Center of Excellence for mHealth and Smart Healthcare, China Mobile Research Institute, China Mobile Communications Corporation, Beijing, China.
Global Health Research Center, Duke Kunshan University, Kunshan, China.
JMIR Mhealth Uhealth. 2019 Jul 19;7(7):e13503. doi: 10.2196/13503.
Mobile health (mHealth) technologies hold great promise in improving the delivery of high-quality health care services. Yet, there has been little research so far applying mHealth technologies in the context of delivering stroke care in resource-limited rural regions.
This study aimed to introduce the design and development of an mHealth system targeting primary health care providers and to ascertain its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) service for strengthening secondary prevention of stroke in rural China.
The SINEMA mHealth system was designed by a multidisciplinary team comprising public health researchers, neurologists, and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following 5 steps: (1) assessing the needs of relevant end users through in-depth interviews of stakeholders, (2) designing the functional modules and evidence-based care content, (3) designing and building the system and user interface, (4) improving and enhancing the system through a 3-month pilot test in 4 villages, and (5) finalizing the system and deploying it in field trial, and finally, evaluating its feasibility through a survey of the dominant user group.
From the in-depth interviews of 49 relevant stakeholders, we found that village doctors had limited capacity in caring for village-dwelling stroke patients in rural areas. Primary health care workers demonstrated real needs in receiving appropriate training and support from the mHealth system as well as great interests in using the mHealth technologies and tools. Using these findings, we designed a multifaceted mHealth system with 7 functional modules by following the iterative user-centered design and software development approach. The mHealth system, aimed at 3 different types of users (village doctors, town physicians, and county managers), was developed and utilized in a cluster-randomized controlled trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients between July 2017 and July 2018. In the end, a survey on the usability and functions of the mHealth system among village doctors (the dominant group of users, response rate=96%, 24/25) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study.
The mHealth system was feasible for assisting primary health care providers in rural China in delivering the SINEMA service on the secondary prevention of stroke. Further research and initiatives in scaling up the SINEMA approach and this mHealth system to other resource-limited regions in China and beyond will likely enhance the quality and accessibility of essential secondary prevention among stroke patients.
ClinicalTrials.gov NCT03185858; https://clinicaltrials.gov/ct2/show/NCT03185858.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.ahj.2018.08.015.
移动医疗（mHealth）技术在提高高质量医疗服务的提供方面具有巨大的潜力。然而，迄今为止，在资源有限的农村地区提供中风护理方面，应用 mHealth 技术的研究很少。
本研究旨在介绍针对初级保健提供者的 mHealth 系统的设计和开发，并确定其在支持在中国农村实施系统集成技术启用模型的中风二级预防服务（SINEMA）中的可行性。
SINEMA mHealth 系统由公共卫生研究人员、神经学家和信息通信技术专家组成的多学科团队设计。mHealth 系统的迭代共同设计和开发涉及以下 5 个步骤：（1）通过对利益相关者进行深入访谈，评估相关最终用户的需求；（2）设计功能模块和基于证据的护理内容；（3）设计和构建系统和用户界面；（4）通过在 4 个村庄进行为期 3 个月的试点测试来改进和增强系统；（5）最终确定系统并在现场试验中部署，最后，通过对主要用户群体进行调查评估其可行性。
通过对 49 名相关利益相关者的深入访谈，我们发现村医在农村地区照顾农村地区的中风患者方面能力有限。初级保健工作者表示，他们确实需要通过 mHealth 系统获得适当的培训和支持，并且对使用 mHealth 技术和工具非常感兴趣。根据这些发现，我们采用迭代的以用户为中心的设计和软件开发方法，设计了一个具有 7 个功能模块的多方面 mHealth 系统。该 mHealth 系统针对 3 种不同类型的用户（村医、乡镇医生和县级管理人员）进行开发和利用，由 25 名村医在中国农村一个资源有限的县进行了一项基于群组的随机对照试验，以管理 2017 年 7 月至 2018 年 7 月间的 637 名中风患者。最后，对村医（主要用户群体，回应率=96%，24/25）对 mHealth 系统的可用性和功能进行了一项调查，结果显示，他们大多数对所提供的基本功能表示满意（71%），并且在研究后热衷于继续使用（92%）。
mHealth 系统可为中国农村地区的初级保健提供者提供中风二级预防的 SINEMA 服务提供帮助。进一步的研究和举措，将 SINEMA 方法和这个 mHealth 系统扩展到中国和其他资源有限地区，可能会提高中风患者基本二级预防的质量和可及性。
ClinicalTrials.gov NCT03185858；https://clinicaltrials.gov/ct2/show/NCT03185858。
国际注册报告标识符（IRRID）：RR2-10.1016/j.ahj.2018.08.015。
