A Ubiquitous Health Facility Framework for Rural Areas in Punjab

Abstract

Ubiquitous computing (also known as pervasive computing) has introduced the possibility of accessing services in the form of electronic services (eServices) at any place regardless of time. In recent years, ubiquitous computing is widely discussed by research community in various disciplines such as education, business, healthcare, agriculture, marketing, government etc. In healthcare area, ubiquitous computing (also termed as eHealth) is addressed by proposing solutions ranging from sending simple SMS messages for healthcare awareness to recoding patient information through wearable sensors and processing recorded information to provide diagnostics. The ubiquitous solutions are particularly important in the context of delivery of healthcare services in remote areas to address the health issues of residents of these areas. Pakistan is a developing country and about 70% of its total population lives in rural areas. Keeping in view that these resource constrained rural areas suffer from shortage of primary healthcare services and have high mortality rate especially for women and neonatal, healthcare professionals working in these areas need to be facilitated through ubiquitous solutions to address the healthcare issues efficiently and effectively. The objective of present research is to investigate the feasibility for provision of ubiquitous healthcare services in rural areas in the region of Punjab, Pakistan. The purpose is to facilitate healthcare professionals in provision of healthcare services to rural population particularly antenatal patients. To conduct this research, a multimethod research approach is employed as it facilitates in establishing a chain of evidences by involving different research methods that complement each other. A systematic mapping study is carried out on eServices literature to collect evidences related to proposed solutions particularly in the area of healthcare. A second mapping study is conducted to analyze evidences available in ubiquitous healthcare literature regarding healthcare solutions. The mapping studies revealed that the healthcare solutions proposed in literature, cover a broad range of healthcare areas and use a variety of techniques to address problems. However, these solutions largely fall under the category of solution proposals and lack real world scenarios in their solution evaluation. In case of addressing healthcare problems in rural areas, we found a few studies that considered healthcare issues in remote areas. These studies are vi limited to notifications and awareness messages sent to particular groups through mobiles and PDAs. Further, the proposed solutions are available only in the form of pilot studies without any evidence of their being evaluated in real environment and enagement of healthcare professionals working in these areas. In this research, efforts are made to address these shortcomings by understanding the problem in depth and in its real context by engaging healthcare professionals in problem identification, solution design and proposed solution evaluation. Case study research technique is employed to construct the case around a real world problem.. For this purpose, an extensive field survey is carried out by visiting basic health units (BHUs) in rural Punjab, Pakistan. The data is collected through focus group interviews with healthcare professionals working at BHUs. A case around provision of healthcare services for antenatal patient is constructed. A proof-of-the concept ubiquitous healthcare framework is constructed by considering the need of healthcare professionals. To evaluate the proposed framework and measure user satisfaction an evaluation framework is designed by integrating usability, and information system evaluation models and standards. The user satisfaction is measured by establishing relationship with twelve constructs of evaluation framework i.e., availability, adaptability, error recovery, ease to understand, ease of learning, execution, navigation, minimum cognitive load, efficiency of use, effectiveness, responsiveness and memorability. Hypotheses are constructed, and questionnaire is prepared to collect data by conducting a second field survey with healthcare professionals working at BHUs. The data was analysed statistically and the results show highly significant relationship between constructs and user satisfaction. During survey, interviews are also conducted with healthcare experts present at BHUs to evaluate framework components especially related to management and monitoring. The interview results also provide high level of satisfaction towards proposed UHFF. From the findings, it can safely be inferred that our proposed solution is able to capture the needs of healthcare professionals in rural areas and can facilitate them in delivery of healthcare services in these areas efficiently and effectively. In future, the proposed framework can be extended by involving cultural context in the form of language and by extending technology support in the form of diagnostics or adding wearable devices for vital sign monitoring. However, for enhanced technological solutions, the need of ICT vii resources and digital literacy will be important elements to be considered in these resource constrained areas.