University of Gondar

College of Medicine and Health science

Institute of Public Health
Department of Health Informatics

mHealth For Health Informatics Students

06/12/2021 1
Mobile Technology

06/12/2021 2
Group discussion

What is mobile device

 What are the different types of mobile device
 What are the basic features of mobile device
Mobile phone components
Limitations of mobile technology
Mobile device manufacturers

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Learning objectives

After the end of this session, students will able to:

• Define mobile technology/device

• Explain the special features of mobile device

• Identify the different types of mobile device

• Describe issues to be consider while selecting mobile device for any mHealth

project

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Terminology
Mobile technology
 From the Latin word “mobilis” meaning “to move”
Able to move freely or easily

 Mobile technology is defined an electronic device that

allows the user to transport, travel and essentially become
mobile 
known as a handheld device

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Common forms of mobile technology
• Mobile phones
• Personal digital assistants (PDAs)
• Tablets
• Patient monitoring devices
• Global positioning system (GPS) devices

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Features of mobile technology
• Portability

• Accessibility

• Ease of use

• Applications

• Personalization
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Limitations of mobile technology
• Privacy and security

• Damage/loss

• Power/battery

• Health effect

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Mobile Phone

 A portable, handheld communications device connected to a wireless

network that allows users to make voice calls, send text messages and run
applications.

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Mobile phone cont’d…

 Is a phone that can make and receive telephone calls over a radio link
while moving around a wide geographic area
Also Known as
Cellular phone,
Cell phone,
Hand phone or
Simply a phone
 Real-time voice communication and basic  SMS  functions serve as the
backbone and the current most common use of mobile phone technology.

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Mobile phone cont’d…

It does so by connecting to a cellular network provided by a mobile

phone operator.
The service area of each base station is called a cell.

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Mobile network operators in Ethiopia

• A mobile network operator also known as a wireless service provider is a

provider of services that owns or controls all the elements necessary to sell
and deliver services to an end user.

• Ethio Telecom, previously known as the Ethiopian Telecommunications

Corporation (ETC), is an integrated telecommunications services provider
in Ethiopia,
• providing internet and telephone services
• data communications

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Mobile phone components and features
Mobile phones Design

 All mobile phones are designed to

 Work on cellular networks and
 Contain a standard set of services that allow phones of different types and in
different countries to communicate with each other
 Roaming which permits the same phone to be used in multiple
countries
 Providing that the operators of both countries have a roaming
agreement
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Mobile phone components

The common components found on all phones are:

A battery: providing the power source for the phone functions

An input mechanism : The most common input mechanisms are keypad and touch screens

SIM card: All GSM phones use a SIM card to allow an account to be swapped among

devices
An International Mobile Equipment Identity (IMEI) number

Display: Mobile phones have a display device

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Input Mechanisms

Keypad Input
• Some mobile phones typically implement a 12-digit keypad.

• This is very intuitive and effective for numerical input but

difficult for entering text.

• This is because each key on a keypad represents three characters.

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Input Mechanisms

Soft keyboards
• The most approachable method of entering text on mobile devices is by using a

soft keyboard, a keyboard displayed on the screen.

• Users enter data by pressing "keys," just as they would on a physical keyboard.

• This method is very easy to learn and use, but it is also takes up screen space.

• It is often used as a backup mechanism when other forms of data input are not

effective.

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Input Mechanisms

Character Recognition
• Character recognition works by interpreting which letters a user is entering on the

screen.
• There is usually a specific area on the screen for users to construct the characters.

• The letters have to be constructed fairly accurately for them to be understood.

• This is usually not a problem for small amounts of data, but can be a challenge for

users who need to enter data quickly.

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Input Mechanisms

Keyboard Input
• Even with the advances being made in other forms of data input, the keyboard remains
the most efficient and easy to use (especially for Western languages such as English).
• Mobile devices have many ways to take advantage of keyboard data entry.

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Mobile phone features

The features of mobile phones are the set of capabilities, services and applications that offer to their

users
Applications like a clock, alarm, calendar, calculator and games

Most handheld devices can also be equipped with 

Wi-Fi, 
Bluetooth,
GPS capabilities
 Camera
Media player feature
Google map

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Types of mobile phones

Mobile phones could be classified based on their features as

Feature/Normal phones

Smartphones
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Type of mobile phones cont’d…

A feature phone is a cell phone which

• Offer basic telephony
• Low-end mobile phones (with limited capabilities) and
• Low cost in contrast to a modern smartphone

Smart phones

• Handsets with more advanced computing ability

• High-end mobile phones

• The Android, Blackberry and Apple are smartphones that have great apps and fully stocked app
stores

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Smart phones

More advanced mobile phone technologies are enabling the

potential for further healthcare delivery

Smartphone technologies are now in the hands of a large number

of physicians and other healthcare workers in low and middle

income countries
5.27 Billion globally

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Smart phones

• The spread of Smartphone technologies opens up doors for mHealth projects such as

• Technology based diagnosis support, 

• Remote diagnostics and telemedicine 

• Web browsing, 

• GPS navigation

• Access to web-based patient information

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Mobile Devices

Some of the other major areas that should be given special attention include the following

• Device size and weight.

• Available memory for applications and data.

• Processor speed: This will affect the types of applications that will be able to run on the
device.

• Screen characteristics such as size, color depth, indoor and outdoor suitability.

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Mobile Devices

Some of the other major areas that should be given special attention include
the following
• Mobile operating system support: Can it be upgraded when a new version
of the operating system is released?
• Expansion slots for adding peripherals such as more memory, wireless
modems, GPS receivers, or digital cameras. Looking into what peripherals
are available is also a good idea.
• Battery life

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Mobile Devices

Some of the other major areas that should be given special attention include
the following
• Integrated features such as digital cameras, keyboards, and Bluetooth.

• Software support, including third-party applications, development tools,

mobile browsers, hardware drivers, as well as others that may be applicable

to your particular situation.

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 Mobile device manufacturers
• Mobile phone applications have created a new industry within the world

• Samsung
• Huawei
• Apple
• LG
• Nokia
• Sony
• Motorola

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Reading Assignment

 Evolution of mobile phone

 Mobile network generation

 Different mobile technology

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 mHealth Program and projects

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mHealth

 A term used for the practice of medicine and public health supported
by mobile devices.

 It is medical and public health practice supported by mobile devices

such as mobile phones, patient monitoring devices, personal digital
assistants (PDAs) and other wireless devices [WHO,2011].

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Motivation of mHealth

The motivation behind the development of the mHealth field arises from two
factors
 Numerous constraints felt by healthcare systems of developing nations
• High population growth,
• A high burden of disease prevalence,
• Low health care workforce,
• Large numbers of rural inhabitants,
• Limited financial resources to support healthcare infrastructure and health
information systems.
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Motivation of mHealth

Recent rapid rise in mobile phone penetration in developing

countries to large segments of the healthcare workforce as well

as the population
 Advancements in their innovative application to address

health priorities has evolved into a new field of eHealth,

known as mHealth.
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Mobile phone penetration

Global Mobile phone penetration rate drastically increasing over the

last decade.
More than 5.27 billion mobile phone users worldwide in 2020

[International Telecommunication Union]

Improvements in telecommunications technology infrastructure and

reduced costs of mobile handsets

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Cont’d…

Almost half the population of Africa subscribed to mobile services in

2015

In Ethiopia
Around 46.75 million mobile users (41%)
GTP II plan to reach 64 million

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Principles for mHealth

 Interoperability – interoperable with sensors and other

mobile/non-mobile devices to share vast amounts of data with
other applications, such as electronic health records and existing
healthcare systems
 Integration – integrated into existing activities and workflows of

providers and patients to provide the support needed

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Principles for mHealth

Intelligence – Offer problem solving ability to provide real

time, solutions based on existing data

Socialisation – Act as a hub by sharing information across a

broad community to provide support, coaching,

recommendations and other forms of assistance.
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Principles for mHealth

Outcomes – Provide a return on investment in terms of cost,

access and quality of care based on healthcare objectives.

Engagement – Enable patient involvement and the

provision of ubiquitous and instant feedback in order to
realise new behaviours and/or sustain desired performance.

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mHealth Application

Possible mHealth application area

Education and awareness

Helpline

Diagnostic and treatment support

Communication and training for healthcare workers

Disease and epidemic outbreak tracking

Remote monitoring

Remote data collection

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Definition
• Programme: a series of projects whose objectives together contribute to a
common overall objective.

E.g. Malaria Control Programme

• Project: a cluster of activities performed in a logical sequence to attain a

specific results or purpose in a fixed time frame

E.g. Administration of primaquine in a Malaria endemic area

 

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Program Vs. Project
 

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 mHealth Application

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mHealth Application
Overview
• The mHealth spectrum ranges from
• Simple mobile phone based applications for the transfer of health information on basic
handsets via short message service (SMS) to

• Highly sophisticated diagnostic applications that rely on advanced equipment and robust
back end data systems
 
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mHealth Application
Overview
• In Africa, most mHealth interventions are targeting general populations and they
have used relatively simple mobile technology and equipment.

• While the field of mHealth is still young, there have been promising early results
and lessons from the dozens of pilot programs that have been conducted in a variety
of geographic and health system settings.
 
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 mHealth Applications

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Health call centers

Are health care telephone help lines

A service created to deliver health care advice services by trained health
professionals
Address specific health issues such as HIV/AIDS, reproductive health/family
planning and drug abuse
This approach has been found to overcome widespread health system barriers

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Health call centers cont’d…

WHO survey adoption level result

The European Region reported more general purpose health call centers (64%) than other regions
 African (17%) and South-East Asia (38%) Regions reported a low level of pilot stage activity for health call
centers initiatives

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Emergency toll free telephone services

• A toll free telephone number or free phone number is a telephone number that is

billed for all arriving calls instead of incurring charges to the originating telephone
subscriber

• WHO survey adoption level

• The South-East Asia Region reported the highest percentage of emergency toll-free
telephone services (88%)
• „The African Region reported the least activity (31%)

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Emergency toll free telephone services

Examples in Africa

• Zimbabwe reported launching a telephone line for citizens to report cholera cases
• Madagascar had a service to support victims of domestic violence

• Togo gave an account of an emergency toll-free telephone service set up for citizens
to obtain information on TB

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Mobile diagnosis and treatment compliance

Mobile diagnosis
• Using camera-enabled phones
• Example: Teleradiology

• Treatment compliance: described as the degree to which a patient correctly follows

medical care/advice
• Worldwide, non-compliance is a major obstacle to the effective delivery of health
care

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Mobile diagnosis and treatment compliance

• Only about 50% of patients with chronic diseases living in developed countries follow
treatment recommendations
• Major barriers to compliance are thought to include the
• Complexity of modern medication regimens and
• Lack of comprehension of treatment benefits,
• The occurrence of un discussed side effects and poor communication

• Efforts to improve compliance have been aimed at providing effective medication reminders
and improving patient education
• Examples: Sending reminder messages by voice or SMS

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Appointment reminders

• Appointment reminders are voice or SMS messages sent to patients to schedule or attend an
appointment
• Include service follow ups (ANC and immunization) and treatment follow ups (ART and TB)

Examples of applications:
• Short Message Service (SMS) alerts,
• E-mail reminders and

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Examples of service reminders in Ethiopia

ENAT Messenger for Maternal Health (SMS focused to remind HEWs)

• Each week, HEWs sent ANC data from their health post to the nearest health center.

• The health center entered the data (sent from the health posts and the ANC data for pregnant
women following ANC at the health center level) into the Enat system manually.

• Based on the data entered, the system automatically calculated the expected delivery date
(EDD) and sent text message reminders to the respective HEWs one month and one week
before a pregnant woman’s EDD.

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ENAT Messenger cont’d…

• The reminder served as a prompt for the HEW to visit the mother to assess her status.

• After each visit, the HEW are expected to send an SMS confirmation back to the
system to confirm the visit.

• The responses were monitored by health care workers at the health center.

• The system could also be used to prompt transport of a mother in labor to a health
facility

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Awareness and Education

• This series of mHealth strategies focuses largely on the client to improve people’s
knowledge, modify their attitudes, and change their behavior.
• Needs targeted, timely health education and actionable health information

Examples of applications
• Short Message Service (SMS)
• Multimedia Messaging Service (MMS)
• Video clips
• Images

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Awareness and Education

WHO survey adoption level result

• Awareness raising initiatives showed relatively low levels of uptake across WHO
regions

• The Eastern Mediterranean (28%), European (28%) and Americas (25%) Regions
reported using awareness raising initiative

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Mobile telemedicine

• The communication or consultation between health professionals about

patients using
• Voice, text, data, imaging or
• Video functions of a mobile device

• To consult with more highly-trained medical professionals in cases of

emergency or urgent treatment

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Mobile telemedicine

• As mobile networks develop and camera-equipped mobile devices become more

common
• Telemedicine applications that use photo and video features may allow for more sophisticated
consultation
Examples:
• Using a mobile phone camera for tele-consultation and diagnosis of soft tissue injuries in
Taiwan, China.
• They found an 85% accuracy rate in the diagnosis,
Adoption level
• The Americas (75%), European (64%) and South-East Asia (62%) Regions reported high
rates of adoption of mobile telemedicine initiatives, though a large proportion of these
initiatives were in the pilot phase.
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Decision Support system

• Point of care decision support tools through mobile phones can help ensure quality of care.
• Information, Protocols, Algorithms, Checklists
• Rule-based instructions

• Examples of applications
• Stored information ‘‘apps’’
• Interactive Voice Response (IVR)

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Health surveys

• Health surveys, in the context of mHealth, are defined as the use of mobile devices
for health related data collection and reporting
• Mobile-based data collection software

• Reporting system : Mobile or web interfaces

• Data exchange : To collect and transmit critical indicators related to health status,
health outcomes and system performance for use at all levels of the health system

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Health surveillance

• Mobile surveillance is defined as the use of mobile devices to input and transmit data that will be used
to track diseases for surveillance program
• Example: Measles investigation and TB active case finding in vulnerable groups

• Examples of applications:
• Short Message Service (SMS)
• E-mail
• Voice communication
• IVR
• GPS also allows real-time mapping of disease outbreaks

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Adoption level
• The use of mobile devices for health surveys was low across all WHO regions,

• „mHealth surveillance activity is more prevalent in countries in the low-income

(40%) and lower-middle income groups (27%) than those in the higher-income
groups

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Mobile referrals

• Notification of incoming referral so that care is immediate

• Improving the referral system

• Skilled delivery especially for high-risk pregnancies

• Such communication could facilitate transportation via ambulance or other means,

• While allowing facilities to ensure they have the staff and equipment available to accommodate
incoming patients.
• This is critical to reducing the “third delay” of care

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Mobile referrals

• The time sensitive nature of referrals, especially in emergencies, means that they
need to be relatively simple (i.e., not require great technological complexity), easy-
to-use and capable of enabling rapid action.

• Voice-based systems would allow for real-time communication with facilities to

ensure readiness for incoming patients or additional consultation

• Example: In emergency obstetric services

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Remote monitoring

• In situations where the patient and provider are far away

• Linking mobile phones to a connected, but independent, external device can facilitate
remote monitoring of clients

• Extending the reach of health facilities into the community and into clients’ homes to
• Conduct, store, transmit and evaluate diagnostic tests through mobile phones
• E.g. Blood glucose tests and electrocardiograms (ECGs)

• Examples of applications: Accessory sensors

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mHealth Application

Possible mHealth application area

Education and awareness

Helpline

Diagnostic and treatment support

Communication and training for healthcare workers

Disease and epidemic outbreak tracking

Remote monitoring

Remote data collection

06/12/2021 66
mHealth Application

Education and awareness

 Education and awareness programs within the mHealth field are largely about the
spreading of mass information from source to recipient through short message
services (SMS).

 SMS messages are sent directly to users' phones to offer information about
various subjects, including testing and treatment methods, availability of health
services and disease management.
 SMSs provide an avenue to reach far-reaching areas such as rural areas.

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mHealth Application

Helpline
Helpline typically consists of a specific phone number that any individual is able

to call to gain access to a range of medical services.

These include phone consultations, counseling, service complaints and

information on facilities, drugs, equipment.

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mHealth Application

Diagnostic and Communication

Diagnostic and treatment support systems are typically designed to provide
healthcare workers in remote areas advice about diagnosis and treatment of
patients.

06/12/2021 69
mHealth Application

Diagnostic and Communication

 Both diagnosis and treatment support projects attempt to alleviate the cost
and time of travel for patients located in remote areas.
Improved communication projects attempt to increase knowledge transfer
amongst healthcare workers and improve patient outcomes through such
programs as patient referral processes.

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mHealth Application

Disease surveillance and epidemic outbreak tracking

 Mobile phones ability to collect and transmit data quickly, cheaply and relatively
efficiently.

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mHealth Application

Disease surveillance and epidemic outbreak tracking

 Data concerning the location and levels of specific diseases (such

as malaria, HIV/AIDS, TB, Avian Flu) can help medical systems or ministries of
health or other organizations identify outbreaks and better target medical
resources to areas of greatest need.
 Policymakers and health providers at the national, district, and community level
need accurate data

06/12/2021 72
mHealth Application

Treatment support and medication compliance

Remote monitoring and treatment support allows for greater involvement in
the continued care of patients.
 Within environments of limited resources and beds and subsequently a
'outpatient' culture
Remote monitoring allows healthcare workers to better track patient conditions, medication regimen
adherence, and follow-up scheduling.
Through either one- or two-way communications systems.

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Challenges of mHealth

Expense (mHealth infrastructure)

Stakeholders resistance
e-literacy
Time & effort required
Incompatibility of hardware/software
Security
Lack of technical expertise

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mHealth in the globe

 Higher-income countries show more mHealth activity than lower-

income countries.

 Countries in the European region are currently the most active and
those in the African region the least active.

 The capabilities of mobile phones in low and middle income countries

has not reached the sophistication of those in high income countries.
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mHealth in the globe

 In US and EU many patients and consumers use their cell phones and
tablets to access health information and look for healthcare services.

 Doctors, nurses and clinicians use mobile devices to access patient

information and other databases and resources.

 In parallel the number of mHealth applications grew significantly the

last years.
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mHealth in developing countries

Healthcare access to all reaches of society is generally low in these countries

physical distance between doctors and patients,
Too few skilled health care professionals and
The extraordinary complexity between insular medical systems and costs of health
care equipment and infrastructure

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mHealth in developing countries

Largely emerges as a means of providing greater access to larger segments of

a population in developing countries, as well as improving the capacity of
health systems in such countries to provide quality healthcare

Governments are expressing interest in mHealth as a complementary strategy

for strengthening health systems

In Ethiopia, got emphasis under HSTP

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 Issues to consider prior mHealth implementation

 Readiness assessment
 Availability of hardware and software
 Consider sustainability
 Security issue
 Backup
 Select of software and hardware

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Reading Assignment

 History of mHealth

 mHealth in Ethiopia

06/12/2021 80
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