Nahar Papreen, Kannuri Nanda Kishore, Mikkilineni Sitamma, Murthy G V S, Phillimore Peter
a Institute of Population Health, University of Manchester, Manchester , UK.
b Indian Institute of Public Health , Hyderabad , India.
Anthropol Med. 2017 Apr;24(1):1-16. doi: 10.1080/13648470.2016.1263824. Epub 2017 Feb 8.
This article examines challenges facing implementation of likely mHealth programmes in rural India. Based on fieldwork in Andhra Pradesh in 2014, and taking as exemplars two chronic medical 'conditions' - type 2 diabetes and depression - we look at ways in which people in one rural area currently access medical treatment; we also explore how adults there currently use mobile phones in daily life, to gauge the realistic likelihood of uptake for possible mHealth initiatives. We identify the very different pathways to care for these two medical conditions, and we highlight the importance to the rural population of healthcare outside the formal health system provided by those known as registered medical practitioners (RMP), who despite their title are neither registered nor trained. We also show how limited is the use currently made of very basic mobile phones by the majority of the older adult population in this rural context. Not only may this inhibit mHealth potential in the near future; just as importantly, our data suggest how difficult it may be to identify a clinical partner for patients or their carers for any mHealth application designed to assist the management of chronic ill-health in rural India. Finally, we examine how the promotion of patient 'self-management' may not be as readily translated to a country like India as proponents of mHealth might assume.
本文探讨了印度农村地区实施可能的移动医疗项目所面临的挑战。基于2014年在安得拉邦的实地调查，并以2型糖尿病和抑郁症这两种慢性疾病为例，我们研究了一个农村地区的人们目前获取医疗服务的方式；我们还探讨了当地成年人目前在日常生活中使用手机的情况，以评估移动医疗倡议实施的现实可能性。我们确定了这两种疾病截然不同的就医途径，并强调了由那些被称为注册执业医生（RMP）但实际上既未注册也未受过培训的人提供的正规医疗系统之外的医疗服务对农村人口的重要性。我们还展示了在这种农村背景下，大多数老年人口目前对非常基本的手机的使用是多么有限。这不仅可能在不久的将来抑制移动医疗的潜力；同样重要的是，我们的数据表明，对于任何旨在协助管理印度农村地区慢性疾病的移动医疗应用程序，为患者或其护理人员确定临床合作伙伴可能有多困难。最后，我们研究了患者“自我管理”的推广可能不像移动医疗支持者所设想的那样容易在印度这样的国家实现。
