title: Study on the potential for delay tolerant networks by health workers in low resource settings.
abstract: BACKGROUND
  Medical Informatics Systems (MIS) have been suggested as having great potential to improve health care delivery in low resource settings. One of the major barriers for adopting MIS in this context is a lack of adequate network/communication infrastructure. Delay Tolerant Networking (DTN) is an approach for establishing network connectivity in situations where it is possible to support physical transport of the digital information. To date most DTN research has been technically oriented, and very few services have been implemented to support healthcare systems using the technology. It is thus unclear about the potential that DTN may have for supporting MIS systems in low resource settings. The goals of the paper are twofold, first, to gain an initial estimate of interest in different services that can be supported by DTN. Second, to find out the necessary frequency associated with each service for supporting health work in low resource settings.
  
  
  METHODS
  Fifty questionnaires were distributed to attendants at the International Conference on Global Health that had acknowledged having health work experience in a poor connectivity context. The respondents were using a 5-point Likert scale regarding if 9 different potential DTN services "would be useful". They also were asked how often data delivery would be necessary for these services to be useful. The Chi square was calculated to measure acceptance.
  
  
  RESULTS
  37 responses were received, aggregating the response rate of 74%. The respondents represented having work experience from 8 months to 15 years from 35 resource poor countries. The Chi square test showed very high statistical significance for "strongly agree and agree" for the potential usefulness of the proposed DTN services, with a p-value less than 0.001. The frequency of data delivery that would be necessary for services to be useful varied considerably.
  
  
  CONCLUSIONS
  This study provides evidence of potential for DTN to support useful services that support health work in low resource settings, and that services like access to email, notification of lab results, backup of EHR and teleconsultation are seem to be most important services that can be supported by DTN. The necessary frequency of data delivery for each service, will be highly dependent on context. In a low resource setting with limited mobility, the physical transport of digital data at a frequency of less than once per week should still be sufficient for useful services like notification of lab results and ordering of medical supplies. Research comparing different methods for delivery of DTN data should thus be useful. Further research and collaboration between MIS and Computer Science research communities is recommended in order to help develop DTN services that can be evaluated. Efforts to enhance awareness among stakeholders about how DTN can be used to support health services should be worthwhile.
authors.affiliation: Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan.
authors.forename: Shabbir
authors.initials: S
authors.lastname: Syed-Abdul
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Scholl
authors.forename: Peisan
authors.initials: P
authors.lastname: Lee
authors.forename: Wen-Shan
authors.initials: WS
authors.lastname: Jian
authors.forename: Der-Ming
authors.initials: DM
authors.lastname: Liou
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Li
mesh_terms: D022126:Access to Information; D000465:Algorithms; D003142:Communication; D003195:Computer Communication Networks; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D020407:Internet; D008297:Male; D008490:Medical Informatics / Q000379:methods*; D008507:Medically Underserved Area; D015233:Models, Statistical; D011203:Poverty; D011795:Surveys and Questionnaires