Development of a Mobile Image-Based Reminder Application to Support Tuberculosis Treatment in Africa
This paper presents the design, development and
evaluation of an application prototype developed to support
tuberculosis (TB) patients’ treatment adherence. The system makes
use of graphics and voice reminders as opposed to text messaging to
encourage patients to follow their medication routine. To evaluate the
effect of the prototype applications, participants were given mobile
phones on which the reminder system was installed. Thirty-eight
people, including TB health workers and patients from Zanzibar,
Tanzania, participated in the evaluation exercises. The results
indicate that the participants found the mobile image-based
application is useful to support TB treatment. All participants
understood and interpreted the intended meaning of every image
correctly. The study findings revealed that the use of a mobile visualbased
application may have potential benefit to support TB patients
(both literate and illiterate) in their treatment processes.
[1] WHO, Global Tuberculosis Report 2012, 2012.
[2] S. Kaufmann and W. Britton, (Eds.), Handbook of tuberculosis, Wiley-
VCH, 2008.
[3] M. Khan, J. Walley, S. Witter, A. Imran, and N. Safdar, “Costs and costeffectiveness
of different DOT strategies for the treatment of
tuberculosis in Pakistan,” Health policy and planning, 17(2), 2002, pp.
178-186.
[4] R. Heeks, “ICT4D 2.0: The Next Phase of Applying ICT for
International Development,” IEEE Computer., 41(6), 2008, pp. 26–33.
[5] P. T. H. Unwin, (Ed.), ICT4D: Information and communication
technology for development: Cambridge University Press, 2009.
[6] A. Prakash, “Importance of development context in ICT4D projects: A
study of computerization of land records in India,” Information
Technology and People, 20(3), 2007, pp. 262-281.
[7] E. Barclay, “Text messages could hasten tuberculosis drug compliance,”
The Lancet, 373(9657), 2009, pp. 15-16.
[8] A. Hanauer, K. Wentzell, N. Laffel, and M. Laffel, “Computerized
Automated Reminder Diabetes System (CARDS): e-mail and SMS cell
phone text messaging reminders to support diabetes management,”
Diabetes technology and therapeutics, 11(2), 2009, pp. 99-106.
[9] P. Kunawararak, S. Pongpanich, S. Chantawong,P. Pokaew, P.
Traisathit, K. Srithanaviboonchai, and T. Plipat, “Tuberculosis treatment
with mobile-phone medication reminders in northern Thailand,”
Southeast Asian Journal of Tropical Medicineand Public Health, 42(6),
1444, 2011.
[10] W. Chen, Z. Fang, Y. Chen, and L. Dai, “Comparison of an SMS text
messaging and phone reminder to improve attendance at a health
promotion center: a randomized controlled trial,” Journal of Zhejiang
University Science B, 9(1), 2008, pp. 34-38.
[11] E. Marsh, and M. White, “A taxonomy of relationships between images
and text,” Journal of Documentation, 59(6), 2003, pp. 647-672.
[12] S. Armstrong, Information Literacy: Navigating and Evaluating Today's
Media, Shell Education, 2008.
[13] K. Akhter, S. Dockray, and D. Simmons, “Exploring factors influencing
non‐attendance at the diabetes clinic and service improvement strategies
from patients' perspectives,” Practical Diabetes, 29(3), 2012, pp. 113-
116.
[14] T. Lester, P. Ritvo, J. Mills, A. Kariri, S. Karanja, H. Chung, and A.
Plummer, “Effects of a mobile phone short message service on
antiretroviral treatment adherence in Kenya (WelTel Kenya1): a
randomized trial,” The Lancet, 376(9755), 1838-1845, 2010.
[15] F. Naughton, J Jamison, and S. Sutton, “Attitudes towards SMS text
message smoking cessation support: a qualitative study of pregnant
smokers,” Health education research, cyt057, 2013.
[16] C. Pop-Eleches, H. Thirumurthy, J. Habyarimana, J. Graff Zivin, M.
Goldstein, D. de Walque, and D. Bangsberg, “Mobile Phone
Technologies Improve Adherence to Antiretroviral Treatment in
Resource-Limited Settings: A Randomized Controlled Trial of Text
Message Reminders,” Aids, 25, 825-834, 2011.
[17] S. Okuboyejo, N. Omoregbe, and V. Mbarika, “A Framework for the
Design of a Mobile-Based Alert System for Outpatient Adherence in
Nigeria,” African Journal of Computing and ICT, 5(5), 2012, pp. 151-
158.
[18] D. Nglazi, G. Bekker, R. Wood, D. Hussey, and S. Wiysonge, “Mobile
phone text messaging for promoting adherence to anti-tuberculosis
treatment: a systematic review protocol,” Systematic reviews, 2(1),
2013, pp. 1-5.
[19] W. A. Kaplan, “Can the ubiquitous power of mobile phones be used to
improve health outcomes in developing countries?,” Globalization and
health, 2, 9.doi:10.1186/1744-8603-2-9, 2006.
[20] K. Sidney, J. Antony, R. Rodrigues, K. Arumugam, S. Krishnamurthy,
G. D'souza, and A. Shet, “Supporting patient adherence to antiretroviral
using mobile phone reminders: patient responses from South
India,” AIDS care, 24(5), 2012, pp. 612-617.
[21] N. Pai, P. Supe, S. Kore, Y. Nandanwar, A. Hegde, E. Cutrell, and W.
Thies, “Using automated voice calls to improve adherence to iron
supplements during pregnancy: a pilot study,” In Proceedings of the
Sixth International Conference on Information and Communication
Technologies and Development: Full Papers-Volume 1 (pp. 153-163).
ACM, 2013.
[22] N. Tran, J. Coffman, K. Sumino, and M. Cabana, “Patient reminder
systems and asthma medication adherence: a systematic review,” Journal
of Asthma, (0), 2014, pp. 1-8.
[23] J. Perron, D. Dao, C. Righini, P. Humair, B. Broers, F. Narring, and M.
Gaspoz, “Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized
controlled trial,” BMC health services research, 13(1), 2013, pp. 1-7.
[24] A. Haji, H. Suleman, and U. Rivett, “Mobile Graphic-Based
Communication: Investigating Reminder Notifications to Support
Tuberculosis Treatment in Africa,” In Health Information Science (pp.
204-211). Springer International Publishing, 2014a.
[25] N. Ngoh, and D. Shepherd, “Design, development, and evaluation of
visual aids for communicating prescription drug instructions to
nonliterate patients in rural Cameroon,” Patient education and
counseling, 31(3), 1997, pp. 245-261.
[26] R. Pettersson, Visual information. Educational Technology, 1993.
[27] MA. Perry, MJ. Furukawa, FH. Kanfer, AP. Goldstein, (Eds.) Modelling
methods: Helping People Change: A Textbook of Methods. New York:
Pergamon Press, 1988, pp. 66-110.
[28] A. Haji, H. Suleman, and U. Rivett, “Developing Mobile Graphic
Reminders for Reinforcing Compliance in Tuberculosis Treatment in
Africa,” Proceedings, the 1st International Conference on the Use of
Mobile ICT in Africa 2014, Stellenbosch, South Africa. ISBN: 978-0-
7972-1533-7, 2014, pp. 11-15, 2014b.
[29] Africa Brains, 2014. Available: http://africanbrains.net/2015/02/19/
android-makes-strong-headway-in-feature-phone-africa/
[30] L. Berg, and H. Lune, “Qualitative research methods for the social
sciences,” (Vol.5). Boston: Pearson, 2004.
[31] U. Kelle, and C. Erzberger, “Qualitative and Quantitative Methods. A
companion to qualitative research,” 2004, pp. 172-177.
[32] C. Dawson, “A Practical Guide to: Research Methods,” Spring Hill
House: United Kingdom, 2007.
[33] Hussain, A., and Kutar, M. “Usability metric framework for mobile
phone application,” PGNet, ISBN, 2099, pp. 978-1.
[34] Michael Oleaga, “iOS vs. Android vs.Windows Phone Market Share
2013: Google Smartphones OS Hits 78 Percent Globally As Apple Inc,”
Drops despite Strong iPhone Sales, 2014.
[35] ITU Statistics, “The world in 2014: ICT facts and figures,” Available:
https://www.itu.int/en/ITU-D/Statistics/Documents/facts/
ICTFactsFigures2014-e.pdf.
[36] S. Prasad, and R. Anand, “Use of mobile telephone short message
service as a reminder: the effect on patient attendance,” International
dental journal, 62(1), 2012, pp. 21-26.
[37] M. Caldwell, “SMS Reminders for Medication Adherence,” 2013.
[38] J. Hoffman, J. Cunningham, A. Suleh, A. Sundsmo, D. Dekker, F. Vago,
and J. Hunt-Glassman, “Mobile direct observation treatment for
tuberculosis patients: a technical feasibility pilot using mobile phones in
Nairobi, Kenya. American journal of preventive medicine,” 39(1), 2010,
pp. 78-80.
[39] K. Buren, “Mobile Media Services at Sub-Saharan African Newspapers:
A Guide to Implementing Mobile News and Mobile Business. Paris,”
The World Association of Newspapers (WAN-IFRA) and the African
Media Initiative (AMI), 2011.
[1] WHO, Global Tuberculosis Report 2012, 2012.
[2] S. Kaufmann and W. Britton, (Eds.), Handbook of tuberculosis, Wiley-
VCH, 2008.
[3] M. Khan, J. Walley, S. Witter, A. Imran, and N. Safdar, “Costs and costeffectiveness
of different DOT strategies for the treatment of
tuberculosis in Pakistan,” Health policy and planning, 17(2), 2002, pp.
178-186.
[4] R. Heeks, “ICT4D 2.0: The Next Phase of Applying ICT for
International Development,” IEEE Computer., 41(6), 2008, pp. 26–33.
[5] P. T. H. Unwin, (Ed.), ICT4D: Information and communication
technology for development: Cambridge University Press, 2009.
[6] A. Prakash, “Importance of development context in ICT4D projects: A
study of computerization of land records in India,” Information
Technology and People, 20(3), 2007, pp. 262-281.
[7] E. Barclay, “Text messages could hasten tuberculosis drug compliance,”
The Lancet, 373(9657), 2009, pp. 15-16.
[8] A. Hanauer, K. Wentzell, N. Laffel, and M. Laffel, “Computerized
Automated Reminder Diabetes System (CARDS): e-mail and SMS cell
phone text messaging reminders to support diabetes management,”
Diabetes technology and therapeutics, 11(2), 2009, pp. 99-106.
[9] P. Kunawararak, S. Pongpanich, S. Chantawong,P. Pokaew, P.
Traisathit, K. Srithanaviboonchai, and T. Plipat, “Tuberculosis treatment
with mobile-phone medication reminders in northern Thailand,”
Southeast Asian Journal of Tropical Medicineand Public Health, 42(6),
1444, 2011.
[10] W. Chen, Z. Fang, Y. Chen, and L. Dai, “Comparison of an SMS text
messaging and phone reminder to improve attendance at a health
promotion center: a randomized controlled trial,” Journal of Zhejiang
University Science B, 9(1), 2008, pp. 34-38.
[11] E. Marsh, and M. White, “A taxonomy of relationships between images
and text,” Journal of Documentation, 59(6), 2003, pp. 647-672.
[12] S. Armstrong, Information Literacy: Navigating and Evaluating Today's
Media, Shell Education, 2008.
[13] K. Akhter, S. Dockray, and D. Simmons, “Exploring factors influencing
non‐attendance at the diabetes clinic and service improvement strategies
from patients' perspectives,” Practical Diabetes, 29(3), 2012, pp. 113-
116.
[14] T. Lester, P. Ritvo, J. Mills, A. Kariri, S. Karanja, H. Chung, and A.
Plummer, “Effects of a mobile phone short message service on
antiretroviral treatment adherence in Kenya (WelTel Kenya1): a
randomized trial,” The Lancet, 376(9755), 1838-1845, 2010.
[15] F. Naughton, J Jamison, and S. Sutton, “Attitudes towards SMS text
message smoking cessation support: a qualitative study of pregnant
smokers,” Health education research, cyt057, 2013.
[16] C. Pop-Eleches, H. Thirumurthy, J. Habyarimana, J. Graff Zivin, M.
Goldstein, D. de Walque, and D. Bangsberg, “Mobile Phone
Technologies Improve Adherence to Antiretroviral Treatment in
Resource-Limited Settings: A Randomized Controlled Trial of Text
Message Reminders,” Aids, 25, 825-834, 2011.
[17] S. Okuboyejo, N. Omoregbe, and V. Mbarika, “A Framework for the
Design of a Mobile-Based Alert System for Outpatient Adherence in
Nigeria,” African Journal of Computing and ICT, 5(5), 2012, pp. 151-
158.
[18] D. Nglazi, G. Bekker, R. Wood, D. Hussey, and S. Wiysonge, “Mobile
phone text messaging for promoting adherence to anti-tuberculosis
treatment: a systematic review protocol,” Systematic reviews, 2(1),
2013, pp. 1-5.
[19] W. A. Kaplan, “Can the ubiquitous power of mobile phones be used to
improve health outcomes in developing countries?,” Globalization and
health, 2, 9.doi:10.1186/1744-8603-2-9, 2006.
[20] K. Sidney, J. Antony, R. Rodrigues, K. Arumugam, S. Krishnamurthy,
G. D'souza, and A. Shet, “Supporting patient adherence to antiretroviral
using mobile phone reminders: patient responses from South
India,” AIDS care, 24(5), 2012, pp. 612-617.
[21] N. Pai, P. Supe, S. Kore, Y. Nandanwar, A. Hegde, E. Cutrell, and W.
Thies, “Using automated voice calls to improve adherence to iron
supplements during pregnancy: a pilot study,” In Proceedings of the
Sixth International Conference on Information and Communication
Technologies and Development: Full Papers-Volume 1 (pp. 153-163).
ACM, 2013.
[22] N. Tran, J. Coffman, K. Sumino, and M. Cabana, “Patient reminder
systems and asthma medication adherence: a systematic review,” Journal
of Asthma, (0), 2014, pp. 1-8.
[23] J. Perron, D. Dao, C. Righini, P. Humair, B. Broers, F. Narring, and M.
Gaspoz, “Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized
controlled trial,” BMC health services research, 13(1), 2013, pp. 1-7.
[24] A. Haji, H. Suleman, and U. Rivett, “Mobile Graphic-Based
Communication: Investigating Reminder Notifications to Support
Tuberculosis Treatment in Africa,” In Health Information Science (pp.
204-211). Springer International Publishing, 2014a.
[25] N. Ngoh, and D. Shepherd, “Design, development, and evaluation of
visual aids for communicating prescription drug instructions to
nonliterate patients in rural Cameroon,” Patient education and
counseling, 31(3), 1997, pp. 245-261.
[26] R. Pettersson, Visual information. Educational Technology, 1993.
[27] MA. Perry, MJ. Furukawa, FH. Kanfer, AP. Goldstein, (Eds.) Modelling
methods: Helping People Change: A Textbook of Methods. New York:
Pergamon Press, 1988, pp. 66-110.
[28] A. Haji, H. Suleman, and U. Rivett, “Developing Mobile Graphic
Reminders for Reinforcing Compliance in Tuberculosis Treatment in
Africa,” Proceedings, the 1st International Conference on the Use of
Mobile ICT in Africa 2014, Stellenbosch, South Africa. ISBN: 978-0-
7972-1533-7, 2014, pp. 11-15, 2014b.
[29] Africa Brains, 2014. Available: http://africanbrains.net/2015/02/19/
android-makes-strong-headway-in-feature-phone-africa/
[30] L. Berg, and H. Lune, “Qualitative research methods for the social
sciences,” (Vol.5). Boston: Pearson, 2004.
[31] U. Kelle, and C. Erzberger, “Qualitative and Quantitative Methods. A
companion to qualitative research,” 2004, pp. 172-177.
[32] C. Dawson, “A Practical Guide to: Research Methods,” Spring Hill
House: United Kingdom, 2007.
[33] Hussain, A., and Kutar, M. “Usability metric framework for mobile
phone application,” PGNet, ISBN, 2099, pp. 978-1.
[34] Michael Oleaga, “iOS vs. Android vs.Windows Phone Market Share
2013: Google Smartphones OS Hits 78 Percent Globally As Apple Inc,”
Drops despite Strong iPhone Sales, 2014.
[35] ITU Statistics, “The world in 2014: ICT facts and figures,” Available:
https://www.itu.int/en/ITU-D/Statistics/Documents/facts/
ICTFactsFigures2014-e.pdf.
[36] S. Prasad, and R. Anand, “Use of mobile telephone short message
service as a reminder: the effect on patient attendance,” International
dental journal, 62(1), 2012, pp. 21-26.
[37] M. Caldwell, “SMS Reminders for Medication Adherence,” 2013.
[38] J. Hoffman, J. Cunningham, A. Suleh, A. Sundsmo, D. Dekker, F. Vago,
and J. Hunt-Glassman, “Mobile direct observation treatment for
tuberculosis patients: a technical feasibility pilot using mobile phones in
Nairobi, Kenya. American journal of preventive medicine,” 39(1), 2010,
pp. 78-80.
[39] K. Buren, “Mobile Media Services at Sub-Saharan African Newspapers:
A Guide to Implementing Mobile News and Mobile Business. Paris,”
The World Association of Newspapers (WAN-IFRA) and the African
Media Initiative (AMI), 2011.
@article{"International Journal of Medical, Medicine and Health Sciences:70492", author = "Haji Ali Haji and Hussein Suleman and Ulrike Rivett", title = "Development of a Mobile Image-Based Reminder Application to Support Tuberculosis Treatment in Africa", abstract = "This paper presents the design, development and
evaluation of an application prototype developed to support
tuberculosis (TB) patients’ treatment adherence. The system makes
use of graphics and voice reminders as opposed to text messaging to
encourage patients to follow their medication routine. To evaluate the
effect of the prototype applications, participants were given mobile
phones on which the reminder system was installed. Thirty-eight
people, including TB health workers and patients from Zanzibar,
Tanzania, participated in the evaluation exercises. The results
indicate that the participants found the mobile image-based
application is useful to support TB treatment. All participants
understood and interpreted the intended meaning of every image
correctly. The study findings revealed that the use of a mobile visualbased
application may have potential benefit to support TB patients
(both literate and illiterate) in their treatment processes.", keywords = "ICT4D, mobile technology, tuberculosis, visualbased
reminder.", volume = "9", number = "8", pages = "620-8", }
