Post authored by Medic’s co-founder and Research Lead, Isaac Holeman.
Medic Mobile’s research team is committed to bringing the latest science and data-driven care to communities facing the highest burdens of poverty and disease. We wanted to take this opportunity to update our scientific collaborators and broader network of partners about our research agenda and the substantial evidence that underpins our work.
Our commitment to open sourcing our insights and research findings began with extensive blogging in 2008, and in 2010 we published a peer-reviewed program evaluation documenting lessons learned during our first pilot at St. Gabriel’s Hospital in Malawi. The paper explained our use of interactive text messaging to coordinate community health workers (CHWs). Our work demonstrated that SMS and the most basic phones could be powerful health systems strengthening tools. It proved to be a pioneering study, because at a time the handful of SMS-focused mHealth programs in lower-income settings were largely focused on blasting out health information in one direction, often circumventing the health system to broadcast to patients, rather than using interactive messaging to strengthen the health system. A later independent evaluation of a similar SMS network that we designed and implemented in Malawi found that texting was 134x faster and 4x cheaper than CHWs’ most common alternative means of delivering reports or communicating with supervisors (walking, bicycle and public transit). This kind of nimble coordination can be vital–the same independent evaluation also documented how CHWs used the messaging network to contain outbreaks of measles and meningitis. With 135 citations, our 2010 paper has become a standard reference in the area of interactive messaging for community health in lower-income settings.
2010 was also the year that we began to publish our insights about the importance of human-centered design for global health equity. We shared our point of view through many conference presentations, as well as peer-reviewed commentaries calling for a more human-centered perspective on how we scale mHealth interventions. Human-centered design remains a central theme of research and practice at Medic. Late last year I completed PhD studies as a Gates Scholar at the University of Cambridge and my thesis is our latest publication on the topic; it’s titled, Sensemaking and Human-Centered Design: A Practice Perspective.
Recently, we set out to organize and reflect on the range of studies about our work. We decided to include publications with Medic Mobile-employed co-authors, as well as independent studies led by our partners and we ended up finding more than we expected! Our Research Archive now includes over 50 publications, including 32 peer-reviewed articles and a range of technical reports and white papers. Our new report on Research at Medic Mobile highlights three core themes that run through these publications:
- Establishing new models of data-driven care that strengthen the role of community health workers;
- Human-centered design as a way of undertaking and studying the complex process of health systems strengthening; and
- A pragmatic, practice-based approach that integrates inquiry with the hands- on work of building new tools, sustaining implementation at scale, and advocating for equity and human rights-based approaches to technology for universal health coverage
Across each of these themes, we can cite highly successful example studies that have been influential in Medic Mobile’s work and, as a result, have had real-world impact at a far greater scale than most peer-reviewed research. At the same time, we had relatively little research capacity in our early years, and quite a few of these efforts have proven less fruitful. Some projects went poorly because a team lacked appropriate resources, time or key research skills.Other studies were more rigorous, but poorly integrated with our organization and as a result have proven irrelevant to our ongoing work. For this reason, the second half of the Research at Medic Mobile report explains our strategy process and the organizational infrastructure we’re putting in place to help focus on the most promising studies and scale-up evidence-based innovations.
In 2018 we’re conducting more, and more rigorous research than ever, and so are our model building partners. Among our partners, 7 randomized controlled trials (RCTs) are ongoing or recently completed, including our support for the Muso team as they conduct one of the world’s largest community health RCTs. Our open source community health toolkit is now at the center of an incredibly exciting network of researchers, and since we also have an ambitious in-house design research agenda, we’re expanding our research capacity.