mHealth in Resource-Constrained Environments

1. Introduction

Rural areas are very often resource-constrained environments where direct access to the Internet, through landlines or mobile phones may be challenging. In such settings, also the quality of health services is often affected by these limitations. In such conditions some chronic diseases are hard to be treated anticoagulant therapy management is one of those because it demands a regular monitoring of patients’ conditions made by doctors or health professionals.

Anticoagulant therapy prevents the formation of thrombus. People at risk of developing thrombosis have to take anticoagulant treatment (warfarin) once a day in a dosage that needs to be adjusted on the basis of the International Normalised Ratio (INR) test results (Cohen et al., 2007). The INR test measures the prothrombin time (PT) – how long it takes for the blood to clot. The dose of warfarin is increased or decreased with the intention of keeping the INR value within an appropriate range. When the treatment starts the INR value is tested every 2-3 days but once its level has stabilised it is tested between 7 and 20 days. Since the INR tests are usually performed in surgeries the patients have to make frequent visits to meet doctors to take the test and receive a prescription of warfarin.

In this paper we present MANTRA (Mobile ANticoagulant TheRApy), a project aimed at studying the feasibility and acceptability of the introduction of mobile technology in the management of anticoagulant therapy involving doctors in the design phases. The project was implemented as a proof of concept for a rural setting in Venezuela. We studied the existing literature and state of the art and performed a study on the end users profiles and the context/environment and designed, developed and evaluated two interactive high-fidelity prototypes for mobile devices (iPads) aimed at support the remote communication between doctors who operate in rural areas and doctors who practice in hospitals. This gave us the chance to derive a general approach to mHealth in the remote management of chronic diseases by supporting the communication among healthcare practitioners.

The paper is organized as follows. First, literature review and state of the art of telemedicine in anticoagulant therapy domain is presented and discussed. In Section 3 the MANTRA project is presented and its research context and methodology are illustrated. Section 4 presents the prototypes design and development and Section 5 illustrates the usability evaluations performed and their results. Finally, conclusion and future developments are presented.