Mobile learning for healthcare training: breaking boundaries?

Niall Winters London Knowledge Lab

Institute of Education, University of London

http://www.lkl.ac.uk/niall | @nwin

ESRC Breaking Boundaries Seminar Series, University of Oxford, March 13th 2014

“… discuss the notion that Information communication technologies can be used to break down boundaries to learning and participation in society”

http://breakingboundariesoxford.org

Mobile in Africa • After China, Africa is the world’s second largest mobile market • There are 150 mobile money services in Africa, over 22 mobile innovation labs, and mobile e-commerce is thriving • In 2013, IBM chose Nairobi for its 12th global research lab • Many mobile phone makers have focused on developing inexpensive (e.g. USD$25) smartphones

What types of boundaries?

“Despite its falling poverty rates, Sub-Saharan Africa is the only region in the world for which the number of poor individuals has risen steadily and dramatically between 1981 and 2010. There are more than twice as many extremely poor people living in SSA today (414 million) than there were three decades ago (205 million). As a result, while the extreme poor in SSA represented only 11 percent of the world’s total in 1981, they now account for more than a third of the world’s extreme poor.” - World Bank, State of the Poor Report

The community in Kibera is characterised by high levels of poverty, insecurity, and inadequate access to basic social services. There is little or no access to water, electricity, basic services and adequate sanitation.  Most structures are let on a room-by-room basis with many families (on average 6 people) living in just one room.  These factors have serious health repercussions, demonstrated by the child mortality rate: for every 1,000 children born in Nairobi’s informal settlements, 151 will die before the age of five (the average for Nairobi as a whole is 62).

Community Health Volunteers are community members who provide basic medical services. Research consistently evidences their pivotal role in providing equitable health access in support of poverty alleviation by preventing and diagnosing diseases like malaria and HIV, treating minor ailments, referring patients and providing support and care for pregnant women and babies.

http://www.mchw.org | @m_CHW

The role of mobile technology in breaking boundaries

•  Focus: Maternal and Child Health (Developmental Milestones)

•  Target: Under 5 children •  Developed based on MDAT

(Malawi Development Assessment Tool)

•  Leverages on Smart phone technology

•  Supports referral decision making

•  Duration of use: 5 months "

Focus on structured support and supervision via the mobile app

•  There is consistent evidence that good quality supervision “is one of the key approaches to improving the quality of health care” (Marquez & Kean, 2002), in particular when backed up by regular support and feedback (e.g. Bhattacharji et al., 1986; Ashwell & Freeman, 1995; Bhattacharyya et al., 2001; Laughlin, 2004; Lehmann & Sanders, 2007; Baqui et al., 2009)

•  Consequently, UNICEF/WHO have recommended that CHW programmes “enable CHWs to organize themselves for peer support and supervision” (Gilroy and Winch, 2006 p.43)

•  Systematic reviews have shown that consistent supervision, peer learning and feedback, rather than single and isolated interventions, can improve CHW performance and integration with the primary healthcare system (e.g. WHO, 2001)

“The members were eager to know the purpose of the phone and the application but I was able to tell them it is good because the information will help us know the development of the child. If the child is growing well, if the child is able to do this, the phone is assisting us to know the steps; when the child is of this age we are able to know he/she should be doing this and that. So it is easy to identify some, may be abnormalities or you are able to know whether the child is growing well.” -CHV

How?

Underpinning conceptualisation

Reconceptualising the “Digital Divide”

•  Conceptualise as information inequality (van Dijk, 1999)

•  Four kinds of access barriers – Lack of experience (lack of interest) – No access to hardware (tradition view) – Resources more generally – MOOCs (Fail?)

– Lack of digital skills – Limited to development of basic skills

– Lack of significant usage opportunities

As Jerome Bruner (1996, p. 146) put it, learning ‘is not simply a technical business of well managed information processing’. Instead, learning can be seen to involve an individual having to make sense of who they are and develop an understanding of the world in which they live. From this perspective learning can be seen as a continuing process of ‘participation’ rather than a discrete instance of ‘acquisition’ (Sfard 1998).

From Sfard (1998)

Avoiding structural inequality

•  Breaking boundaries – Learning as participation

•  Addressing inequality through empowerment

•  Immediate next steps •  Mobile web app generator (mWAG) •  Researcher position (Mar 28th)

•  Post-2015: Sustainable development goals

Thanks!

•  n.winters@ioe.ac.uk •  http://www.lkl.ac.uk/niall •  http://www.mCHW.org •  @nwin