title: Development and Implementation of Culturally Tailored Offline Mobile Health Surveys.
abstract: BACKGROUND
  In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings.
  
  
  OBJECTIVE
  The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs.
  
  
  METHODS
  In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets.
  
  
  RESULTS
  Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners.
  
  
  CONCLUSIONS
  Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs.
authors.affiliation: School of Medicine & DentistryDepartment of Public Health SciencesUniversity of RochesterRochester, NYUnited States.
authors.forename: Scott
authors.identifier: 0000-0002-5776-9617
authors.initials: S
authors.lastname: McIntosh
authors.affiliation: School of Medicine & DentistryClinical and Translational Science InstituteUniversity of RochesterRochester, NYUnited States.
authors.forename: José
authors.identifier: 0000-0002-6654-6984
authors.initials: J
authors.lastname: Pérez-Ramos
authors.affiliation: School of Medicine & DentistryClinical and Translational Science InstituteUniversity of RochesterRochester, NYUnited States.
authors.forename: Margaret M
authors.identifier: 0000-0003-2377-4343
authors.initials: MM
authors.lastname: Demment
authors.affiliation: Recinto de Ciencias MédicasDepartamento de Ciencias SocialesUniversidad de Puerto RicoSan JuanPuerto Rico.
authors.forename: Carmen
authors.identifier: 0000-0002-3147-4597
authors.initials: C
authors.lastname: Vélez Vega
authors.affiliation: Universidad de Ciencias MédicasSan JoséCosta Rica.
authors.forename: Esteban
authors.identifier: 0000-0002-5083-7242
authors.initials: E
authors.lastname: Avendaño
authors.affiliation: School of Medicine & DentistryDepartment of Public Health SciencesUniversity of RochesterRochester, NYUnited States.
authors.forename: Deborah J
authors.identifier: 0000-0003-2918-597X
authors.initials: DJ
authors.lastname: Ossip
authors.affiliation: School of Medicine & DentistryDepartment of Obstetrics & GynecologyUniversity of RochesterRochester, NYUnited States.
authors.forename: Timothy D
authors.identifier: 0000-0002-9801-4712
authors.initials: TD
authors.lastname: Dye
keywords: ethical review; mobile health; survey research