Using cell phones to help patients connect to health care
About 93% of Kenyans are mobile phone users.
By the end of 2015, it is expected that cellphone subscriptions will exceed the world’s population.
CIHR Foundation Grant Recipient
Dr. Richard T. Lester
Department of Medicine, Division of Infectious Diseases
Faculty of Medicine
University of British Columbia, Vancouver
Dr. Lester’s Research
Many patients do not take their medications as prescribed by their health care providers. This can lead to negative health outcomes, and is very expensive for the health care system.
In 2007, Dr. Lester’s team developed an interactive text-messaging system, with the goal of helping Kenyan health care providers and patients improve compliance with the prescribed use of medications for HIV/AIDS. In the case of HIV/AIDS patients, a failure to take their medications as prescribed can lead to the development of drug resistance that can, in turn, force the patient to take stronger, more expensive drugs.
The WelTel service, developed by Dr. Lester and his colleagues, encouraged patients to comply with treatment plans through regular text messages and cell phone calls from clinic staff. The team found that patients who participated in the study were 24% more likely to take their drugs as prescribed, as compared to patients attending clinics not using the WelTel service. In addition, HIV patients who received the text messages and cell phone calls were more likely to have the disease under control a year after starting treatment. The researchers credit the regular contact between patients and clinic staff for the service’s success.
Since this early work in Kenya, the program has expanded to include support for patients with other infectious and chronic diseases and has been adapted for use in Canada and other countries. However, despite the success of the WelTel system, few mobile health (mHealth) services have been implemented on a large scale.
Supporting advances in mobile health (mHealth)
The goal of Dr. Lester’s Foundation grant is to build evidence on how to deliver an effective, large-scale mHealth service in multiple countries. To do this, his team will be asking questions about what makes certain mHealth projects focused on HIV, tuberculosis, and asthma successful. Finding out the answers to this question will ultimately save lives and money. Their plan is to create a database of the factors associated with the successful adoption and cost-savings of mHealth services. This will help the team and other researchers better understand how to ensure the successful implementation of these programs.
Dr. Lester will be using a strong integrated knowledge translation approach, since his team of scientists and trainees includes a diversity of knowledge users like policy makers, health care providers and community leaders. This multi-disciplinary team will inform the research process to ensure the relevance of the research and to support the translation of results into policy and action.
“Our work as researchers does not end with publishing our findings, or even with educating our healthcare peers. To effectively scale something up, we need to ensure the public is aware, as they create the demand for better services and are the ultimate beneficiaries. Our knowledge translation strategies include methods to help keep the public informed so they can advocate on behalf of themselves.” – Dr. Rich Lester
About Dr. Lester
Dr. Lester completed his medical degree at the University of Alberta, followed by a residency in internal medicine at the University of Toronto. He obtained Infectious Diseases Clinical Fellowships at the University of British Columbia and with the University of Manitoba / University of Nairobi collaborative projects (WHO Collaborative Centre for HIV/STD Research and Training). A Michael Smith Foundation for Health Research (MSFHR) Scholar, Dr. Lester was profiled in 2009 on CBC’s The National for his work using cell phones to help people with HIV/AIDs in Kenya.
The study’s authors concluded:
"Patients who received the SMS [text messaging] support were more likely to report adherence to anti-retroviral therapy and were more likely to have their viral load suppressed below detection levels than patients who received the standard care alone. It's not actually reminders, per se; it's actually the support that they seek, and timely triggers to be able to report on any problems that they have."
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