The Roles of Mhealth Integrated Technology - Literature review Example

Literature Review Holtz (2008) reported that the global prevalence of chronic diseases is in the rise with renewed focus on developing countries where communicable diseases are already a major medical challenge. Increased cases of chronic diseases in both developed and developing countries have not only resulted to deaths but have also led to increased burdening of individuals and state authority. Increased global prevalence of chronic diseases has been directly associated with increased mortality rate especially in developed nations. Based on a report by Harris (2013) chronic diseases are currently the leading causes of deaths globally with the exception of Africa where infectious disease are still leading. However, the report indicated that in the next two decades non-communicable diseases in Africa would be the leading cause of deaths based on current projections. Apart from deaths, chronic diseases are also the major cause of disabilities among the population. Chronic diseases have further resulted to economic burden on the state government. In addition to non-communicable diseases, developing countries struggle with management of infectious diseases such as HIV/AIDS and malaria epidemics. Jeffreys (2011) argued that the prevalence of chronic diseases in these states does not displace the effects of the infectious diseases but enhances further the deteriorative effects of both diseases. This has led to overburdening of the medical budget, which directly affects medical healthcare services. Increased cases of chronic diseases have been closely linked with poorer healthcare services due to inadequacy of funds and strained medical staff that are often overworked and underpaid. In the end, continual prevalence of non-communicable diseases is likely to deter economic growth of developing countries. This is due to diversion of funds to health care systems as opposed to allocation of the funds to income generating projects. There also exits the burden of managing risk factors associated with chronic diseases. According to Defronzo (2004), chronic diseases can be easily controlled by minimization of associated risk factors. The main risk factors associated with non-communicable diseases include the following: tobacco use in any form, intake of high cholesterol, low fruit and vegetable diet, overweight and obesity, alcohol consumption and sedentary lifestyle. Studies by Centre for Disease Control (2014) indicated that 80% of heart diseases, stroke and Type 2 diabetes could be prevented and controlled by avoiding chronic risk factors. Prevalence of risk factors among members of the society is likely to indicate eminent onset of chronic disease. This can be best demonstrated by Saudi Arabia that is characterized increased cases of obesity. As result, diabetes prevalence rate in KSA is among the highest in Asia. Consequently, research indicated that alienated cases of chronic conditions could not be prevented but their effects and complications could be successfully slowed down by elimination of the shared risk factors. Inequalities in Health Access in Developing Countries Rural Health Majority of rural residents have difficulty in accessing quality health care services. This could be attributed to lack of medical professionals in the rural areas. A case study conducted by ITC’s international business division in India indicated that out of 78 health practitioners interviewed only 16 % qualified to practice medicine in the rural areas (Chaval and Anupindi 2012). The findings of the study further noted the number of medical practitioners declined drastically beyond 11 kilometres from the urban centres. Similarly, Bangladesh has been reported to having shortage of human health resources and higher disparity in the geographical distribution of health workers according to the World Health Organisation (2014). Health workers are concentrated in the country’s secondary and tertiary hospitals in the urban centres while over 70 % of the total population reside in rural areas. Rural areas are characterized by economic hardships and offer limited incentives to medical practitioners. Consequently, most nurses and doctors seek employment in urban centres. This has worsened the management of chronic diseases that normally require highly trained medical practitioners. Rural areas also present the challenge of geographic barriers. Developing countries predominantly comprise rural areas with countable cities and urban centres. Rural areas lack elaborate transport system that could facilitate transportation of chronic patients to existing health care facilities. According to Harris (2013), studies indicated that lack of access to continuing development on research and lack of peer support due to limited peers contributed to limited supply of health services in the rural Australia. Rural residents are further subjected to dilapidated health care facilities that are understaffed. Existing medical centres lack ambulances and modern equipment that are prerequisite for effective management of chronic diseases. Residents suffering from non-communicable diseases are thus forced to seek medical services from the urban centres that are often costly. To address the issues affecting access to health services in India, studies by ICT recommended the use of e-choupal infrastructure, a three-tier network originally designed to link farms to the markets. The first tier would be located at the village level to ensure wellness of villagers through provisions of basic health information and awareness. The information would be transmitted by use of e choupal portal and radio link. The second tier would constitute of a health centre having a primary health clinic, pathology lab and a pharmacy. A medical practitioner, qualified pharmacist and a pathologist would oversee these centres. Consequently, the third tier would be primary consists of local partners inclusive of local hospitals, local doctors, insurance companies and tertiary care hospitals. Similarly, Saudi Arabian rural health care sector is also faced with the challenges of transport barriers, regional variations and rural-urban inequalities. Health care access and the challenge of transport barrier have been further worsened by cultural practices that require male members to facilitate transportation process. Like Bangladesh, Saudi Arabia is also facing shortage of health workers since expatriate in the sector of health accounted for 60% of medical professionals. However, the impact of culture as a barrier to healthcare access in the rural areas was more detrimental in Saudi Arabia’s rural areas as compared to other developing countries like India and Bangladesh. Women and Healthcare Women in developing countries are not comprehensively covered by the existing healthcare systems. Although campaigns aimed at empowering women have ensured provision of equal opportunities for employment and education, there still exist inequalities in the provision of health care services. Research by Centre for Disease Control (2014) estimated that over 63.2 million unintended pregnancies occurred in 2012 due to lack of access to modern contraceptives. Rampant health inequalities could be associated to gender inequity issues such as cultural beliefs, limited education and failure of legal systems to safeguard women’s rights. Women rights in Saudi Arabia have been significantly undermined by the country’s incorporation of Islamic principles with the state laws. In Saudi Arabia, the law provides that women can only be admitted in public hospital when accompanied by male guardian. Some cultural beliefs further prohibit women from being examined by male gynaecologist or obstetrician. In addition, most hospitals do not recognize medical consent signed by a female in case of emergency operation. Existence of gender and healthcare inequalities drastically deter the successful control and prevention of chronic disease in the developing countries. Mobile Health Applications The nature of chronic diseases has necessitated the need for a mobile application platform that would enable constant communication and linkage between patients and their medical services providers. The growth of mobile technology and its global outreach to larger proportion of the population has led to the development of numerous health application programs that use mobile phones. These application programs are commonly referred to as Mhealth apps. According to Istepanian et al (2011), mobile health (Mhealth) refers to use of small portable and wireless computing and communication gadgets (e.g. Mobile phones, smart phones, ipads) to provide medical information to both healthcare professionals and related patients or clients. The continual growth of Mhealth applications could be attributed to two factors. Iakovidis et al (2004) wrote that chronic disease patients require utmost attention and medicinal adjustment hence the need to maintain constant communication with medical experts. Second, the use of Mhealth applications effectively reduce the costs associated with chronic disease management such as travel cost when visiting physicians. According to USAID (2012), Justtested is a sms based support and information for HIV testing and counselling individuals which was successfully implemented in South Africa. The project was primarily aimed at providing support to individuals who had just conducted HIV test regardless of the final status. Subscribers choose between just tested negative or positive free sms that were available in Afrikaans, English and isiXhosa dialects. After subscription, the service sent over 39 messages within duration of three months. The projected commenced on May 2012 and has spread to Overberg district and Nelson Mandela Metro district. The project was highly accepted by the population indicating a tenfold increase of subscribers. Majority of subscribers indicated that they had gained new information from the services and did not wish to unsubscribe. In the case of Saudi Arabia, the project could be modified to provide support and information to non-communicable diseases patients instead of HIV. This will provide patients with pertinent information regarding the prevention, control and treatment of the diseases especially in rural areas. Furthermore, lesson learnt from the South Africa’s project indicated that the sms should have identifiable brand name, sms are recommended to be free and individuals who have unsubscribed by mistake should be allowed to subscribe again. The Role of Mobile Technology in Healthcare Through collaboration, care providers and mobile applications companies have been able to development patient oriented programs that offer medical solutions to both patients and medicals services providers. The use of Mhealth apps by both patients and medical practitioners result to enhanced communication and interaction at a reduced cost. These applications facilitate assessment of patient’s conditions, enable patient to check in with their doctors on a daily basis, facilitate constant patient guidance by doctors and further provide patients with necessary information regarding their health status. These applications further enable customized service provision for each patient through personalization research data and assessment of accurate medical data obtained from each patient’s medical feedback. The growth of mobile technology in Africa has greatly promoted the development of Mhealth mobile applications in the continent. According to survey by Donner and Mechael (2012), Africa has 60% penetration of cell phones compared to 50% penetration of cell phones in the United States. Availability of mobile phones and established network providers impacted significantly on the development of Mhealth mobile applications. Based on the studies by World Health Organisation (2014), some of the successful Mhealth applications in Africa include the following: MoTECH in Ghana, which provides pregnancy information to expectant women and wired mothers project in Zanzibar, which links midwives and expectant women. However, the study of existing mobile health applications indicated that majority of mobile health applications concentrated on communicable diseases and pregnancy solutions. Mhealth applications in Africa specifically target those affected by HIV/AIDS and malaria. In addition, majority of non-governmental organisations also concentrated on funding projects that focused on malaria, HIV/AIDS and maternal health medical solutions. In addition to focusing on infectious diseases, majority of mobile health application programs were based in the rural areas. From the findings, Donner and Mechael (2012) noted that it was essential that healthcare providers in collaboration with mobile application companies develop Mhealth applications specifically designed to cater for chronic diseases patients such as diabetes, cancer and cardiovascular diseases. Furthermore, relevant authority and program coordinators should expand the coverage of the Mhealth services to urban areas where studies indicate increased prevalence of chronic diseases due to global growth of urban lifestyles. Research Gap The study indicated that majority of the Mhealth applications were developed under pilot projects. Consequently, information regarding these projects did not sufficiently support decision-making process for government, private investors or international donors in relation to geographic information, the implementation process and the methods that were applied. In addition, majority of existing documentation focused on provision of medical services to patients suffering from infectious diseases such as malaria, HIV/AIDS and tuberculosis. Hence, available research lacked adequate information pertaining to chronic diseases in relation to Mhealth applications. This was contrary to expectations as indicated by increased prevalence of chronic diseases conditions in the developing countries. The existence of knowledge gap regarding assessment of the performance of Mhealth application in relation to chronic diseases was likely to hinder evaluation and feasibility study of the acceptability of Mhealth application to manage diabetes in the kingdom of Saudi Arabia To address the issues of research gap in the study of Mhealth applications, the study plans to employ a myriad of techniques that will include the following: undertaking a comparison of studies, interstate studies, and role assessment of the integrated technology, establishment of a model study design and general cost-benefit study of each project. Studies comparison: This technique will enable the study and assessment of various forms of Mhealth application technology. This study will mainly focus on the assessment of short messages services, voice calls and mobile internet data supporting Mhealth services. Data collected from this study will be sufficient to inform stakeholder’s decision-making process. Critical study of existing Mhealth application programs in both developing and developed countries will also be conducted. This will form a basis for comparison of how Mhealth technology functionality varies with countries. The study will further be structured to explicitly demonstrate the roles of Mhealth integrated technology. Consequently, the research study will incorporate decision-making support tools, data collection mechanism, forms of electronic records and active community participation platforms. In addition, the study plans to develop a model study design that will encompass necessary requirement for quantitative and qualitative analysis of the entire Mhealth project. Implementation of the proposed model will be accompanied with constant evaluation of each stage of the project to assess the impact of the application on patient’s health status. Finally, for the purposes of feasibility study of the project, cost benefit study of every project under examination will be conducted. Resulting information from cost benefit studies could be used to indicate the economic viability of Mhealth services to the government, prospective donors or private investors. Case Study The paper is aimed at studying the acceptability of Mhealth applications to manage diabetes in the kingdom of Saudi Arabia. Studies indicate that diabetes has the highest rate of prevalence in comparison to other non-communicable diseases globally. According to a report by Oxford Business Group (2007), the global prevalence of diabetes has risen over six times within a period 20 years. The report further indicated that diabetes currently affects over 246 million people globally and the figures are expected to reach 380 million by 2025. The research also attributed 3.8 million deaths annually to diabetes that is equivalent of 6% of the global deaths. According to World Health Organisation (2014), diabetes refers to a medical condition in which the pancreas does not produce sufficient insulin or when the body is unable to metabolize effectively the produced insulin. Insulin is the primary hormone responsible for regulation of sugar levels in our bodies. Consequently, diabetes may occur as either Type 1 or Type 2. Type 1 diabetes is characterized by deficiency in insulin production by the body and hence patients require daily administration of insulin for regulation of sugar levels. Type 2 diabetes patient suffers from ineffective use of insulin and is the most common form of diabetes globally. Currently, principal cause of Type 1 diabetes is unknown and cannot be prevented by elimination of existing risk factors. Medical scholars argue that the global prevalence of diabetes has already transformed into an epidemic. According to International Diabetes Federation Annual Report (2012), in 1985 the number of people suffering from diabetes globally was 30 million. By 1995, the figure had risen to 135 million and currently it is estimated that 177 million people suffer from diabetes. The number is expected to reach 300 million by 2025. Consequently, observed prevalence of diabetes has resulted to economic burden on individuals, existing healthcare system and state economy. Developing countries are the most affected due to additional prevalence of infectious diseases such HIV/AIDS and malaria. Globally it is estimated that the total expenditure on management of diabetes by 2035 will amount to $627 billion. Based on statistics by International Diabetes Federation, countries with the leading number of diabetes patients include China, India Unites States, Russia and Brazil. However, Saudi Arabia, Nauru and Mauritius have been noted as the leading countries with the highest prevalence rate. The kingdom of Saudi Arabia (KSA) has been observed to be developing at a rapid rate hence accelerating urbanization of the population. Urbanization in the KSA has been associated with adoption of new lifestyles, which has resulted to emergence of chronic diseases among the urban population. Numerous studies have indicated epidemic occurrence of diabetes cases in the kingdom with the latest prevalence at 23.9% hence placing KSA as the seventh leading state in diabetes prevalence. Oxford Business Group (2007) reported that over 19 % of the urban population is suffering diabetes in KSA and the figures are expected to rise. Projections from the survey further indicated that the number Saudi citizens suffering from the disease could reach 5.5 million from the current 2.8 million patients by 2030. Consequently, over 2.1 million Saudi citizens continue to live with diabetes without diagnosis. As a result, the introduction of mobile health application in Saudi Arabia presents an opportunity to offer medical services to the vast population suffering from diabetes. The utilization of mobile health application services is best suited for Saudi Arabia based on the following factors. The country is currently struggling to curb the prevalence of chronic diseases with most efforts aimed at preventing and controlling diabetes. Concerted efforts focused on neutralizing risk factors associated with chronic diseases are face limitation of resources. Cosby (2011) also noted that conservative laws predominantly govern Saudi Arabia and as noted earlier certain laws and cultural practices may limit full exploitation of health care services by minority groups especially women. The use of mobile health applications present solution to most challenges associated with chronic diseases in the country. Mobile health applications will greatly benefit women who will be able to access medical services without being subjected to cultural traditions and suppressive Islamic laws. Implications The current health crisis facing Saudi Arabia could be attributed to urbanization, suppressive customary laws and ineffective legislation. Prevalence of chronic disease in the kingdom been closely linked to the rise in obesity cases among members of the society. Female Saudi citizens were more likely to suffer from obesity that their male counterparts. This is because Saudi Arabia laws prohibit participation of women in any form of physical activities hence encouraging sedentary lifestyle. Al-Mohamed (2008) also noted that existing healthcare system did not offer specialized medical packages to women but rather discriminated them based on their gender. The findings also showed that chronic patient from rural areas faced healthcare inequality due to lack of comprehensive health system and were likely to incur huge cost travelling to the cities for treatment. Measures to control and prevent prevalence of chronic diseases in the kingdom of Saudi Arabia were negatively impacted by limited resources and funding by the state government. Public hospitals lacked sufficient medical staff and appropriate technology necessary to management the epidemic of chronic diseases. The studies thus projected that developing countries are most likely to face the aforementioned challenges in regards to prevalence of chronic diseases. 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