with ASHA members to supervise the ingestion of medication   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Patients have a mobile phone, however are not well versed with its functions. APCHI-13, Bangalore | 26th September, 2013 Study CONCLUSIONS  
  • © Himanshu seth   Patients have a mobile phone, however are not well versed with its functions. Phone is used as a shared resource APCHI-13, Bangalore | 26th September, 2013 Study CONCLUSIONS  
  • © Himanshu seth   Patients have a mobile phone, however are not well versed with its functions. + Phone is used as a shared resource The intervention should not use mobile phone as a medium for dispersion.   APCHI-13, Bangalore | 26th September, 2013 Study CONCLUSIONS  
  • © Himanshu seth   3# RELATED WORK Some Interventions in the field of Tuberculosis U-BOX | eCompliance | STOP TB Carnival
  • © Himanshu seth   •  palm-sized, smart Pillbox   •  Related Work U-Box   addresses to the problem of patients to travel to providers to consume medicines U-BOX     [Image from : http://www.appropedia.org/UBox_Electric_Pillbox_for_TB accessed on 10th September 2013 ] [uBox, a Smart Pillbox for TB Treatment. http://innovatorsinhealth.org/solutions/pillbox.shtml ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   •  palm-sized, smart Pillbox   •  Related Work U-Box   addresses to the problem of patients to travel to providers to consume medicines It allows the patients to take the medicine themselves, which according to DOTS program in India, is not allowed   U-BOX     [Image from : http://www.appropedia.org/UBox_Electric_Pillbox_for_TB accessed on 10th September 2013 ] [uBox, a Smart Pillbox for TB Treatment. http://innovatorsinhealth.org/solutions/pillbox.shtml ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   •  uses a combination of biometric and mobile technology to enhance TB treatment   •  Related Work eCompliance   uses fingerprints to verify the presence of patients during the treatment eCompliance     [Image from : http://www.opasha.org/our-work/ecompliance-innovation-and-health/ accessed on 10th September 2013 ] [Batra, S., Ahuja, S., Sinha, A., & Gordon, N. (2012). eCompliance: Enhancing Tuberculosis Treatment with Biometric and Mobile Technology. Proceedings of M4D 2012 28-29 February 2012 New Delhi, India, 28(29), 36. ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Related Work eCompliance   Focuses primarily on therapy monitoring.   Doesn’t, however focuses on increasing information awareness about the disease, which would not only motivate patients but will also ensure their adherence to the therapy   [Image from : http://www.opasha.org/our-work/ecompliance-innovation-and-health/ accessed on 10th September 2013 ] [Batra, S., Ahuja, S., Sinha, A., & Gordon, N. (2012). eCompliance: Enhancing Tuberculosis Treatment with Biometric and Mobile Technology. Proceedings of M4D 2012 28-29 February 2012 New Delhi, India, 28(29), 36. ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Related Work STOP TB Carnival   CD-ROM based campaign by MDR-TB partnership to create awareness on TB among children through edutainment and games   STOP TB Carnival     [Image from : http://www.freedomtb.org/games/StopTB_Carnival.html accessed on 10th September 2013 ] [STOP TB Carnival http://www.freedomtb.org/games/StopTB_Carnival.html, April 19, 2013. ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   ISSING?   M O WHAT ’S S Study CONCLUSIONS   The problems of unawareness and ignorance of patients towards important disease-related information, resulting in demotivation to TB adherence are not yet addressed through an ICT Intervention. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   ISSING?   M O WHAT ’S S Also   Study CONCLUSIONS   We are unaware of an existing solution that addresses the problem of unawareness combined with therapy monitoring for TB patients in the low-income and low-literate rural communities of India. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth     R STAND ! OU Study CONCLUSIONS   We believe that introducing interventions addressing to unawareness will increase motivation of Tuberculosis patients, in turn increasing their self initiated inclination towards DOTS therapy and subsequently curing of the disease. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   4# PARICHAYA A Low-Cost Device to Increase Adherence Among Tuberculosis Patients in Rural Assam SYSTEM OVERVIEW | DESIGN SPECIFICATION | CONTENT | PROTOTYPING
  • © Himanshu seth   Parichaya SYSTEM OVERVIEW   Parichaya is a low cost medical kit for increasing the adherence towards TB therapy, which makes the patients aware about the disease combined with supervising the therapy. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya OVERVIEW   It takes advantage of the idle time of the patients while ingestion of medicines due to small-supervised breaks/gaps between every pill. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya OVERVIEW   E FOR CATEGORY - I   DOTS REGIM 7 pills every alternate day X APCHI-13, Bangalore | 26th September, 2013 6 months
  • © Himanshu seth   E FOR CATEGORY - I   DOTS REGIM Parichaya OVERVIEW   Parichaya replaces the conventional medicine blister packs for Category-I patients for the first month of their medication. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya OVERVIEW   The medical kit being devoid of any video interface, is very cheap to manufacture and can be assembled easily by ASHA members/ health staff for successive days, without any technical know-how. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   PARICHAYA | Working
  • © Himanshu seth   Parichaya SCENARIO  
  • © Himanshu seth   Parichaya SCENARIO  
  • © Himanshu seth   Parichaya SCENARIO  
  • © Himanshu seth   Parichaya SCENARIO  
  • © Himanshu seth   Parichaya SCENARIO  
  • © Himanshu seth   Parichaya SCENARIO  
  • © Himanshu seth   INSPIRATION   Parichaya DESIGN SPECIFICATION   Inspired from Bioscopes, very famous in rural parts of Assam   The medical kit is made up of two circular discs attached to each other at the center. Uses the metaphor of narrating a story through moving pictures, viewed from a circular cavity. http://www.thehindu.com/features/cinema/a-peep-into-the-bioscope/article2984651.ece APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   APCHI-13, Bangalore | 26th September, 2013 Parichaya DESIGN SPECIFICATION  
  • © Himanshu seth   Parichaya DESIGN SPECIFICATION   The numerals in Assamese script on the outer disc assist navigation in different sectors. 2   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya DESIGN SPECIFICATION   Numerals and hierarchy in the form of size difference & appearance sequence facilitates navigation in icons. 2   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya DESIGN SPECIFICATION   The bigger circle depicts a broader category of information, whereas smaller circles denote the category specific information. 2   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   ion uce the risk of illustrat Red misunderstanding Parichaya DESIGN SPECIFICATION   Audio captioning for the illustrations to reduce the risk of misunderstanding APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   ion uce the risk of illustrat Red misunderstanding Parichaya DESIGN SPECIFICATION   Audio captioning for the illustrations to reduce the risk of misunderstanding Numbered push buttons below the illustrations to play the respective audio APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   About illustrations Parichaya DESIGN SPECIFICATION   Graphics/illustrations of the course were drawn in accordance of the culture and social norms of Assam. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   About illustrations Parichaya DESIGN SPECIFICATION   Graphics/illustrations of the course were drawn in accordance of the culture and social norms of Assam. Hand drawn illustrations in the form on line drawings [Medhi,  I.,  Prasad,  A.  and  Toyama  K.  Op:mal  audio-­‐visual  representa:ons  for  illiterate  users.  Interna:onal  World  Wide  Web  Conference,   Canada,  (2007),  873-­‐882.  ]   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Colored Black & White v/s APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya CONTENT   The course module of the medical kit for 12 medication days is based on that used in STOP TB Learning Zone included in STOP TB Carnival package.   [Image from : http://www.freedomtb.org/games/StopTB_Carnival.html accessed on 10th September 2013 ] [STOP TB Carnival http://www.freedomtb.org/games/StopTB_Carnival.html, April 19, 2013. ] APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   OR CO IA F TENT N APCHI-13, Bangalore | 26th September, 2013 Parichaya CONTENT  
  • © Himanshu seth   APCHI-13, Bangalore | 26th September, 2013 Parichaya CONTENT  
  • © Himanshu seth   APCHI-13, Bangalore | 26th September, 2013 Parichaya CONTENT  
  • © Himanshu seth   APCHI-13, Bangalore | 26th September, 2013 Parichaya PROTOTYPING  
  • © Himanshu seth   The medical kit was prototyped using low-cost and durable sunboard material. APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya PROTOTYPING   USB Recording Module-300 Second was used to implement audio feedback for illustrations. Average length of audio - 55 seconds on each push button APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   5# TESTING Subjective Evaluation
  • © Himanshu seth   “ Patients will get attracted to use this device and will come regularly just to use it.” “ By using this the patients won’t waste their time during the medication.” APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   “ Patients will get attracted to use this device and will come regularly just to use it.” “ By using this the patients won’t waste their time during the medication.” “ This very informative and by using this I will be able to take precautions.” “ It is entertaining and fun to use.” APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   6# CONCLUSION + FUTURE WORK So what’s next ?
  • © Himanshu seth   CONCLUSION   Parichaya, is an attempt to introduce an ICT intervention that addresses the problem of unawareness combined with therapy monitoring for TB patients in the low-income and low-literate rural communities of Assam.   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   FUTURE WORK   Initial evaluation of the medical kit has brought out positive feedback from the field.   In future we are preparing for an extensive pilot study in Kamrup district.   APCHI-13, Bangalore | 26th September, 2013
  • © Himanshu seth   Parichaya THANK YOU Open for questions/comments ! Himanshu Seth and Keyur Sorathia APCHI-13, Bangalore | 26th September, 2013