At the University of British Columbia’s School of Population and Public Health (SPPH), researchers are working with health care professionals and industry to find technological solutions to overcome barriers to access and export these solutions around the world.
Canada’s universal health care system doesn’t always live up to its promise of equal and accessible care for all, especially for marginalized populations, rural communities and those with complex and chronic needs. The scale of these challenges can feel insurmountable. For a pregnant woman in one of B.C.’s northern communities, prenatal classes are often limited, geographically challenging to reach, and costly. In response, Dr. Patricia Janssen and her colleagues created SmartMom, a comprehensive prenatal education program delivered through text messaging, at no cost to participants.
Through the program, women receive three messages per week, timed to be relevant to each stage of pregnancy. Dr. Janssen’s team has worked with B.C. health authorities to ensure that the program is not only evidence-based but also personalized, interactive, and connects moms-to-be to resources in their community. The impact is clear; SmartMom has been shown to increase knowledge about how to have a healthy pregnancy while decreasing rates of anxiety, depression and fear of childbirth.
“I like that I can sit down and read just one tip. I am a busy mom with a busy toddler so simple messaging is important for me,” one user explains.
In the time it takes to boil a pot of water or run a bath, she can receive a short message and read about the importance of folic acid, or click a link to find resources for depression.
The eruption of the Internet – despite all of its benefits – has made it increasingly difficult to discern which information can be trusted. “When you go to Google, you can find anything. It [the Internet] is very scary sometimes,” another participant explains. “But if you have a reputable text and you know where it’s coming from and you trust the source, then you’re more likely to go to that resource and believe it and seek it out.”
Given SmartMom’s huge success and uptake – more than 6,000 moms in British Columbia have enrolled, and 600 are registering every month – the need is evident. Going forward, Dr. Janssen and her colleagues hope to expand the program to help women across Canada. They are also broadening the scope of their project with SmartParent, which will address the infant’s critical first year of life, and is scheduled to launch in 2020.
Mobile phone-based health care, or mHealth, provides the opportunity to improve access to care, collect data, and improve health systems. SPPH researcher Dr. Richard Lester leads the mHealth Research Group and has spent much of his career implementing mobile health programs in Canada and abroad. Dr. Lester explains that the benefit to mHealth, as an accessible form of telehealth, is that most individuals have a mobile phone capable of sending and receiving text messages. “More than 23 billion SMS messages are sent around the world every day, and it is the most accessible way to reach across any demographic. The transferability of this technology is evident from the wide scope of projects Dr. Lester has successfully implemented through his start-up company, WelTel. From chronic disease management in Haida Gwaii to maternal and neonatal health in Kenya, mHealth has proven to be an invaluable tool to bridge shortcomings in access both at home and abroad.
For many people, interactions with care providers can be stressful and overwhelming. Dr. Lester has noticed a consistent benefit to mHealth on this front, regardless of where it is implemented: patients ask questions by text message that they didn’t feel comfortable asking in person, forgot to ask, or needed help clarifying. This is especially important when the condition may be stigmatized, like with Dr. Lester’s work to increase health care engagement with HIV patients in Kenya, Rwanda and Vancouver.
The success of Dr. Lester’s mHealth programs has not gone unnoticed. On Friday, a team led by Dr. Lester received a grant of $500,000 from the Canadian Institute for Health Research (CIHR) to apply his wealth of mHealth experience to address the spread of COVID-19. His project will use existing mHealth technology to support individuals in self-isolation and reduce transmission of the virus.
The technology also shows promise to improve health care systems based on patient feedback. Dr. Lester is collaborating with Vancouver General Hospital and is currently working on an mHealth project to support patients after discharge to reduce the number of unplanned readmissions. By using new natural language processing computing tools that they are developing, supported by an innovation-to-commercialization grant from the Michael Smith Foundation for Health Research, they can rapidly analyze large numbers of patient responses so that health care providers can improve and evolve processes to better meet needs identified by the patients they care for.
“The goal of this work is to be patient centered, to make the patient part of the innovation and research so we can solve the problems they are really facing. At the end of the day, the patient is the voice that is the most important,” Dr. Lester explains.
Reaching patients where they’re at has also been a focus of Dr. Mark Tyndall’s work on Vancouver’s downtown eastside. He made waves earlier this year with Canada’s first pharmaceutical vending machine, a biometrically secure way to dispense medications to those who otherwise are hesitant or unable to access health care through traditional channels due to discrimination and marginalization.
The machine currently is supplying prescription opioids to individuals who are struggling with addiction, but Dr. Tyndall sees potential for the machine that expands well beyond its current iteration.
It’s easy to imagine how individuals working multiple jobs or atypical shift hours would have difficulty getting to a pharmacy and would benefit tremendously from the flexibility of this type of technology. Additionally, it could help improve adherence among those who feel that stigma is preventing them from accessing their prescriptions – from treating Hepatitis or HIV to accessing pharmaceuticals like contraceptives or pre-exposure prophylaxis (PrEP).
As a physician, Dr. Tyndall is excited by the potential that this technology could help patients improve their adherence to any necessary medication.
“The machine could be used for anything someone would prefer not to get at a pharmacy – it would help anyone who is hesitant to stand in a line and be asked about their condition.”
A current lack of resources is the greatest limitation to scaling his project, but Dr. Tyndall is keen to build new partnerships that can bring secure and low-barrier access to those still in need.
Across SPPH, researchers have worked with partners to bridge gaps in access to care. With the role of technology in health care poised to grow exponentially, privacy concerns remain important. SPPH Associate Dr. Lianping Ti and her collaborator Dr. Jenna van Draanen from the UBC Department of Sociology are leading community and stakeholder research to address these concerns.
“We have the classic problem of technology being way ahead of our ethical conversations on this,” Dr. Ti explains. “We have the ability to do things without knowing if we should or not.”
The two are working with BRAVE, a technology co-op that has developed a passive surveillance device with the ability to detect overdoses in spaces like washrooms based on movement and changes in breathing. The challenge for this project – and any innovative technology – is a lack of guidelines for addressing privacy issues, especially when the technological advance is the first of its kind.
Through engaged stakeholder workshops involving people with lived/shared experience, small business owners, researchers, service providers, and members of the public, Dr. Ti and Dr. van Draanen are working to identify core research questions and provide guidance about how technological solutions can be implemented responsibly.
Dr. Ti and Dr. van Draanen’s research highlights one of SPPH’s greatest strengths: as an interdisciplinary school, researchers in seemingly different fields are conducting work that complements one another. It allows for collaboration and innovation as they implement projects to solve local problems and scale these projects to address global issues.
By Elizabeth Samuels