Grants:Project/Rapid/Mgonzalezmillan/Wikipedia Project for Offline Education in Medicine (POEM) Phase 2/Report
Did you meet your goals? Are you happy with how the project went?
The POEM team is satisfied with the project’s results. The goal of testing the Internet-in-a-Box in the Dominican Republic was achieved through a pilot in ten clinics. This allowed identifying ways to improve the device and its content as well as potential ways to implement it in the country at a larger scale. Moreover, the research involved speaking to various local stakeholders like government and universities, which has initiated a local ecosystem for content creation and the implementation of the device. Overall, the results of the project will help Wikipedia learn how to get their medical content to remote areas without connectivity.
Please report on your original project targets.
|Target outcome||Achieved outcome||Explanation|
|Test the Internet-in-a-Box in the field||The Internet-in-a-Box was tested in the field through a pilot in 10 clinics in the Dominican Republic||The team selected 5 clinics in the province of Peravia (1 hour west from Santo Domingo) and 5 clinics in the province of San Jose de Ocoa (2 hours west from Santo Domingo) with the help of the Regional Health Service offices. Some of these clinics were remote and had connectivity issues while others were more accessible to allow follow-up meetings. The team gave a device to the doctors in these clinics and trained them on how to use it through a presentation and printed material.|
|Determine applicability of the Internet-in-a-Box||The applicability of the Internet-in-a-Box was determined through interviews and bi-weekly follow-up meetings||At the beginning of the pilot the team interviewed 17 physicians (4 attending doctors and 13 interns) in the 10 clinics. The goal was to detect the technology they currently use and their information needs as well as to measure their ability to access medical information and solve medical questions.
· Most clinics have electricity but they experiment frequent outages.
· Most clinics have computers and internet but only to gather patients’ records.
· Doctors rely on books, the National Health Service guides, internet (mostly Google and Wikipedia), mobile apps, and colleagues to get medical information.
· Doctors rate their ability to access information at 8.0 out of 10 and their ability to solve medical questions at 7.8 out of 10.
In addition, the team visited doctors in their clinics every two weeks to observe if they were using the device and their overall experience:
· Doctors used the device on average 1.5 times a week. However, some used it more than 3 times while others didn’t use it at all (mainly due to lack of time).
· They used the device in their daily practice, for instance to analyze laboratory tests, check dosage, and confirm diagnosis.
· They also used it to study, for example to refresh their knowledge, learn a new topic, and dwell on a specialty of interest.
· Doctors considered that both their ability to access information and their ability to solve medical questions increased to 10 out of 10 after having the device.
· They consider the device to be useful in their day-to-day activities and would like to continue having access to it.
|Identify improvements in the device’s hardware, software, and content||Improvements in the device’s hardware, software, and content were identified through focus groups||At the end of the pilot, the team conducted two focus groups (one for each province) with doctors in the 10 clinics to gather their opinion about the device:
· In terms of hardware, users in clinics without electricity had to take the batteries home to charge them; they mentioned it would be helpful to have solar batteries. In addition, they said they would like to be able to have internet access through their data plan while using the device.
· Regarding software, some users had problems accessing the device because they typed the address incorrectly; the option of having a captive portal is being explored. Besides, some users mentioned it was hard to view the content in their smartphones; thus, the mobile version needs to continue to be improved.
· In terms of content, users value the National Health Service guides and Wikipedia the most; they also like images and video. However, they suggested including information on differential diagnosis, pediatric dosage, interpretation of laboratory tests, and communication with Creole-speaking patients. Also, most of them don’t speak English because they studied in a public university, so they prefer content in Spanish.
|Develop the local environment for the implementation of the Internet-in-a-Box||An environment for implementation was initiated through meetings with important stakeholders||Meetings with several local actors were conducted to discuss ways to move forward in terms of content creation and implementation of the device:
1. National Health Service and Regional Health Service in Peravia and San Jose de Ocoa
2. Universidad Iberoamericana (UNIBE)
3. Instituto Tecnologico de Las Americas (ITLA)
The National and Regional Health Service asserted their interest in continuing with implementation, while UNIBE reaffirmed their willingness to contribute by generating content (for instance, videos on how to treat Creole-speaking patients). The team had a meeting with the director of ITLA (an engineering school); the university showed enthusiasm for the device and expressed disposition to finds ways to collaborate in its production.
Because of this, the team suggested to the National Health Service an implementation model with the participation of the universities and started communications among these actors to set off collaboration.
Projects do not always go according to plan. Sharing what you learned can help you and others plan similar projects in the future. Help the movement learn from your experience by answering the following questions:
- What worked well? A lesson learned is that it is necessary to engage local actors from the onset to get their input and prepare the environment for implementation. Training and monitoring are also fundamental to ensure users utilize the device properly and identify any problems. Finally, measuring relevant indicators such as usage and satisfaction with the device is important to observe how things are working and the results of the project.
- What did not work so well? In terms of things that didn’t work as well, interactions with the local government can be slow sometimes. Because of this, planning things ahead of time and being both patient and insistent is needed. It is also important to find people and organizations that are interested in the project and willing to invest their time and efforts in making it succeed.
- What would you do differently next time? Something that could have been done differently is bringing the National Health Service and the universities together earlier. This way, there could have been more time to discuss ways to collaborate and supervise and support their interaction.
Grant funds spent
Please describe how much grant money you spent for approved expenses, and tell us what you spent it on.
- $1,300 in 10 Internet-in-a-Box
- $200 in taking the devices to the Dominican Republic
- $500 in accommodations
Do you have any remaining grant funds?
No remaining grant funds.
Anything else you want to share about your project?