title: Using Portable Health Information Kiosk to assess chronic disease burden in remote settings.
abstract: BACKGROUND
  Cancer, cardiovascular disease, chronic respiratory disease, and type 2 diabetes, are responsible for over 50% of worldwide mortality. Chronic diseases have broad negative impacts in developing countries. Contributing to the development of chronic diseases are sedentary lifestyles, poor nutrition and eating habits, and air pollution, among other risk factors. These are also greatly increasing, and obesity has become a global phenomenon. Health promotion, and chronic disease prevention and surveillance, can be achieved through information and communication technologies (ICT), which acquire, disseminate and store health-related information electronically. The portable health information kiosk (PHIK) can be a powerful tool for promoting health education in communities in both urban and rural settings. The objective of the study was to utilize a PHIK as a tool to assess the burden of chronic disease and associated risk factors in diverse settings in India.
  
  
  METHODS
  A convenience sample was enrolled from three diverse geographical locations including urban, rural and tribal to explore the utilization of a PHIK for chronic disease health risk assessment in a community setting. Cross-sectional data was recorded during the period of March-May 2010 in Rourkela and Bhubaneswar in the state of Orissa, India. Participants were asked to use a touch screen, electronic kiosk that gathered subjective and objective data to understand the burden of chronic diseases and associated risk in the community setting. The subjective data included responses to a series of multiple-choice questions and the objective data was gathered using multiple physiological sensors such as weight, blood sugar and blood pressure. Descriptive analysis was performed using univariate statistics with results for the continuous variables being reported as means and standard deviations while results for the categorical variables were reported as frequency statistics as appropriate.
  
  
  RESULTS
  A total of 429 participants aged 18 years and older were enrolled in three different community settings: urban, slum and tribal. Significant differences were seen in the systolic blood pressure of those living in the urban settings as compared with those living in either slum (p=0.04) or tribal settings (p=0.02). Significant differences in the blood sugar levels were seen only among those living in the tribal as compared with the urban settings (p=0.04). Results showed high prevalence of pre-hypertension, stages 1 and 2 hypertension among those living in the slum and tribal settings.
  
  
  CONCLUSIONS
  The results show the presence of chronic diseases in tribal and slum communities. The assessment of chronic health conditions in these populations is insufficient. Poor infrastructure and lack of qualified personnel are challenges to providing a meaningful service, as low wages, poor living and working conditions are obstacles that prevent the trained workforce from establishing themselves in these areas of extreme need. Health kiosks can be a multifaceted solution, as they can be used to assess health outcomes in areas that normally are not covered due to lack of infrastructure or health personnel, to establish health education modules and inform the local population about them. They can support evidence-based decisions for national and regional programs and policies.
authors.affiliation: Center for Global health and Development, University of Nebraska Medical Center, Omaha, Nebraska, USA. ashish.joshi@unmc.edu
authors.forename: Ashish
authors.initials: A
authors.lastname: Joshi
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Puricelli Perin
authors.forename: Mohit
authors.initials: M
authors.lastname: Arora
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D006801:Humans; D017064:Process Assessment, Health Care; D012424:Rural Population; D017216:Telemedicine / Q000706:statistics & numerical data*