mOralHealth Early Detection Personas

DATHMU MY RISK FACTORS MY FUNCTIONAL ABILITY MY SYMPTOMS I have very little money but we support each other in the community to share the things we need. I don’t brush my teeth. Meeting basic needs Oral hygiene I went to primary school for five years. I have a healthy diet with lots of fruit and vegetables. Nutrition Education MY DEVICES Alcohol consumption I don’t drink alcohol. DATHMU I have smoked all my life and I also frequently chew areca nuts. I do not own a mobile device. ABOUT ME My name is Dathmu. I am 51 years old and live in a rural area of Meghalaya state in north-east India. I live by myself as my wife passed away 15 years ago, but I am close with my local community so I receive support from them. Tobacco use Basic mobile phone MY SYMPTOMS I have had many problems with my mouth during my lifetime such as toothache and caries. I have lost several teeth to decay. I feel that, now I have reached this age, there is not much point worrying about it. MAIN USE At Work For Personal Life Other Apps SMS Voice INCOME LITERACY TECHNOLOGY LITERACY PRIMARY HEALTH CARE CENTER COMMUNITY HEALTH WORKER ME & THE HEALTHCARE SYSTEM (10min) where do I go for medical treatment? Who do I interact with, and at what frequency? HOSPITAL MY SUPPORTS DAY IN MY LIFE (10min) What my usual day looks like, places where I go, how I commute, activities I do (interaction with healthcare system, leisure, etc.), people I meet. Who are the people I refer to and trust the most? MORNING Community Health Worker Community MY COMORBIDITIES AFTERNOON I have the general problems normally associated with ageing. I often feel weak and tired, and my heart is not as strong as it used to be. EVENING

Dathmu has an undiagnosed oral cancer Dathmu has an undiagnosed oral cancer. We need to design a system which can be used to increase the likelihood that Dathmu’s cancer will be diagnosed at an early stage so that treatment can begin. A community health worker visits his village once every two weeks but only sees patients who say they need medical attention. In two minutes, write down by yourself as many ideas as you can for how Dathmu’s oral cancer could be diagnosed using his healthcare system and the existing technology available. At this stage, it doesn’t matter how impossible or unfeasible the ideas are, the main aim is to think of as many creative ideas as possible.

Share your ideas among the group. Dathmu has an undiagnosed oral cancer. We need to design a system which can be used to increase the likelihood that Dathmu’s cancer will be diagnosed at an early stage so that treatment can begin. A community health worker visits his village once every two weeks but only sees patients who say they need medical attention. Share your ideas among the group.

Dathmu has an undiagnosed oral cancer Dathmu has an undiagnosed oral cancer. We need to design a system which can be used to increase the likelihood that Dathmu’s cancer will be diagnosed at an early stage so that treatment can begin. A community health worker visits his village once every two weeks but only sees patients who say they need medical attention. As a group, discuss which ideas might realistically be most helpful in Dathmu’s situation. Consider the advantages and disadvantages of each idea and select the three most relevant ideas.

Dathmu has an undiagnosed oral cancer Dathmu has an undiagnosed oral cancer. We need to design a system which can be used to increase the likelihood that Dathmu’s cancer will be diagnosed at an early stage so that treatment can begin. A community health worker visits his village once every two weeks but only sees patients who say they need medical attention. For each of the three ideas, spend five minutes as a group planning how it could be integrated into the existing healthcare system. Which activities would be needed for diagnosis? Which people are needed to achieve these? Which technology is necessary? What protocol could therefore be included in standard practice for the healthcare system?

CHALLENGE! There is no longer funding for the community health worker to visit Dathmu’s village so frequently. From now on, she will only be there once every three months. How can the top three ideas be adapted to overcome this challenge?

COMMUNITY HEALTH WORKER MY RISK FACTORS MY FUNCTIONAL ABILITY I am now living off my retirement pension. I don’t have enough money to spend it on lots of expensive things I don’t need but I have enough to get by. I brush my teeth every morning and evening. Meeting basic needs Oral hygiene I eat the food provided by the care home, which is mostly quite healthy. I especially enjoy having cake as a treat. I went to primary and secondary school but left education aged 15 to work as a secretary. Nutrition Education Alcohol consumption I don’t drink alcohol any more, but I did when I was younger. MY DEVICES CAMILLE I do not own a mobile device, but the careworkers all have smartphones. I don’t understand how they work myself. ABOUT ME My name is Camille and I am 74 years old. I live in a residential home in France where I receive help from the staff with daily activities like washing and getting dressed. My husband died a few years ago. My three children try to visit when they can but they are all busy with their own families, so I only see them around once per month. I smoke about six cigarettes a day and have done for may years. Tobacco use Basic mobile phone MY SYMPTOMS I have had many problems with my mouth during my lifetime such as toothache and caries. I have lost several teeth to decay. I feel that, now I have reached this age, there is not much point worrying about it. MAIN USE At Work For Personal Life Other Apps SMS Voice INCOME LITERACY TECHNOLOGY LITERACY PRIMARY HEALTH CARE CENTER COMMUNITY HEALTH WORKER ME & THE HEALTHCARE SYSTEM (10min) where do I go for medical treatment? Who do I interact with, and at what frequency? HOSPITAL MY SUPPORTS DAY IN MY LIFE (10min) What my usual day looks like, places where I go, how I commute, activities I do (interaction with healthcare system, leisure, etc.), people I meet. Who are the people I refer to and trust the most? MORNING Care worker Children MY COMORBIDITIES AFTERNOON My memory is not as good as it used to be and I have a lot of heart problems. I suppose these are the sort of problems that come with ageing. EVENING

Camille is at high risk of oral cancer Camille is at high risk of oral cancer. We need to design a system which can be used to increase the likelihood that any developing cancer will be diagnosed at an early stage so that treatment can begin. Camille sees her care workers every day as she lives in a care home. In two minutes, write down by yourself as many ideas as you can for how Camille’s oral cancer could be diagnosed using her healthcare system and the existing technology available. At this stage, it doesn’t matter how impossible or unfeasible the ideas are, the main aim is to think of as many creative ideas as possible.

Camille is at high risk of oral cancer Camille is at high risk of oral cancer. We need to design a system which can be used to increase the likelihood that any developing cancer will be diagnosed at an early stage so that treatment can begin. Camille sees her care workers every day as she lives in a care home. Share your ideas among the group.

Camille is at high risk of oral cancer Camille is at high risk of oral cancer. We need to design a system which can be used to increase the likelihood that any developing cancer will be diagnosed at an early stage so that treatment can begin. Camille sees her care workers every day as she lives in a care home. As a group, discuss which ideas might realistically be most helpful in Camille’s situation. Consider the advantages and disadvantages of each idea and select the three most relevant ideas.

Camille is at high risk of oral cancer Camille is at high risk of oral cancer. We need to design a system which can be used to increase the likelihood that any developing cancer will be diagnosed at an early stage so that treatment can begin. Camille sees her care workers every day as she lives in a care home. For each of the three ideas, spend five minutes as a group planning how it could be integrated into the existing healthcare system. Which activities would be needed for diagnosis? Which people are needed to achieve these? Which technology is necessary? What protocol could therefore be included in standard practice for the healthcare system?

CHALLENGE! Camille’s family now have enough time to look after her at home, so they have removed her from the care home. But they have no medical or dental expertise so would fail to identify an oral cancer if Camille developed one. How can the top three ideas be adapted to overcome this challenge?

COMMUNITY HEALTH WORKER MY RISK FACTORS MY FUNCTIONAL ABILITY Oral hygiene My family has very little money. We sometimes struggle to buy food. My parents don’t brush my teeth Meeting basic needs My mother completed primary school but then had to stop to help her mother at home. My father went to secondary school for three years. I was breastfed for six months after I was born, but it stopped my mother from being able to work at a stand selling food so she couldn’t feed me for longer than that. Now I mostly eat a maize-based food called sakora. Education Nutrition MY DEVICES My father has a basic mobile phone which he uses to hear about work. But it is expensive to send messages so he tries not to use it too much. DAVID Nobody in my family smokes. It would cost too much money. ABOUT ME My name is David and I am two years old. I live in Niger with my parents. I don’t have any brothers or sisters. My mother looks after me and sells food from the front of our house. My father does whatever work is available, but there is not much he can do. Tobacco use Basic mobile phone MY SYMPTOMS We often get toothache and swollen gums. But we don’t have our adult teeth yet so hopefully it will be better when they grow. Smartphone MAIN USE At Work For Personal Life Other Apps SMS Voice INCOME LITERACY TECHNOLOGY LITERACY PRIMARY HEALTH CARE CENTER COMMUNITY HEALTH WORKER ME & THE HEALTHCARE SYSTEM (10min) where do I go for medical treatment? Who do I interact with, and at what frequency? HOSPITAL MY SUPPORTS Who are the people I refer to and trust the most? Parents MY COMORBIDITIES Malnutrition, frequent infections

David is at high risk of developing noma David is at high risk of developing noma. We need to design a system which can be used to increase the likelihood of diagnosis at an early stage so that treatment can begin. David sees a community health worker for a check-up every month, but the community health worker has no knowledge of oral health conditions such as noma. In two minutes, write down by yourself as many ideas as you can for how David’s early-stage noma could be diagnosed using his healthcare system and the existing technology available. At this stage, it doesn’t matter how impossible or unfeasible the ideas are, the main aim is to think of as many creative ideas as possible.

David is at high risk of developing noma David is at high risk of developing noma. We need to design a system which can be used to increase the likelihood of diagnosis at an early stage so that treatment can begin. David sees a community health worker for a check-up every month, but the community health worker has no knowledge of oral health conditions such as noma. Share your ideas among the group.

David is at high risk of developing noma David is at high risk of developing noma. We need to design a system which can be used to increase the likelihood of diagnosis at an early stage so that treatment can begin. David sees a community health worker for a check-up every month, but the community health worker has no knowledge of oral health conditions such as noma. As a group, discuss which ideas might realistically be most helpful in David’s situation. Consider the advantages and disadvantages of each idea and select the three most relevant ideas.

David is at high risk of developing noma David is at high risk of developing noma. We need to design a system which can be used to increase the likelihood of diagnosis at an early stage so that treatment can begin. David sees a community health worker for a check-up every month, but the community health worker has no knowledge of oral health conditions such as noma. For each of the three ideas, spend five minutes as a group planning how it could be integrated into the existing healthcare system. Which activities would be needed for diagnosis? Which people are needed to achieve these? Which technology is necessary? What protocol could therefore be included in standard practice for the healthcare system?

CHALLENGE! The community health worker’s mobile phone breaks so that it can no longer be used. She still visits David but has no means of direct communication with other health professionals. How can the top three ideas be adapted to overcome this challenge?

M&E Indicators Discuss the potential indicators which could be used to access how effective the programme is at increasing early diagnosis of 1) noma and 2) oral cancer. List at least ten and then choose the three best ones for each disease. How could these three indicators be measured? Would it be measured at an individual or population level? What measurement tool would be used? How frequently would the indicator be measured? Who would be responsible for carrying out measurement? How would we ensure that the data was good quality?

Slides from earlier draft to follow (no longer relevant, just kept for reference)

ADVOCACY PROMOTION (10min + 10min) As a group, design an approach using SMS or social networks to improve the prioritisation of Oral Health in Agnès’ policymaking. What approach will you use? How will you ensure that the message reaches Agnès and other policymakers? What recruitment strategy would be best? Write down some draft ideas for messages that could be sent to policymakers like Agnès via your chosen method What messages will you send? How often will they be sent? What other factors need to be considered?