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Upchar

In this project, we designed a smart medi-kit for tackling the problem of poor adherence to TB medication in India.

Project Overview

Efficient management of chronic diseases such as Tuberculosis remains a common problem. Non- adherence to the prescribed medical regimen remains a tremendous barrier to the effective management of Tuberculosis and is considered one of the most serious problems that the medical world faces at present, especially in developing nations like India. In our research, it was found that adherence records lacked authenticity as well as efficiency, which becomes critical in a chronic diseases such as Tuberculosis.

Solution

We conceptualized a system consisting of a medi- kit which is technologically enabled to keep track of dosage records and default cases. This enables providers and supervisors with a system facilitating regular monitoring. Besides this, the problem of side-effects was also identified as one of the primary reasons for defecting from treatment. The medi-kit has the facility to keep a track of the side-effects being encountered by the patient, which would help in regular monitoring of the patient’s health profile and assist in taking pertinent medical action.

Project Info

Timeline: Aug '14 - May '15
Theme: User Research, System Design, Prototyping
Contribution: I was responsible for leading the interview sessions with the heath workers and DOTS providers.

A TLDR version of the project

This project involved thorough ground research - we met multiple doctors, health workers and DOTS providers.

We created a smart medi-kit for dispensation of medicine which also allowed the DOTS providers to capture side-effects directly.

We also proposed an overall system design for DOTS to overcome some of the prevalent problems today.

Existing solutions tackling the same problem
Competitor Analysis

Microsoft has implemented a biometric monitoring system in New Delhi, using fingerprinting technology, called eCompliance. The visitation log is uploaded regularly via SMS to a central location, where program managers can analyze the data and offer targeted counseling or supervision for patients who have missed their dose. Smart pillboxes like uBox for timely reminders of medication have also been developed (MIT). Parichaya, an interactive medi-kit, helps in utilizing their idle time during medication to create awareness about the DOTS therapy among patients. The storage device not only stores the medicine but enables patients to listen to TB awareness information through an audio module. Microsoft has implemented a biometric monitoring system in New Delhi, using fingerprinting technology, called eCompliance. The visitation log is uploaded regularly via SMS to a central location, where program managers can analyze the data and offer targeted counseling or supervision for patients who have missed their dose. Smart pillboxes like uBox for timely reminders of medication have also been developed (MIT). Parichaya, an interactive medi-kit, helps in utilizing their idle time during medication to create awareness about the DOTS therapy among patients. The storage device not only stores the medicine but enables patients to listen to TB awareness information through an audio module.

Research
Contextual Inquiry

Field survey was conducted with the help of Health workers and ASHA volunteers with 40 patients across two districts: Kamrup and Dhubri Home visits were made to the houses of the patients, especially defaulters Semi structured interviews were conducted with open ended questions focusing on socio-economic status: occupation, livelihood etc., bad habits, complications during medication, problems associated with lack of adherence

Observations
Observations Data Analysis

We categorized the reasons for default into 5 main categories as shown. We tried to get a sense of how each of these different factors were applicable to the patient across the two settings: Urban and Rural

Impact Model
Contextual Inquiry
Key Insights
Research

1. Mode of communication is not always convenient for patients and even providers and could result in the provider just handing over the medicines directly to the patient, which results in failure of DOTS.

2. Side effects are a major reason for patients discontinuing from the course of medication. They are often not addressed on time leading to default cases.

3. Records are vulnerable to tampering. Lack of maintenance of the records is a major drawback in the DOTS system.

4. The workers mostly learn from their experience. They are not trained to maintain records or report issues to higher authorities or even properly counsel the patients and their family.

5. Most of the times if any default occurs, it is not reported to any health officers. This poses a major problem as taking the medicines in time is a major factor in rendering the treatment successful and prevent the disease from spreading.

6. There is no central database maintained as a result of which medication dissemination is not possible from a different center.

7. The supervision of records taking place is temporally discontinuous. The damage is already done before records get to the higher authorities. TB being a chronic communicable disease needs a real-time check as any let-up in the treatment often has long term repercussions on the entire health system.

8. Incentives to workers are not sufficient to keep them motivated throughout.

9. There are time constraints associated with the DOTS system which makes it inaccessible to daily wage laborers.

10. Patients have been found to come under a false sense of well-being after a certain period of time into the treatment(2 months generally) which can divert them from undergoing the full cycle of treatment.

11. Social stigma associated with TB also has negative repercussions. In the urban areas especially, patients affected by TB generally find themselves surrounded by social prejudices and taboo, which can be detrimental towards treatment.

Personas
Persona Patient Persona Supervisor Persona Healthworker
Morphological Matrix
Matrix

We generated 4 storyboards and speed dated with a few participants. The ideas varied from an anonymous question answering platform to a platform for more informative course registration to one which sets up students with mentors to automated course selection. We tried to play around with the level of automation and human involvement in our ideas to see the reactions from people.

Prototype
Prototype

The product consists of a cuboidal shaped box which has the capacity to hold the medication supply for a limited no. of patients under a sub-centre. As the reader recognizes the registered ID card, the tablet strip for a day’s dosage is dispensed automatically and appropriate updates are done at the centre against the tag ID identified. A panel at the top indicates the kind of side-effects that the patient might encounter. One can identify the appropriate side- effect from the panel and register it in the kit itself via the interface provided. The data recorded would be sent to the central server via GSM module. Also, for refilling purpose, the lock can be opened only by the manager at the centre via his own ID card in order to restrict manipulation by the providers. The product was tested by a few design students to identify usability issues. Some of the problems identified are as follows: 1. The plus and minus buttons were counter intuitve. Due to the transparency of the material used for the buttons, they appeared like LED lights. 2. There was no signal when the selection button was pressed. An LED or a sound signal was required.