Integration of Decentralized Data of Community Health Activities in Thailand by Using a Tablet Data Entry System Ota, Katsumasa Nagoya University Arakawa, Naoko Nagoya University Ishikawa, Masatoshi Tokyo Seitoku University Matsuda, Masami Tokyo Kasei-gakuin University Hara, Shoichiro Kyoto University

Introduction Amazing improvement of primary health care in Thailand from 1990’s to 2000’s ◦ 2002, the introduction of community health nurses: CHN facing with primary care ◦ 2005, the start of decentralization which facilitates reform of community health care and nursing ◦ 2008, the start of Healthy Tambon Project that deals with aging society and health risks caused by lifestyle related disease ◦ 2009, the start of TCNAP project (M. Matsuda, 2013)

Village Primary Care Unit ： PCU Community Hospital （ Connecting Unit Primary Care : CUP ） A hospital B PCU Nurses:3 Health Volunteers:30 D village Residents: 3000 E Village Residents: 2500 F Village Residents: 4000 C PCU Nurses:4 Health Volunteers:48 G Village Residents: 6500 H Village Residents: 4000 Structure of community health care in Tambon The number of nurses working in PCU is limited. Therefore, they cannot deliver health care service to all residents in several Tambons. CHNs are supported by Health Volunteers who live in communities regarding follow-up and collection of necessary health information. Example of community health in the north east of Thailand (2011)

Medical records of residents regarding disease are recorded on network system that connects between each PCUs and a community hospital.

Family Health Records Family structure Health related data Life style information Home environment, et. ct. recorded by CHNs

Activities of Health Volunteers  Home visit of residents (Measurement of Blood pressure, Blood sugar, Body weight)  Transportation of patient to the hospital  Support of health guidance and Self-help groups Their information are essential for CHNs to follow-up critical residents and to assess health status of residents Health Volunteers collet many valuable health information of each resident through their daily activities

Health Volunteer Ledger (book) Each HV covers about 7 to 18 families. Those family data are recorded on this ledger by them. If there happen some problems, HV soon calla at / refers to the supervisor(CHN) by mobile phone. However, in general these records are reported to the supervisor(CHN) only once or twice in year. Health Volunteer Ledger (book) Each HV covers about 7 to 18 families. Those family data are recorded on this ledger by them. If there happen some problems, HV soon calla at / refers to the supervisor(CHN) by mobile phone. However, in general these records are reported to the supervisor(CHN) only once or twice in year.

Health Volunteer Ledger (book)

Problems in HVs information The burden of CHNs caused by sudden and immediate call by HVs The loss and dispersion of data related to their home visits of residents Time lag in information sharing

Preparation for this study Identification of actually collected information/data in community health activities 54 information/data from Mar survey Selection based on frequency of collection and necessity out of 54 information / data 5 FGIs with 8 CHNs and 27 HVs in 5 PCUs in Aug  Most of the information were actually collected by HVs.  Actively shared information with CHNs was limited.

Design of Interface of iPad (1) Refinement of items ◦ Categories of items of 55 items  demographics  health status and disease  medical treatment  family structure  economic condition  housing condition  hygiene condition

Design of Interface of iPad (2) Along with longitudinal and latitudinal data, we made a prototype data entry system on iPad. Data base is based on FileMaker Pro Client interface is FileMaker Go

Structure of data entry system

[B] 1. List of Family 24

[B] 1. List of Family 25 Back to 0. main menu (Page 12 ) Add new data (Page 14 ) Move to details of selected family (Page 14 ) Delete each record (a family)

[C] 2. Family (1)

27 Back to 0. main menu (Page 12 ) Back to [B] 1. List of Family (Page 13 ) House location measurement by GPS Move to [D] 2. Family (2) (Page 15) Move to [E] 2. Family (3) (Page 16) Add new person (Page 17) Delete a person. Move to details of selected person data (Page 17)

[E]2. Family (3) 28 Family of the Google Map

[D] 3. Person

Methods Participants: 22 HVs and nine CHNs in 4 PCU (Tambon) in the North East part of Thailand Instruction in data entry using iPads: 60 to 90 minutes Questionnaire inquiring (1) usability and availability of the system and (2) necessity of each item Conducted on March 2013

Usability and Availability CHNs: Total 28.3 points HVs: Total 26.5points They were highly satisfied with / expect this iPad data entry system.

Unnecessary Items CHNs: only 2 items regarding residents’ room ◦ Other items than these 2 items are necessary HVs: no item is unnecessary / all items are necessary

Family place Next visit Photo of disease

Discussion This study showed that a simple data entry system with spatio-temporal data could improve data collection and use for health- care activities, despite the limited computer literacy of HVs. However, more simpler data entry system must be better. “Smart-phone” version is desired.