Matéria produzida originalmente em inglês, para português clique aqui e veja a tradução do Google.
The following article has been prepared in the scope of the master thesis study with the preliminary title: “mHealth Evaluation: An Exploratory Research for a Framework in Brazil.”
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Mobile health (mHealth), defined “as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices,”[1] continuously grows in Latin America, and especially in Brazil. GSMA and PwC India valued the worldwide mHealth market at 4.5 billion USD in 2013 and forecasted a rapid growth to 23 billion USD by 2017. More specifically, Latin America’s mHealth market is expected to be worth 1.6 billion USD by 2017. In the same year, Brazil will be, with a market size of 0.7 billion USD, the seventh largest mHealth market in the world.[2] This literal market explosion is user-driven, says Michele Nogueira, Professor for Computer Science at UFPR and author of the book “Saúde Móvel.” In addition to users, Claudio Giuliano, Director of FOLKS e-Saúde, identifies the general expansion of mobile technologies that find their ways into healthcare as well as the need of healthcare providers to improve quality while reducing costs as driving forces for the rapid growth of mHealth.
The opportunities that mHealth creates are manifold. In the report “Socio-economic impact of mHealth: An assessment report for Brazil and Mexico,” PwC India estimates that through mHealth an additional 28.4 million people could gain access to the healthcare system in Brazil, without increasing the number of doctors. Moreover, public and private healthcare spending could be reduced by 14 billion USD while providing the same care. These savings would be achieved mainly through applications in prevention, wellness and monitoring. If these savings would be reinvested, an additional 4.3 million patients could be treated.[3] mHealth opens new horizons and challenges today’s healthcare system in Brazil, states Ana Maria Malik, Professor for Healthcare Administration at FGV-EAESP. However, Brazil trails behind the leading markets in the adoption of information and communication technology (ICT) in healthcare, says Claudio Giuliano.
Although this new technology approach is promising, most initiatives and projects are still in the early start-up phase. According to a WHO report from 2011, around two thirds of mHealth programmes worldwide are in the pilot or informal stage.[1] Orwat, Graefe & Faulwasser (2008) even estimated the number of computing systems in healthcare, including systems with mobile devices among others, that are in the prototype or pilot stage to be as high as 84%.[4]
Getting a business of the ground is challenging. In general, approximately 75% of venture-backed firms in the USA do not return the invested capital, says a research by Shikhar Ghosh, a senior lecturer at Harvard Business School. And according to a study by the U.S. Bureau of Labor Statistics about 40% of start-ups do not survive the first three years. Although the numbers are disputed and change with different definitions, the trends are clear.[5] The website Statistic Brain used sources from The Small Business Development Center at Bradley University to identify the main reasons for failure, namely incompetence, lack of managerial experience and lack of experience in the line of service. Furthermore, the statistics show in the intersecting industries of mHealth that failure is higher in the information than in the healthcare industry.[6]
The reasons for start-up failure and delay in a wider adoption of mHealth could be linked to the lack of best practices, strategic orientation and impact monitoring. Only 12% of WHO member states reported evaluating mHealth services. The mHealth initiatives require evaluation from the early planning stage throughout the entire lifecycle in order to share and promote the best results among entrepreneurs, healthcare providers, patient and professional users and policy decision-makers, among other stakeholders.[1] Magdala Novaes, Professor for Health Informatics at UFPE as well as founder of the research group for health information technology (TIS) and the nucleus for telehealth (NUTES) at UFPE, has recently performed an evaluation of a mHealth project for adolescents in Pernambuco. She confirms that publications of evaluation are rare what hinders the further development of the field in Brazil.
A recently published systematic review of evaluation frameworks in eHealth, the field of ICT in healthcare, compares existing frameworks for the implementation of telehealth services that possibly contribute to the success rate of future endeavors. Although none of the studies that described the theoretical frameworks explained the rationale for selection, one promising evaluation framework will be described in more details in this article.[7]
The Khoja-Durrani-Scott (KDS) comprehensive evaluation framework for eHealth, which was developed as a PANACeA-initiative (PAN Asian Collaboration for Evidence-based eHealth Adoption and Application), allows a structured way of evaluation along the lifecycle stages of a mHealth solution. The matrix framework focuses on different strategies for each of the outcome dimensions throughout the lifecycle stages of the implementation. Therefore, for each of the 28 cells (four eHealth lifecycle stages and seven evaluation themes), the framework defined the desired outcomes as shown in the extract below.[7, 8]
Figure 1. Extract of desired outcomes per stage of the eHealth lifecycle. Reprinted from “A Review of Telehealth Service Implementation Frameworks,” by L. van Dyk, 2014, International Journal of Environmental Research and Public Health, 11, 1279-1298.
Moreover, the team around the KDS framework developed a questionnaire tool, which is available on the project’s website.[9] For each question, the respondent answers to a series of statements that are linked to a Likert scale and a point system: unsatisfactory (1), below expectations (2), meets expectations (3), above expectations (4), extraordinary (5) and don’t know (1). Additionally, the sets of questionnaires differ depending on the viewpoint of the respondent: manager, healthcare provider and client. The end scores identify strengths and needs for improvement for each outcome dimension.[8]
Although the framework does not aim at the evaluation of results, it indirectly questions if the mHealth organization measures impact. Thus, one can say that instead on quantifying impact, the KDS evaluation framework rather focuses on providing strategic guidance during the implementation and scaling-up. Nevertheless, the results could imply generally applicable orientations for best practices and qualitative evaluations. These could support organizations to be more successful in the highly complex field of mHealth. The PANACeA-initiative currently tests the KDS framework and will officially release the tool in a later publication.
In the study “mHealth Evaluation: An Exploratory Research for a Framework in Brazil,” we aim at adapting and applying the framework and tool in the context of mHealth in Brazil in order to analyze its usefulness for the evaluation of mHealth companies and products in Brazil.
Keep reading, following and commenting our progress on EmpreenderSaúde.com.br
Sources:
- Kay, M., Santos, J., & Takane, M. (2011). mHealth: New horizons for health through mobile technologies. World Health Organization (WHO).
- Vishwanath, S., Vaidya, K., Nawal, R., Kumar, A., Parthasarathy, S., & Verma, S. (2012). Touching lives through mobile health: Assessment of the global market opportunity. Bangalore (India): PricewaterhouseCoopers (PwC).
- PwC India. (2013). Socio-economic impact of mHealth: An assessment report for Brazil and Mexico. PricewaterhouseCoopers (PwC).
- Orwat, C., Graefe, A., & Faulwasser, T. (2008). Towards pervasive computing in health care – a literature review. BMC Medical Informatics and Decision Making, 8 (26), 1-18.
- Gage, D. (2012). The Venture Capital Secret: 3 out of 4 Start-Ups Fail. Retrieved 2014, from The Wallstreet Journal
- Statistic Brain. (2014). Startup Business Failure Rate By Industry. Retrieved 2014, from Statistic Brain
- van Dyk, L. (2014). A Review of Telehealth Service Implementation Frameworks. International Journal of Environmental Research and Public Health, 11, 1279-1298.
- Khoja, S., Durrani, H., Scott, R. E., Sajwani, A., & Piryani, U. (2013). Conceptual framework for development of comprehensive e-health evaluation tool. Telemedicine and e-Health, 19, 48-53.
- Panacea Evaluation
