Digital Health Promotion in Iringa, Tanzania
Condition: HIV Infections; Tuberculosis; Cysticercosis; Tapeworm Pork
MeSH terms: Tuberculosis; Cysticercosis; Taeniasis; Neurocysticercosis
Study type: Interventional

Summary: 
      Increased health education has the potential to facilitate better use of health care services
      and to promote early treatment, thus it can strengthen the health care system, and ultimately
      reduce morbidity and mortality. In this study, we will develop and test the effect of digital
      health messages related to HIV, Tuberculosis (TB) and Taenia solium cysticercosis/taeniosis
      (TSCT) (the intervention diseases) in Migoli and Izazi (the intervention villages), in
      Iringa, Tanzania (TZ).

      The intervention is planned as follows: A digital platform, providing the intervention
      villages with digital health messages related to the above-mentioned diseases, will be
      implemented in TZ in 2019. The platform will be accessible free of charge, through own
      devices and tablets based in the local Wi-Fi spots in the villages.

      In the first part of this project, the doctoral research fellow will participate in
      developing the digital health messages, together with experts from the medical and teaching
      environments in Tanzania, Norway, Germany and USA.

      The second part of the PhD-project consists of a cluster non-randomised controlled trial and
      semi-structured interviews in Tanzania. The digital health messages will be physically shown
      to the participants in the intervention group. The study is planned to investigate the
      knowledge related to the intervention diseases, before the intervention, immediately after
      exposure to the intervention, and at follow-up points throughout one year, after the
      intervention has been implemented. Semi-structured interviews with clients (users of the
      intervention) from each of the intervention villages are included, to explore the perception
      and reception of the intervention.

      The baseline study and the immediate after survey will take place in Tanzania in Q1 2019,
      while the other follow-up studies and interviews (3, 6 and 12 months after baseline) will be
      undertaken throughout one year.
    

Detailed description: 
      Introduction This protocol is registered in Helseforsk, University of Oslo, and the project
      has been assessed by Norwegian Centre for Research Data (NSD), ref. number 59643. Ethical
      approval from the National Institute for Medical Research (NIMR), Tanzania, has been granted
      with the reference number NIMR/HQ/R.8a/Vol IX/2947.

      The PhD-project consist of three work packages (WPs): WP1: A systematic review and
      meta-analysis, WP2: A cluster non-randomised controlled trial and WP3: Semi-structured
      interviews with clients in the intervention group. Only WP2 and WP3 are elaborated upon in
      this protocol.

      The planned research project will be included as a health-research component in the Norwegian
      Government- and Norwegian Research Council- funded innovation project "Non-discriminating
      access for Digital Inclusion" (DigI). The project runs from January 2017 to September 2020.
      Altogether 11 partners from eight countries are collaborating on the project. Professor Josef
      Noll from the Dept. of Technology Systems (ITS), University of Oslo (UiO), is the project
      owner, and the doctoral research fellow's co- supervisor. Responsible for the health-research
      component and main supervisor of the doctoral research fellow, is Professor Dr. Andrea
      Winkler at the Institute of Health and Society, UiO. Head in TZ, is Dr. Bernard Ngowi
      (HIV/AIDS and TB specialist) from NIMR and Associate professor Helena Ngowi (TSCT specialist)
      from Sokoine University of Agriculture (SUA). Associate professor Maurice Isabwe from Dept.
      of Information and Communication Technology at University of Agder is head of developing the
      digital health messages. This study is thus multicentre with several institutions responsible
      for research.

      In Tanzania, DigI will facilitate a digital health education platform, where digital health
      messages related to HIV / AIDS, Tuberculosis (TB) and Taenia solium cysticercosis/taeniosis
      (TSCT) will be transferred to the community; hereby called clients, defined by the World
      Health Organization (2017) as "members of the public that are potential or current users of
      health services, including promotion activities" .

      The digital health messages will be accessible at a Wi-Fi spot in the local village close to
      the local health post. The digital health messages will also be shown face-to-face to each of
      the participants in the intervention group, by enumerators in the research team from SUA and
      the doctoral research fellow. The intervention will be available for all clients in the
      intervention villages, not only for the participants in the study described in this protocol.

      The intervention will be maintained by NIMR Muhimbili Centre in Dar es Salaam during the
      first phase, but is going to be managed as a sustainable business model where a local sales
      man or woman is selling vouchers to access the World Wide Web. NIMR have close contact with
      the village authorities and health workers in the intervention villages, and will be alerted
      if the intervention for some reason is not functioning. The Wi-Fi network that provides the
      access to the digital health education platform, reaches within a radius of 50 meters, and is
      driven by a solar panel. This means that the intervention will be accessible even if the
      electricity locally shuts down.

      Background and Rationale Today's education channels are changing, thus health education
      interventions must meet the target population at their own level of technology, and further
      do rely upon the characteristics of the technology available. A useful tool to deliver
      education and improve health seeking behaviour and health-related lifestyle decisions, is
      mobile technologies, because they make people more contactable. Health seeking behaviour may
      change after the target group has been exposed to adequate health messages that provide
      relevant information to the target population, , thus digital health information can
      contribute to prevention and management of diseases.

      Digital health and digital health education Digital health is defined by World Health
      Organization (2016) as "The use of digital, mobile and wireless technologies to support the
      achievement of health objectives. Digital health describes the general use of information and
      communications technologies (ICT) for health and is inclusive of both mHealth (mobile health)
      and eHealth (electronic health)" . eHealth is defined by the WHO (2005) as "the
      cost-effective and secure use of information and communications technologies in support of
      health and health-related fields, including health-care services, health surveillance, health
      literature, and health education, knowledge and research" . mHealth is a component of
      eHealth, and commonly referred to as the use of mobile and wireless technologies for health.
      WHO (2011) defines it 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" .

      Health behaviour change may reduce the burden of preventable disease and death around the
      world, "as health education covers the continuum from disease prevention and promotion of
      optimal health to the detection of illness to treatment, rehabilitation, and long-term care"
      .

      The use of eHealth is now understood as central in order to provide more care and better care
      to more people, especially those most in need. A key part of the Sustainable Development Goal
      3 relates to reaching people with the information they need in order to live healthier lives,
      and eHealth is regarded as a tool to reach the public with health messages and support, as
      well as encouraging clients to take active roles in their health and wellbeing (ibid).

      The use of smart devices and mobile data services are rapidly changing, and it is likely that
      an increasingly part of the population in for example Sub-Saharan Africa will have access to
      both in the future.
    

Intervention name(s): Digital health promotion intervention
Intervention type(s): Other
Intervention description(s): Digital health promition related to HIV, Tuberculosis and TSCT in a digital format.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: digital health; digital health promotion; health promotion; disease prevention; HIV; Tuberculosis; Cysticercosis