title: A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka.
abstract: Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management.
  
  
  
  To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems.
  
  
  
  One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches.
  
  
  
  Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components - digitized surveillance, dynamic disease mapping and digitized dengue education - on a common platform. The system was developed through an iterative, evolutionary, collaborative process, consistent with the Spiral model of software development and is currently being used by all 55 PHIs in the CMC system.
  
  
  
  Given the entrenched nature of existing paper-based systems in PHIs' work habits, we expect a gradual adoption curve for Mo-Buzz in the future. Equally, we expect variable adoption of the system with respect to its specific components, and specific PHI sub-groups (younger versus older). The Mo-Buzz intervention is a response to multiple calls by the global mHealth community for collaborations in the area of mobile interventions for global health. Our experience revealed that the benefits of this paradigm lies in alleviating country-specific public health challenges through a commonly shared understanding of cultural mores, and sharing of knowledge and technologies. We call upon future researchers to further dissect the applicability of the Spiral Model of software development to mHealth interventions and contribute to the mHealth evidence debate from theoretical and applied perspectives.
authors.affiliation: Centre of Social Media Innovations for Communities, Nanyang Technological University, Singapore, Singapore.
authors.forename: May O
authors.identifier: 0000-0003-1832-8242
authors.initials: MO
authors.lastname: Lwin
authors.forename: Santosh
authors.identifier: 0000-0003-1083-7966
authors.initials: S
authors.lastname: Vijaykumar
authors.forename: Vajira Sampath
authors.identifier: 0000-0002-3519-1842
authors.initials: VS
authors.lastname: Rathnayake
authors.forename: Gentatsu
authors.identifier: 0000-0001-5843-0992
authors.initials: G
authors.lastname: Lim
authors.forename: Chitra
authors.identifier: 0000-0003-3493-8390
authors.initials: C
authors.lastname: Panchapakesan
authors.forename: Schubert
authors.identifier: 0000-0003-3043-0450
authors.initials: S
authors.lastname: Foo
authors.forename: Ruwan
authors.identifier: 0000-0001-5880-8684
authors.initials: R
authors.lastname: Wijayamuni
authors.forename: Prasad
authors.identifier: 0000-0003-3871-0262
authors.initials: P
authors.lastname: Wimalaratne
authors.forename: Owen Noel Newton
authors.identifier: 0000-0003-1486-1314
authors.initials: ON
authors.lastname: Fernando
mesh_terms: D000328:Adult; D003715:Dengue / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D061108:Social Media; D013188:Sri Lanka; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult
keywords: dengue; mhealth; needs assessment; prevention and management; public health inspector; social media; surveillance