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Introduction to mHealth technology

Provides overview of mHealth technology in context of rehabilitation
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HANNAH KUPER: So today we’re going to talk about mobile health technology. I’ve spent lots of time working in low resource settings conducting surveys of different impairments like hearing and vision and working in very low resource settings. So sometimes, we use equipment like this to measure visual impairment. You can see that it’s very basic, and that it won’t give you the same kind of quality of the visual impairment assessment as you might get in an optometry clinic. Other times– so for instance with hearing– the equipment can be very expensive. It’s difficult to move around. And you need very specific kinds of conditions where you can measure hearing. So that can make those examinations very expensive.
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But a lot of this can now be replaced with one of these, something that many of us are carrying in our pockets. So mobile health technology has really moved along and allows us now to do really world class, gold standard assessment of visual and hearing impairment. It does more than that though as well. It allows us to try and link people through doctors at a distance to do diagnosis and testing, or even linking with rehabilitation. So things like mobile apps to provide rehabilitation. Mobile technology can also help people be provided with information or linking with support groups.
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So really, mobile health technology is becoming a real game changer in thinking about how we can identify the health and rehabilitation needs of people with disabilities, how we can link them in with services, and also provide them with rehabilitation. And now they’re going to be different practitioners who are going to give different kinds of examples of how mobile health technology can be helpful.
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[SLIDE: MHEALTH TECHNOLOGY EXAMPLE CARE FOR STROKE]
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SURESH KUMAR: Stroke or cerebral vasular accident is a leading cause for death and disability worldwide. Every year globally, 6.5 million people die due to stroke. And nearly 26 million survive a stroke, experiencing different kinds of disabilities. There are several gaps in the provision of stroke rehabilitation services, especially in low and middle income countries. The gaps are related to accessibility, availability, and affordability of post-stroke services. In order to bridge the gap, a smartphone enabled care supported, education intervention was systematically developed and it was name Care for Stroke. Care for Stroke intervention is aimed at the management of physical disabilities following stroke.
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The intervention has nearly 63 videos of two to three minutes duration organised in five different sections, such as stroke information, functional skills, exercises, activities of daily living, and assistive devices. The intervention was found feasible and acceptable in an Indian context. Hence, as a step forward, the intervention is currently evaluated for its cost and clinical effectiveness through a randomised controlled trial in India. Care for Stroke is web enabled. And hence, there is scope for customising the intervention according to the context for rehabilitation in different countries and establish the validity of the intervention globally.
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It also provides useful insights for experts in the field of disability and rehabilitation to envision similar interventions for other disabling conditions, such as cerebral palsy and spinal cord injury. An increase in the prevalence of stroke will increase the demand for stroke rehabilitation services. The present barrier to availability, accessibility, and the lack of awareness of the problem among those affected widen the gap that has to be bridged in order to meet the increasing demand for strokes services worldwide. This warrants development of innovative rehabilitation interventions that can bridge the gap and meet the needs of the affected individuals and their families. Care for Stroke is one such strategy for addressing the unmet needs for stroke rehabilitation services worldwide.
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[SLIDE: MHEALTH TECHNOLOGY EXAMPLE: HEARTEST AND HEARSCREEN]
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TESS BRIGHT: 360 million people in the world are affected by disabling hearing impairment, with the majority living in low and middle income countries where human and technological resources to identify, treat, and rehabilitate are scarce. Mobile technology is increasingly being developed and used in a variety of settings. Many smartphone based audiometry devices are low cost and can be used by non-specialist staff. HearScreen and hearTest are smartphone based tools for conductive hearing assessments developed by researchers from the University of Pretoria. The tools have been scientifically validated against gold standard measures. They are portable, lower cost, and currently available equipment and are designed to be used by non-specialist staff.
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Therefore, these innovative technologies have huge potential for improving access to hearing services in low resource settings. They can also be used to scale up data collection in prevalence surveys of hearing loss. Evidence from which could be used to advocate for, plan, and scale up needed hearing services. We conducted a national survey of disability in Guatemala and used hearTest successfully to measure hearing impairment for those who self-reported difficulties. A prevalence of 4% was found in people aged 18 years and older in this study. [SLIDE: MHEALTH TECHNOLOGY EXAMPLE: PEEK]
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ANDREW BASTAWROUS: There’s about 39 million people in the world who are blind.
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90% of those are living in countries like Kenya.
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80% of them are blind from diseases that we already know how to cure or prevent.
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SCHOOL CLASSROOM TEACHER: Can everybody write all you can see on the blackboard?
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ANDREW BASTAWROUS: I still can’t believe we’re in a world where we’ve already worked out how to provide most of the treatment, and it’s still not happening. That felt deeply unfair. Most of the resources for eye care are in big towns and cities. Most of the patients who need access to that are out in more rural areas. So you have this big gap between where provision is and where people who need it are. One of the options is you take the equipment to the community. And that’s what we tried to do.
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All of this heavy, very sensitive equipment– over 100,000 pounds worth of kit– and a team of 15 people, putting it in the back of the van going on non-tarmac roads to places with no electricity, the impact we’re having was still very, very small. And something was going to change Than I thought it must be possible to recreate all of these tests I’m doing in the clinic on a smartphone.
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Vision testing in itself is quite complex.
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The idea is to simplify the process so much that anyone can do the test. So in two to three minutes, I can teach you how to deliver this test anywhere on anyone. And this device here allows you to look inside the eye with the phone. Look how sharp the detail is That was in 30 seconds, and he’s already now getting a view of the retina. We don’t think of ourselves as a technology company. Everything that we do is built on good people.
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Teachers in schools, health care workers out in the community– they can use a test which will provide accurate, reliable, objective results and share that with the specialist who can make the decision as to whether or not they need to come for treatment.
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HANNAH KUPER: So now we’ve come to the end of the section on mobile health technology. I hope that you’ve enjoyed hearing from this range of different experts and please do keep on contributing to the conversations and discussions that are taking place.

In this video, Professor Hannah Kuper presents an introduction to mHealth technology which is then followed by three mHealth technology examples from clinical practitioners.

Following the mHealth technology introduction, Dr. Suresh Kumar, an Early Career Research Fellow in Public Health at Wellcome Trust DBT India Alliance, Public Health Foundation of India, and Occupational Therapist, presents Care for Stroke.

Tess Bright, a Research Assistant and Doctoral Student at International Centre for Evidence in Disability at LSHTM, and Clinical Audiologist, then presents HearScreen and HearTest.

Finally, Dr. Andrew Bastawrous, from the International Centre for Eye Health at LSHTM, Ophthalmologist and Founder & CEO Peek, presents Peek.

Have you used mHealth technology before? Share your examples and experiences below.

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