Informational and technological needs of public health inspectors and design of mobile, social media solutions for dengue prevention in Sri Lanka

Abstract

Background: Among tropical countries, Sri Lanka is among the worst affected by Dengue. In 2012, nearly 40,000 people were affected by Dengue with reports that the capital city of Colombo was the epicentre from which Dengue was spreading to different parts of the country. While Dengue prevention efforts by public health authorities have witnessed vast improvements over the past 5 years, the magnitude of the problem demands that existing systems be enhanced and strengthened. The unprecedented penetration of mobile phones and profusion of social media in Asia calls for the optimization of such technologies to address this issue. Objectives: 1) To understand the information flow related to Dengue case incidence among the public health authorities in Colombo; 2) To understand gaps in Dengue surveillance and education, and thereby examine informational and technological needs of public health inspectors (PHIs); 3) To obtain feedback from PHIs on the utility of a mobile, social media-based system in development by the team that integrates three components: a) predictive surveillance, b) civic engagement and c) health education. Methods: We conducted a mixed methods cross-sectional study among PHIs in Colombo, Sri Lanka. First, we conducted a 10-minute paper based survey that included demographics, technological self efficacy and information seeking behaviors of PHIs. Then, we conducted semi-structured interviews to understand the information flow (dynamics and challenges of identifying and reporting Dengue cases), educational activities related to Dengue, technology use and preferences, client interaction and feedback on the system under development. Results: Survey - Our respondent pool comprised 29 PHIs with a mean age of 31 years. More than 90% of the group had obtained diplomas, almost all were Sinhalese, and reported a mean employment history (as PHIs) of 3 years. More than 80% of PHIs had used the Internet and 60% used smartphones previously. PHIs’ top preferences of devices for Dengue data collection included tablets (3.87/5.00) and smartphones (3.54/5.00). Interviews - Current paper-based information and reporting mechanisms of new Dengue cases span 5-7 days. In terms of data collection, the time required to complete the Dengue Investigation form varied from 10-45 minutes with wealthier groups being less cooperative with PHIs. The paper-based health education materials required enhancement in terms of content and interactivity. With reference to system feedback, PHIs reacted positively to the tablet-based interface. PHIs helped to identify opportunities to digitize parts of the data collection system and online reminders for fogging and case follow-ups. They noted that the ability to take pictures (with the mobile camera) would bolster them with evidence while enforcing punitive actions. They consistently expressed a need for interactive health communication combining pictures, text and videos in order to make communication more engaging and effective in shaping behavior change. Conclusions: Current technological skills and preferences among PHIs present new opportunities for system enhancement through innovation. Our social media-based system can strengthen existing Dengue surveillance and prevention by digitizing reporting mechanisms in a phased manner, bolstering preventive actions by enabling PHIs to click and report pictures of breeding sites, and introducing interactive health education modules.