Smartphones or tablets group discussion
In this study clinicians used on average 8. Findings from another study [ 13 ] conducted in a rural setting in Pwani Region in Tanzania, which highlighted that it is faster to use electronic protocols than IMCI chart booklet, could not be confirmed. Instead results from urban Dar es Salaam showed that electronic clinical decision support systems lead to more laboratory tests done compared to routine practice [ 20 ] resulting in longer consultation duration and more laboratory work. However, it must be considered that consultation time varies depending on the setting.
In rural areas it is often longer than in urban ones. Earlier studies showed that the shorter the consultation duration, the higher the risk that children are not properly assessed [ 23 , 24 ]. This can lead to poor clinical outcomes especially when danger signs are not properly identified. Case management and health outcomes cannot be improved if clinicians are not prepared to allocate sufficient time for consultations following IMCI guidelines [ 24 ]. The willingness to follow medical standards is a pre-requisite for the sustainable application not only of electronic tools such as ALMANACH but also decision charts in general, whatever the support.
Although the majority of the respondents assessed the devices very positively and highlighted their strengths, they also reported health system related barriers in almost all interviews. The Tanzanian health system is characterized by shortage of health care providers, which affects also intervention aimed at improving health care delivery [ 25 - 27 ].
Understaffing and high number of patients prevented many clinicians from making long-term use of the electronic devices as they were concerned that these new tools lead to excessive delays for patients and over hours of health workers. An assessment of health workers performance during outpatient consultations in Dodoma urban and Morogoro region rural reported that clinicians have ample time and are not overworked [ 28 ]. On the other hand, the same researchers mention that there could be a relationship between low performance of clinicians and high workload [ 28 ].
This was perceived as double work. However, this duplication was related to the nature of this pilot implementation where routine data collected through the electronic devices directly to the server were not considered suitable for the continuous monitoring of diagnoses and treatment, because they could not be linked to the usual HMIS.
This concern would ultimately no more be relevant, once all clinical data can be collected directly in an integrated electronic monitoring system. Lack of financial incentive was an additional barrier mentioned by the interviewees. Health workers perceived the use of the electronic tools as extra work, and expected therefore extra payment. No incentives were given during field implementation because the smartphone or tablet were designed and used as an aid to appropriately assess a sick child, and not as a research tool to satisfy scientific curiosity.
Smartphones, Tablets, and Mobile Devices Discussions
The same procedure was applied when Rapid Diagnostic Tests for malaria were pilot-implemented in Dar es Salaam, and the intervention went smoothly and was then scaled up in a national strategy [ 15 ]. This is of course a risk since previous studies reported poor performance of health personnel when there was no monetary or non-monetary incentives [ 28 - 31 ]. It is common practice to pay incentives when extra work is asked to the clinician and no benefit to either staff or patients is expected.
In the present study, the use of smartphones and tablets was aimed at improving clinical outcome and reducing unnecessary antibiotic prescriptions. Therefore it is possible that the absence of incentives for what could be considered as extra work because of the research environment, and the potential reduction of informal payments because of smartphone or tablet use, could have contributed to their poor uptake. Patients assessed using the electronic devices were more likely to be sent to the laboratory for testing.
The way respondents presented health system barriers was in most of the cases the same regardless of the uptake levels.
Belonging to a low uptake level was therefore not linked to a negative assessment of the device. The very same health personnel with low uptake level that praised the ALMANACH, highlighted the impact of health system barriers and held them responsible for the low uptake. Sufficient health workforce, good access to medical products and technologies, effective service delivery systems are crucial for achieving good quality of care [ 35 ].
Results of this study highlight that sufficient staff, adequate payment system, enabling working environments including supportive supervision, and access to affordable medicine are important factors that influenced the uptake of the ALMANACH. However, increasing, staffing, training and supervision might not be sufficient [ 28 , 36 ]. The study focused on primary health care workers in the largest city of Tanzania, Dar es Salaam. While the results might be applicable to other urban settings, they cannot be generalized to rural settings that are often characterized by less patients and different health care infrastructure.
The role of the first author which included project implementation as well as data collection might have influenced the responses of the study participants. In order to deal with that, all study participants were encouraged to be as open as possible prior to the interview. In addition, participants were assured that the interviews aimed at assessing the ALMANACH and factors affecting its implementation following the low uptake observed.
The interviews showed that respondents felt at ease sharing their experiences with the first author as they had over the years developed trust and mutual respect. It is argued that future studies should not only focus on technical aspects of mobile technology. Context related aspects needs to be addressed as well in order to foster a setting that allows for sustainable uptake and use of mobile devices. The present study contributed to the increasing body of mobile health literature from the perspective of primary care health workers.
Smart Phones: Latest trend or harmful device.
Both were perceived as powerful tools which simplify work, give correct classification and reduce unnecessary use of antibiotics. However, health system barriers influence the long-term uptake. Further studies are needed in order to better understand whether uptake is feasible for health workers given health system barriers and additional contextual factors. Hereby barriers highlighted by health workers s will be addressed. This study would not have been possible without the great support of all HWs who agreed to participate in the interviews and focus group discussions.
Judith Kahama-Maro deceased.
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Competing interests. NS and JKM assisted preparing the data collection. AFS collected data and drafted the manuscript. All authors have read and approved the final manuscript. Amani Flexson Shao, Email: Clotilde Rambaud-Althaus, Email: Ndeniria Swai, Email: Blaise Genton, Email: Constanze Pfeiffer, Email: National Center for Biotechnology Information , U. Published online Apr 2. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Aug 26; Accepted Mar This article has been cited by other articles in PMC. Methods A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Methods The PeDiAtrick project The study was conducted within the PeDiAtrick project which aimed at improving the quality of healthcare for Tanzanian children by assessing the use of electronic decision support to promote evidence-based medicine and rational use of drugs.
Open in a separate window. Figure 1. Figure 2. Study design and setting The qualitative study presented here was carried out in the urban intervention sites in Dar es Salaam city in Tanzania between February and March smartphones and between September and October tablets. Figure 3. Table 1 Characteristics of the health facilities. Participant selection and data collection Study participants were sampled among all clinicians who formed part of the project. Data analysis All in-depth interviews were recorded, transcribed, and translated from Swahili to English. Results Socio-demographic characteristics of the study participants A total of 40 clinicians participated in the study, 24 in the in-depth interviews and 16 in the focus group discussions.
Health care worker perceptions related to the application of smartphones and tablets This section explores factors influencing the uptake of the two different devices, smartphone and tablet. Figure 4. Reduction of antibiotic prescription Health workers pointed out that the ALMANACH assisted them to reduce antibiotic and antimalarial prescription as the device walked them step-by-step through the consultation starting from diagnosis to treatment including calculation of proper dosage of required drugs.
Usability of devices Typing In general, technical usability of the smartphone as well as tablet was considered to be easy. Lack of staff motivation Lack of financial incentive was mentioned in almost all interviews. They based their expectations on various reasons as narrated by a female health worker below: Lack of drugs The application of the smartphone and tablet raised expectations among patients related to treatment that often could not be fulfilled.
Discussion To our best knowledge, this is the first qualitative study which investigated facilitating factors and barriers for routine use of electronic decision supports, namely smartphones and tablets, in developing countries. Smartphone users get affected three times more likely to this disease.
Do Smartphones Help or Hurt Students' Academic Achievement? - The Atlantic
According to research those who are suffering from 'homophobia' are more likely to be found gambling online, socialising on social networks, listening to music and playing video games. Playing online games and surfing social websites have become common among youths now a days and they miss out on physical sporting activities.
Student's life which is meant for studying, is affected because of misuse of smartphones. The time which should be utilised for studying is being distracted by the use of smartphones. The present technology is deteriorating county's future to some extent where parents are not careful about the amount of time children donate with smartphones. Kids who are addicted to technology rarely have any time to spare on outdoor sports which can be a great damage to their health. They are away from those games which will be helpful in having good and strong physique. Too much emphasizing on smartphones at young age can cause vision problem.
Toxic phthalates are found on iPhone cables and which require warning labels on products exposing consumers to phthalates. This lead to violation of 'Right to be informed' under Consumer Protection Act. Thus consumers should be warned of its dangerous containments. Staying connected to smartphones is hazardous for health.
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Repetitive use of phones for texting and gaming may cause soreness in wrist and thumb, can put hand and fingers in risk of injury, neck aches and other symptoms. Micro tears or soreness can heal with time but problem regarding posture and neck aches can increase the pressure on the discs that cushions the bone of neck. Though smartphones are helpful in every field, it causes certain disorder to human health.
Parents should look after their child that they should not misuse their gadgets. Smartphones are the mobile phones having advance features similar to personal computers. Teenagers should be aware of its harmful effects which is caused by regular use. Parents should help their child by talking about its drawbacks.
Though it is harmful, it is also useful. The use of smartphones should be restricted to works and time spent on it should be limited to a few hours only. Discussion RE: And mostly childrens are forgot about the outdoor games becos of this smart phones. So they wil not get Good Physical Fitness. Brain also affected by frequent use of this smartPhones. Now a days most people mainly younger want to have smartphone. But smartphone has also many advantages like smartphone is not less than computer in any manner.
By installing different apps like Google maps,whether forecasting,railway info,etc. We can get information. So smartphone is good for those who use this is in good way otherwise conventional phone is better than smartphones. It is more harmful to heaith like ear problems etc. A phone is considered a necessity, while a tablet is much more a luxury or productivity device like a computer.
In many ways, smartphone users are more immersed in the use of the device than people using a tablet. Most people use tablets as content consumption devices rather than as the personal communication hub that is the smartphone. When you craft your marketing plan, therefore, the type of marketing you do to each platform will be different because of the way people see and use the device. For example, the marketing you do towards tablet users will be much more closely related to the marketing you do towards desktop users than it will be towards smartphone users.
When you target a smartphone, you are targeting an individual. This will play a role when you are deciding how to target your marketing material. Targeting an individual is different than targeting a small group of people. It should also be pointed out here that almost everyone uses smartphones in the same way. First and foremost it is a phone, but it also has productivity apps, and glance worthy information. Some people use it as a content consumption device, while others use it as a laptop replacement.
In many ways, smartphones are easier targets for marketing strategies because they are carried everywhere, have constant Internet connections, and are used as communication devices.