http://doi.org/10.33698/NRF0302-Surya Bali, A. J Singh
Abstract:Present study was conducted during May to December 2005 in Naraingarh sub division of Ambala district in Haryana. Mobile phone number of the principal investigator (PI) was communicated to general population. People were told that they were free to contact any time the PI for any medical consultation pertaining to the treatment of themselves or their family members. Details of the phone calls received were duly recorded. During the study period 660 calls were received by the PI from the different part of the country. The mean call duration was 2.7 min. Eighty percent calls were made by males. About half (48.3%) of the total calls were made during office time (9 AM to 5 PM). About 60% (414) calls were made from the mobile phones. About 34% (224) calls were made for the advice on particular health problems or disease followed by 196 (27.3%) for treatment of a particular ailment. Most common morbidities for which the clients called were skin problems 83 (17.5%), respiratory problems 66 (13.9%), mental problems 45 (9.5%), sexual problems 44 (9.26%) gastro intestinal problems 42 (8.8%) and locomotors problems 39 (8.2%) etc. The concept of using mobile phones for medical consultation seemed to be acceptable to people in rural Haryana.
Key Words: Feasibility, information communication technology, mobile phones, rural, primary health care.
Introduction:In many part of the world, health care industry is struggling to satisfy the most basic and fundamental needs of its clients. Information technology sector has come up as a reliable partner to the health care planners. Experience in western countries shows that the elderly, handicapped and others with high-risk medical conditions can find a new level of security when their hospitals use computer and telephone system to guarantee them almost instant response in emergency1. In India also, information technology has entered in the health sector in a big way. However, full potential of mobile phone has not been exploited by the health care providers. Mobile phones (MPs) can make the remote medical monitoring, consulting and health care more flexible and convenient. Unfortunately, apart from limited number of pilot projects or individual applications little is known about the impact of MPs on health2. Against this background present study was conducted to ascertain the feasibility of mobile phone medical consultation in rural area.
Materials and methods:This exploratory study was conducted at Rural Health Training Center (RHTC), School of Public Health, PGIMER, Chandigarh during May to December 2005. At the outset, the mobile phone number of the principal investigator (PI) was communicated to general public during Anganwadi monthly meetings, health education sessions, collaboration meetings with NGOs, breast feeding meetings, Kishori Shakti Yojna (KSY) meetings, health education sessions, OPD patient consultations, health camps, Dai training sessions, women empowerment camps etc. Print media (local news papers) was also used to publicize the phone number. People were told that they were free to contact anytime the PI for any medical consultation for themselves or their family members. Details of the phone call received (phone number of client, date, time and duration of calls, sex of the client, purpose of call was made, type of the used, place of the calls etc) were recorded in a call description from immediately after the call was over. This data was later enter in a computer. Mobile phone memory recording system was also used for retrievining necessary details on the individual phone calls. In some instances call back were made to callers to seek information. Consent of the respondents was taken to use the collected data for research purpose. Confidentiality and anonymity was assured. SPSS version 10 statistical software was used for data analysis.
Results:Details of the 660 calls were received by the PI is given in Table 1. The mean call duration was 2.7 min (SD=1.23; Range= 0.39 min-7.26 min); 145 calls lasted for less than 2 minutes. The mean call length differed significantly across urban to rural setting. Eighty percent calls were made by males. Number of calls gradually increased from only 16 per month in May to 186 per month in December 2005. About 60% calls were from Naraingarh sub division. About 60% (414) calls were made from mobile phones.A total of 146 (22.1%) calls were returned back to PI either for telling the feedback about the treatment or advice. Few calls (23; 5.5%) were made for seeking appointment and 74 (11.2%) calls were made for other miscellaneous purpose. Most common morbidities for which the clients called were skin problems 83 (17.5%), respiratory problems 66 (13.9%), mental problems 45 (9.5), sexual problems 44 (9.26%) gastro intestinal problems 42 (8.8%) and locomotor problems 39 (8.2%) etc.
Table 1: Profile of the calls received
(N=660)
| Variables | Numbers | Percentage | |
| Sex of the caller | |||
| Male | 528 | 80.0 | |
| Female | 132 | 20.0 | |
| Timing of the Calls | |||
| 6 AM to 9 AM | 80 | 12.1 | |
| 9.01 AM to 5 PM | 319 | 48.3 | |
| 5.01 PM to 9.00 PM | 212 | 32.1 | |
| 9.01 PM to 5.59 AM | 49 | 7.4 | |
| Duration of Calls (Min)
|
|
|
|
| <1.00 | 27 | 4.1 | |
| 1-2 | 143 | 21.7 | |
| 2-3 | 260 | 39.4 | |
| 3-4 | 126 | 19.1 | |
| 4-5 | 62 | 9.4 | |
| >5 | 42 | 6.4 | |
| Mean =2.7 Min; SD =1.23 Min | Range 0.39-7.26 | ||
| Places from Where Calls Made | |||
| Naraingarh Town | 288 | 43.6 | |
| Naraingarh Rural | 106 | 16.1 | |
| Other parts of Ambala | 39 | 5.9 | |
| Other district of Haryana | 11 | 1.7 | |
| Other states (U.P., Chandigarh, Delhi) | 216 | 32.7 | |
| Number of Calls per Month | Numbers | Percentage | |
| May | 16 | 2.4 | |
| June | 21 | 3.2 | |
| July | 25 | 3.8 | |
| August | 34 | 5.2 | |
| September | 42 | 6.4 | |
| October | 168 | 25.5 | |
| November | 168 | 25.5 | |
| December | 186 | 28.2 | |
| Type of Phones Used for Calls |
|
|
|
| Personal landline Phones | 114 | 17.3 | |
| Mobile Phones | 414 | 62.7 | |
| STD/PCO | 132 | 20.0 | |
| Calls made for Whom | |||
| Self | 359 | 54.4 | |
| Family Member | 197 | 29.8 | |
| Relatives | 37 | 5.6 | |
| Friends and others | 67 | 10.2 | |
| Purpose of Calls | |||
| Advice on health problem | 224 | 33.9 | |
| Treatment | 193 | 27.3 | |
| OPD follow up calls | 146 | 22.1 | |
| Seeking Appointments | 23 | 5.5 | |
| Miscellaneous | 74 | 11.2 | |
Discussion
In recent years, the world has seen an explosion in the growth of information and communication technologies, and particularly mobile communications. Indeed, the mobile phone has moved beyond being a mere technological object to become a key “social object” pervading every sphere of our daily lives. With exponential rise in MP ownership India is set to become third largest mobile phone user in the world by 20073.
Extensive penetration of MPs even in rural areas is reflected by the fact that 63% of the calls received by the PI were made from MPs.
The experience with the use of mobile phone for providing health care consultation to the catchment population of RHTC in our study shows that people were quite receptive to this new idea. Popularity of this facility is evident by the gradual increase of number of calls from May to December 2005.
However, our results reveal that females had significantly lesser access to mobile phone than their male counterparts. This may be due to lesser status of females in the family and society in rural India.
Moreover, the PI received as many as 40% of the total calls from outside of the study area where the MP number was not communicated. This indicates that our local respondents themselves had publicized the availability of this facility to their distant relatives.
Access of peoples living in rural areas to appropriate health care is constrained by structural, social, economic, psychological barriers. Mobile phone can certainly help in enhancing the outreach of health services to these areas. Use of mobile phones for health care consultation reduces the travel time as well as waiting time in hospital. Moreover, it can also help in reducing unnecessary hospital visits for trivial ailments. In India the usual pattern is that for hospital visits, patients are accompanied by one or more escorts even for minor ailments. In India the usual pattern is that for hospital visits, patients are accompanied by one or more escorts even for minor illnesses4,5. This is particularly true for conventionally dependent members of the family like children, women and elderly. Use of mobile phones for such cases, especially when the illness is mild, prevents unnecessary visits to the hospital. This is a boon since this eliminates the need of any escort to bring them to the hospital. Thus, such facility will save manpower, money as well as fuel.
The mean call duration was only 2.7 min (SD=1.23; Range=0.39 min-7.26 min) in our study in comparison to 5.9 min (SD 3.6, Range 0.3-35.8) in a study by Shapiro et al6 and 3.9 min (Range,0.25-25) by Fatovich et al8, which are quite less in comparison in our findings. This indicates that compared to the pattern of western countries our respondents did not believe in long telephonic conversation for medical consultation, possibly due to expenses involved.
Although most of the calls were made during working hour (9 AM to 5 PM), few calls were indeed made at night after 9 PM. This indicated that MPs could be used to stretch the consultation hours for patients. This may help clients to get requisite advice even without meeting the doctors during odd hours. In contrast to our results Crouch et al7 reported in their study that the majority of calls recorded were made during the evenings, afternoons and weekends –i.e. the periods when the availability of GP and community based primary care services is more limited.
Limitations
Present report is the results of an exploratory study. The implications of mainstreaming this technology into the health care delivery system are manifold. Firstly we need experienced and trained staff to provide such consultation since consequences of error during such service provision can be serious.
Complete diagnosis through phone i.e. conversation is not possible. This should only be a step before face-to-face consultation. However with the proper use of the mobile phone can both facilitate patient care and maximize the available human resources. It fulfils a genuine community need and helps promote better community relations8.
Our experience also revealed many problems in this approach e.g. disturbances to concerned doctor due to unnecessary calls, missed calls, wrong number dials etc. Unless adequately funded it may also lead to economic burden for service provider in calling back to missed calls and due to roaming charges. There may also be inconvenience due to the calls during odd hours/ late night. Over use of mobile handset for receiving and doing calls may also be hazardous to the service provider. Moreover, many medical problems need clinical examination for proper treatment and cannot be dealt on the phones.
Further efforts are required to educate both patients and physicians on the advantages and limitations of mobile phones health communication, and to remove fiscal and legal barriers to its adoption.
References
- Protti DJ. The application of information science, technology and management to public health: In: Oxford Textbook of Public Health, Fourth Edition, Volume 2; Oxford; Oxford University Press 2000: 417-433.
- Mechael PN. Mobile phones for mother and child care: Case history from Egypt.http://www.i4donline.net/may05/casestudtegypt.asp.5May2005. (Accessed on 26th Feburary 2006)
- India Mobile Statstics: Posted by Josh Dhaliwal (Tues 10 Jan 2006) http:// w2forum.com/download_report_toc.php. (Accessed on 16.03.06.)
- Singh AJ. Mobile clinic approach to tackle reproductive health problems of women in North India. Bull PGI 2004:38:66-70.
- Singh AJ. Reproductive health of women of North Indi-Men’s point of view. Journal of Family Welfare 1999; 80-85
- Shapiro SE, Izumi S, Tanner CA, Moscato SR, Valanis BG, David MR, et al Telephone advice nursing services in a US health maintenance organisation. J Telemed Telecare 2004; 10 (1): 50-4.
- Crounch R, Patel A, Williams S, Dale J. An analysis of telephone calls to an inner-city accident and emergency department. J R Soc Mef 1996; 89:324-328.
- Fatovich DM, Jacobs IG, McCance JP, Sidney KL, White RJ. Emergency department telephone advice. Med J Aust 1998; 169 (3): 143-6.