Parichaya - APCHI 2013, 25th September, Bangalore

© Himanshu seth

Parichaya
A Low-Cost Device to Increase Adherence Among
Tuberculosis Patients in Rural Assam

Himanshu Seth and Keyur Sorathia
APCHI-13, Bangalore | 26th September, 2013

© Himanshu seth

1#
INTRODUCTION

Some Statistics about Tuberculosis

WORLD | INDIA | ASSAM | KAMRUP | DOTS IN INDIA

© Himanshu seth

Statistics WORLD

Tuberculosis is world’s leading cause of death
from a single infectious disease.

http://en.wikipedia.org/wiki/File:Mycobacterium_tuberculosis.jpg
[TB INDIA 2012, Revised National TB Control Programme, Annual Status Report]

© Himanshu seth

Statistics WORLD

8.8 million

As per the WHO Global TB Report 2011, there
were an estimated 8.8 million incident cases of
TB globally in 2010….


© Himanshu seth

Statistics INDIA

India contributes to one-ﬁfth of the global
burden of Tuberculosis.


© Himanshu seth

Statistics INDIA

In 2009, out of the estimated global annual
incidence of 9.4 million TB cases, 2 million were
estimated to have occurred in India.


1

= 470000 people

© Himanshu seth

Statistics ASSAM & KAMRUP

Tuberculosis has been identiﬁed as one of the
major diseases prevalent in Assam.

[Indranee Dutta, Shailly Banwari, Health and Healthcare in Assam: A Status Report, 2007 ]

© Himanshu seth

Statistics ASSAM & KAMRUP

8%

Kamrup registered 8% growth in “suspects
examined per smears positive case diagnosed”
in 2010 compared to 2009

[RNTCP Case Finding and Treatment Outcome Performance, 1999–2010]

© Himanshu seth

Introduction DOTS IN INDIA

The antibiotics for curing TB are available
free of cost in India.

© Himanshu seth


7 pills for 6/8 months (Cat.-I/Cat.-II) 3 times a
week

© Himanshu seth


Patients are supposed to visit nearest DOTS
center for ingestion of medicines under
direct supervision.

© Himanshu seth


Based on interviews with healthcare workers

© Himanshu seth

2#
STUDY
A Contextual Enquiry in the Rural Kamrup District in Assam
OBJECTIVE | DEMOGRAPHICS | PARTICIPANTS | CONCLUSIONS

© Himanshu seth

Study GOALS

• 

• 

Understand existing situation
of incoherence of DOTS

• 


Investigating problems faced
by TB patients

Patient-professional
relationship

© Himanshu seth

Study GOALS

• 
• 


Access to diagnosis and
treatment
Social and family dynamics,
technology usage and Literacy
among the TB patients

© Himanshu seth

Study OBJECTIVE

The study was performed to gain insights in order
to propose new ICT interventions for
empowerment of TB patients.


© Himanshu seth

Study DEMOGRAPHICS

Moriyapati Health
Center A in Amingaon
NGPHC in Collegenagar
GMC in Guwahati

Bishnuram Medhi
Community Health
Center in HAJO

© Himanshu seth

Study PARTICIPANTS

`

The study consisted of 15 participants (comprising a mix of
healthcare workers, ASHA members, patients and family
members) at 3 community health centers and 1 sub-center.

© Himanshu seth

BLISHED

U
NDINGS P
FI

Findings and analysis of qualitative user study
of tuberculosis patients in rural Assam, India
Himanshu Seth, Keyur Sorathia

© Himanshu seth

Study CONCLUSIONS

Small, advised breaks of around 5 minutes, prior
to the ingestion of every pill


© Himanshu seth

Study CONCLUSIONS

Idle waiting time at health centers


© Himanshu seth

Study CONCLUSIONS


+
Idle waiting time at health centers
Opportunity for indulging the patients in serious
information knowledge sessions for spreading
awareness about the disease.


© Himanshu seth

Study CONCLUSIONS

No-low literacy level among the patients and their
family members


© Himanshu seth

Study CONCLUSIONS

family members
Lack of information mediums in
the health centers


© Himanshu seth

Study CONCLUSIONS

family members

+

Lack of information mediums in
the health centers

Introducing interventions for increasing information
awareness about the disease, ideally using regional
languages


© Himanshu seth

Study CONCLUSIONS

Role of peers/social groups and the social
importance of ASHA members


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Study CONCLUSIONS


Lack of basic knowledge about the disease


© Himanshu seth

Study CONCLUSIONS


Lack of basic knowledge about the disease

Insuﬃcient time with ASHA members to
supervise the ingestion of medication


© Himanshu seth

Patients have a mobile phone,
however are not well versed
with its functions.


Study CONCLUSIONS

© Himanshu seth

with its functions.
Phone is used as a shared
resource


Study CONCLUSIONS

© Himanshu seth

with its functions.

+

Phone is used as a shared
resource
The intervention should not use
mobile phone as a medium for
dispersion.


Study CONCLUSIONS

© Himanshu seth

3#
RELATED WORK

Some Interventions in the field of Tuberculosis

U-BOX | eCompliance | STOP TB Carnival

© Himanshu seth

• 

palm-sized, smart Pillbox

• 

Related Work U-Box

addresses to the problem of patients to
travel to providers to consume medicines

U-BOX

[Image from : http://www.appropedia.org/UBox_Electric_Pillbox_for_TB accessed on 10th September 2013 ]
[uBox, a Smart Pillbox for TB Treatment. http://innovatorsinhealth.org/solutions/pillbox.shtml ]

© Himanshu seth

• 

palm-sized, smart Pillbox

• 

Related Work U-Box

addresses to the problem of patients to
travel to providers to consume medicines

It allows the patients to take the medicine
themselves, which according to DOTS
program in India, is not allowed

U-BOX

[Image from : http://www.appropedia.org/UBox_Electric_Pillbox_for_TB accessed on 10th September 2013 ]
[uBox, a Smart Pillbox for TB Treatment. http://innovatorsinhealth.org/solutions/pillbox.shtml ]

© Himanshu seth

• 

uses a combination of biometric
and mobile technology to
enhance TB treatment

• 

Related Work eCompliance

uses fingerprints to verify the
presence of patients during the
treatment

eCompliance

[Image from : http://www.opasha.org/our-work/ecompliance-innovation-and-health/ accessed on 10th September 2013 ]
[Batra, S., Ahuja, S., Sinha, A., & Gordon, N. (2012). eCompliance: Enhancing Tuberculosis Treatment with Biometric and Mobile Technology. Proceedings
of M4D 2012 28-29 February 2012 New Delhi, India, 28(29), 36. ]

© Himanshu seth

Related Work eCompliance

Focuses primarily on therapy monitoring.

Doesn’t, however focuses on increasing information awareness
about the disease, which would not only motivate patients but will
also ensure their adherence to the therapy

[Image from : http://www.opasha.org/our-work/ecompliance-innovation-and-health/ accessed on 10th September 2013 ]
[Batra, S., Ahuja, S., Sinha, A., & Gordon, N. (2012). eCompliance: Enhancing Tuberculosis Treatment with Biometric and Mobile Technology. Proceedings
of M4D 2012 28-29 February 2012 New Delhi, India, 28(29), 36. ]

© Himanshu seth

Related Work STOP TB Carnival

CD-ROM based campaign by MDR-TB
partnership to create awareness on TB
among children through edutainment
and games

STOP TB Carnival

[Image from : http://www.freedomtb.org/games/StopTB_Carnival.html accessed on 10th September 2013 ]
[STOP TB Carnival http://www.freedomtb.org/games/StopTB_Carnival.html, April 19, 2013. ]

© Himanshu seth

ISSING?

M
O WHAT ’S
S

Study CONCLUSIONS

The problems of unawareness and ignorance of patients towards
important disease-related information, resulting in demotivation
to TB adherence are not yet addressed through an ICT
Intervention.


© Himanshu seth

ISSING?

M
O WHAT ’S
S
Also

Study CONCLUSIONS

We are unaware of an existing solution that addresses the problem
of unawareness combined with therapy monitoring for TB patients
in the low-income and low-literate rural communities of India.


© Himanshu seth

R STAND !
OU

Study CONCLUSIONS

We believe that introducing interventions addressing to
unawareness will increase motivation of Tuberculosis patients, in
turn increasing their self initiated inclination towards DOTS
therapy and subsequently curing of the disease.


© Himanshu seth

4#
PARICHAYA
A Low-Cost Device to Increase Adherence
Among Tuberculosis Patients in Rural Assam

SYSTEM OVERVIEW | DESIGN SPECIFICATION | CONTENT | PROTOTYPING

© Himanshu seth

Parichaya SYSTEM OVERVIEW

Parichaya is a low cost medical kit for increasing the
adherence towards TB therapy, which makes the
patients aware about the disease combined with
supervising the therapy.


© Himanshu seth

Parichaya OVERVIEW

It takes advantage of the idle time of the
patients while ingestion of medicines due to
small-supervised breaks/gaps between
every pill.


© Himanshu seth

Parichaya OVERVIEW

E FOR CATEGORY - I

DOTS REGIM

7 pills every
alternate day X


6 months

© Himanshu seth

E FOR CATEGORY - I

DOTS REGIM

Parichaya OVERVIEW

Parichaya replaces the conventional medicine blister packs for Category-I patients for the first
month of their medication.

© Himanshu seth

Parichaya OVERVIEW

The medical kit being devoid of any video
interface, is very cheap to manufacture and
can be assembled easily by ASHA members/
health staﬀ for successive days, without any
technical know-how.


© Himanshu seth

PARICHAYA | Working

© Himanshu seth

Parichaya SCENARIO

© Himanshu seth

INSPIRATION

Parichaya DESIGN SPECIFICATION

Inspired from Bioscopes, very famous
in rural parts of Assam

The medical kit is made up of two
circular discs attached to each other at
the center.
Uses the metaphor of narrating a story
through moving pictures, viewed from
a circular cavity.
http://www.thehindu.com/features/cinema/a-peep-into-the-bioscope/article2984651.ece

© Himanshu seth


Numerals and hierarchy in
the form of size diﬀerence &
appearance sequence
facilitates navigation in
icons.
2


© Himanshu seth


The bigger circle depicts a
broader category of
information, whereas smaller
circles denote the category
specific information.
2


© Himanshu seth

ion
uce the risk of illustrat
Red
misunderstanding


Audio captioning for the illustrations to reduce the risk of
misunderstanding


© Himanshu seth

ion
uce the risk of illustrat
Red
misunderstanding


Audio captioning for the illustrations to reduce the risk of
misunderstanding
Numbered push buttons below the illustrations to play the
respective audio


© Himanshu seth

About illustrations


Graphics/illustrations of the course were drawn in accordance of
the culture and social norms of Assam.


© Himanshu seth

About illustrations


Graphics/illustrations of the course were drawn in accordance of
the culture and social norms of Assam.
Hand drawn illustrations in the form on line drawings
[Medhi,
I.,
Prasad,
A.
and
Toyama
K.
Op:mal
audio-‐visual
representa:ons
for
illiterate
users.
Interna:onal
World
Wide
Web
Conference,

Canada,
(2007),
873-‐882.
]


© Himanshu seth

Parichaya CONTENT

The course module of the medical kit for 12 medication days is
based on that used in STOP TB Learning Zone included in STOP TB
Carnival package.

[Image from : http://www.freedomtb.org/games/StopTB_Carnival.html accessed on 10th September 2013 ]
[STOP TB Carnival http://www.freedomtb.org/games/StopTB_Carnival.html, April 19, 2013. ]

© Himanshu seth

Parichaya PROTOTYPING

USB Recording Module-300 Second
was used to implement audio
feedback for illustrations.
Average length of audio - 55
seconds on each push button


© Himanshu seth

“ Patients will get attracted to use this device and will
come regularly just to use it.”
“ By using this the patients won’t waste their time during
the medication.”


© Himanshu seth

“ Patients will get attracted to use this device and will
come regularly just to use it.”
“ By using this the patients won’t waste their time during
the medication.”

“ This very informative and by using this I will be able to
take precautions.”
“ It is entertaining and fun to use.”

© Himanshu seth

CONCLUSION

Parichaya, is an attempt to introduce an ICT intervention that
addresses the problem of unawareness combined with therapy
monitoring for TB patients in the low-income and low-literate rural
communities of Assam.


© Himanshu seth

FUTURE WORK

Initial evaluation of the medical kit has brought out positive
feedback from the field.

In future we are preparing for an extensive pilot study in Kamrup
district.


Parichaya - APCHI 2013, 25th September, Bangalore

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