NAYO Clinic Ada Application Study Design

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Josh Marshall | Nov 30, 2017 | in Health Consulting

The Health team in Malawi have made substantial progress in the opening days of their December project. Specifically, the team has re-engaged with contacts at the NAYO clinic, a local health clinic providing various health services within rural areas of Malawi. The clinic has been very interested in the the team’s idea of a pre-diagnostic health application, and have agreed to allow for the testing of one such application called Ada in their clinic within the following weeks. The team first outlined the parameters, process and methodology internally, before further discussing these with the staff of the NAYO clinic to gain insight to their opinions of the project.

In terms of parameters, the team decided to focus on accuracy, efficiency and usability. The team then defined each of these parameters, and then evaluated how these would be measured. The team defined accuracy as the ability for application to correctly diagnose patients, which will be assessed through comparison of the Ada diagnosis with clinician/nurse diagnosis, and then conducting hypothesis testing using a paired t-test. The team defined efficiency as the ability for Ada to reduce time in the diagnosis process, and plan to measure this by comparing the time spent in the clinic with the time using the application. For time spent during the clinic, the team will take measurements of both the entry and exit time to the clinic, and for the Ada application, recording start and finish time of using the application. Although these times will overlap, the team does not expect them to impact each other due to the long lines identified at the NAYO clinic during the health team’s initial empathising stage. For usability, the team has implemented a questionnaire at the end of the entire process, to understand the ease in navigating the Ada application. This questionnaire is still to be finalised, with a following post discussing this in greater detail.

When testing the Ada application, the team wanted to make the process as effective and efficient as possible for the NAYO clinic and its patients. The team were weary of the possibility of creating a greater workload for the staff at the NAYO Clinic, and therefore committed to the least disruptive process applicable. Patients will enter the NAYO Clinic and proceed to registration, where they will be asked to participate with the trial of the Ada application. We acknowledge that taking patients from within the queue may cause confusion and greater congestion, and therefore will question patients from the back of the line to minimise this disruption. Patients will receive an ID Form and lead to a separate room where the Project Everest team will be waiting. The ID Form enables privacy and confidentiality as no names will be recorded during data collection. The form will also include four designated time slots, as explained above. An explanation of the application process will be provided and patients will be guided through each question. At completion of the questions, a screenshot will be taken of the suspected diagnosis for our data records, however we will not provide this information to the patient. This is to ensure that the patient does not carry a bias when seeing the nurse or clinician and therefore impact their judgement of the overall diagnosis. Patients will have the option to access to their Ada diagnosis following completion of their consultation with the nurse or clinician.

An obvious issue to the entire process is the language barrier in the local community, with the majority of people speaking the local language Chichewa and not English. As none of the team speaks Chichewa, the team requires translators to translate Ada for the patients. Currently, the team has at least one volunteer from the NAYO clinic to help with this, and potentially another depending on available resources at the clinic. Another idea the team had to overcome this issue was to develop a partnership with the local College of Medicine and gain access to Chichewa and English speaking students to help with translation. This would be beneficial for both parties, as the team would then be able to increase total data collected, while students at the college gain invaluable education, understanding and experience associated with working in rural areas. The team is currently in the process of contacting the college to develop this relationship.

The December health team is very excited about the current avenue they are exploring in terms of using the Ada application as a pre-diagnostic tool. The team believes that if successful, the tool can help reduce the many barriers to healthcare that have previously been identified in the greater Blantyre region of Malawi. These include a reduction in patient waiting times, a reduction in long patient travelling times as well as the potential to even improve accuracy of clinic diagnoses, as suggested by a nurse at the NAYO clinic. Hopefully through testing Ada at the NAYO clinic in the coming weeks, the team will gain a better understanding of the viability of both Ada and a pre-diagnostic tool in the future.