Linearity of Expectation (LoE)

mHealth Reality Booth (#131)

noreply@blogger.com (James BonTempo) — Fri, 02 Dec 2011 19:14:00 +0000

Some of the top organizations and corporations working in the mobile technology and health space will gather December 5–7 at the mHealth Summit near Washington, D.C. The summit program offers several tracks and a wide range of sessions and exhibits for just about anyone interested in mobile technology and health.

A few months back, Linda Raftree and I came up with the idea to co-host a “Reality Booth” at the Summit.

Innovative business models are great. New behavior change communication technologies open huge opportunities. Mobile tools to help health professionals build capacity to improve healthcare systems sound like a dream come true. But what happens during implementation? What are the real life barriers and challenges that practitioners face when implementing programs with an mHealth component? Where can you get some honest answers?

The Reality Booth is a place for practitioners working in rural settings or implementing programs in ‘developing’ countries to connect with others working in similar situations and facing comparable challenges. It offers a space to share and learn from peers who implement mHealth programs on the ground and to get advice on resolving the kinds of difficulties that probably won’t be highlighted during the official presentations.

We’ve invited some of the most respected mHealth practitioners to attend the booth for an hour or 2, and are pleased to mention that we’ll have some fantastic folks joining us. (We’re filling our last few remaining slots, so stop by booth number 131 for the full schedule on Monday!)

Come and share your mHealth reality stories, ask your implementation questions and get some practical or strategic advice from:

Monday, Dec 5
11:15-12:00 Isaac Holeman
12:00-1:00 Heather La Garde
1:00-2:00 David Isaak
2:00-3:15 David Cantor
4:30-5:30 Pamela Riley

Tuesday, Dec 6
2:00-3:30 David Cantor
3:30-5:00 Neal Lesh

Wednesday, Dec 7
10:00-11:00 David Isaak

We’re also planning to make a short video on ‘mHealth Realities,’ so stop on by if you have a ‘reality story’ to share.

The Reality Booth is co-hosted by MCHIP, USAID’s flagship maternal, newborn and child health program, and Plan International USA, one of the oldest and largest children’s development organizations in the world, and co-coordinated by James BonTempo of Jhpiego and Linda Raftree of Plan International USA. Contact James (JBonTempo@jhpiego.net) or Linda (Linda.Raftree@planusa.org) for more information.

In addition to the Reality Booth, we’re hosting ICT4Drinks at Thai Pavilion from 5.30-7.30 on Tuesday, December 6. Meet and mingle with your fellow mHealth practitioners! Free drinks for the first folks in the door and fantastic Thai munchies for everyone!

Provider-level supply side elements of doing

noreply@blogger.com (James BonTempo) — Sun, 17 Apr 2011 15:12:00 +0000

My wife likes to make fun of me for having a whiteboard in my "man cave." She thinks I'm a total nerd. And I am. Anyway, while trying to free up space--rearranging and rewriting some things, including a diagram re: instructional design as user experience design--I found myself inspired to draw this "elements of doing" diagram:

Six provider-level supply side elements of doing

I've considered similar things before (e.g., see Clinical decision-making, a behavioral economics perspective) but this is a little different because it goes beyond making a decision to actually doing (i.e., putting that decision into practice). The six elements I came up with--and there are probably more I haven't thought of--are: capacity, motivation, tools & materials, time, rights, demand.

I was going to provide more detail about each element but, as I started to write everything out, it seemed unnecessary: they all seem pretty self-explanatory to me (but be sure to let me know if they're not).

I'm sure this is nothing new; my ignorance of writing, academic or otherwise, on this subject making me think it's somehow unique. If you can point me to any existing articles, essays, books, etc., please do!

What I Didn't Know Yesterday #62: Why mLearning & ICT4E in general is hard

noreply@blogger.com (James BonTempo) — Thu, 10 Mar 2011 04:19:00 +0000

MobileActive has written a piece about mLearning and how it hasn't seemed to live up to it's potential (hype?). As I thought about this a thought occurred to me: learning isn't transactional and that may have something to do with it.

Take mBanking -- it's pretty simple. Money goes in, money gets transferred, money gets withdrawn. Easy. Or even healthcare. Steps in a protocol are followed, data is collected, diagnoses are determined, treatments are administered, you wait to see how the patient responds, then repeat. There are a wide set of possibilities but, still, it's a pretty straightforward process.

Health service provision is really just pattern recognition -- recognizing symptoms and treating them appropriately (maybe my father-in-law, a philosophy professor and playwright, is on to something when he says an M.D. is just a glorified professional degree :P). And banking is just storing and transferring information. Both things that ICTs are particularly well suited for.

But learning is anything but straightforward. It's certainly more than data collection, transmission or computation. And maybe that's why it's so difficult to find appropriate applications of ICT that will really effectively facilitate the process. I don't know, I'm just thinking out loud here...

What I Didn't Know Yesterday #66; Sometimes you know more than you realize

noreply@blogger.com (James BonTempo) — Thu, 10 Mar 2011 03:28:00 +0000

Sometimes you have more knowledge & expertise wrapped up in your head than you realize. And it simply takes the the right, probing questions to pull it out. I guess it's somehow related to my realization that teaching can potentially be more like facilitation (i.e., getting your learners to share their knowledge and effectively provide the necessary learning content by asking the right questions and guiding the conversation).

What I Didn't Know Yesterday #65: Everyone's looking to ICT

noreply@blogger.com (James BonTempo) — Tue, 08 Mar 2011 03:45:00 +0000

Today I attended a briefing at the World Bank on a report detailing what the future of health professions education around the world should look like. I was surprised to hear presenters make references to ICT, mobile technology and open educational resources. And not only that, one presenter actually called for the "aggressive use" of technology to support and transform education. I guess it's just nice to hear such respected non-techies make reference to the importance of and need for technology in the company of so many important decision makers. It makes me feel like my work is worthwhile. Now if only my colleagues were convinced of that, too...

What I Didn't Know Yesterday #61: Nintendo, it's like riding a bike

noreply@blogger.com (James BonTempo) — Mon, 07 Mar 2011 02:09:00 +0000

Today I joined some colleagues at Mr. Yogato. It's a frozen yogurt place near our office. But that's not the important part -- they have an old school (though 3rd generation) Nintendo set up there with a stack of games. Among them is Mike Tyson's Punch-Out. I popped that cartridge in and the next thing you know I was KO-ing Glass Joe & Von Kaiser like I was still 14 years old! Talk about muscle memory :P I'm going to have to go back and play when I have more time. But maybe next time I'll throw in Mega Man (also in that stack of games) instead...

What I Didn't Know Yesterday #63: Smalltimore

noreply@blogger.com (James BonTempo) — Mon, 07 Mar 2011 02:08:00 +0000

My friend Alan -- we went to college together almost (gasp!) 20 years ago and we haven't see each other in about 10 -- came to Baltimore for a party at his wife's friend's place. Her name is Ethel and she was a resident at University of Maryland. It turns out she knows a friend of ours, Eric, who is also a resident there. Then the twin sister of someone that I used to work with at Jhpiego showed up: her daughter was a clinical mentor for Ethel. And it turned out that two of the women that came with her live two blocks down the street from us. Sometimes the city can really start to feel like a small town.

What I Didn't Know Yesterday #64: Home improvement is never done

noreply@blogger.com (James BonTempo) — Mon, 07 Mar 2011 02:08:00 +0000

The problem with home improvement is that once you start doing it you realize there's a lot more that could be done. I started with fixing a crack in one of our plaster walls. Then I noticed there were these remnants of a baby gate from the previous owner that I wanted to remove (which required more plaster work). Then while painting over the fixed plaster I noticed the banister could use some paint. Then I noticed there was a small hole in the wall in the kitchen that needed to be filled (and then painted). Then...

What I Didn't Know Yesterday #60: Not every opportunity can/should be taken

noreply@blogger.com (James BonTempo) — Fri, 04 Mar 2011 12:48:00 +0000

Today I was presented with a really interesting opportunity. Someone had actually sought me out with a decent offer, as opposed to the other way around (I'm usually the one approaching others with ideas). The unfortunate thing was that there was no way we could take advantage of this opportunity -- the timeframe was just too tight and our in-country staff already too overburdened to make room for more work.

It was one of those times when it becomes clear that not every opportunity can be seized. And I would add that even if an interesting opportunity can be accommodated for it doesn't automatically mean that it should be. As with all other business decisions, this sort of decision needs to be made in the context of many other things, not just time & staff availability -- most importantly, your vision, mission and organizational objectives.

What I Didn't Know Yesterday #60: Qualcomm

noreply@blogger.com (James BonTempo) — Thu, 03 Mar 2011 03:14:00 +0000

Today I attended Dr. Irwin Jacobs's (co-founder of Qualcomm) Blumenthal Lecture (and award ceremony) at Johns Hopkins University's Whiting School of Engineering. He shared with the group in attendance the story of Qualcomm's beginnings and how the team overcame adversity and skepticism to become one of the world's biggest and most successful technology companies. And I was particularly happy when he gave significant exposure to the Wireless Reach initiative -- a program to bring the power of mobile and wireless technologies to aid underserved communities around the world. Perhaps someday I'll be lucky enough to work with the team at Qualcomm to apply the power of ICTs to some of the most pressing development issues...

What I Didn't Know Yesterday #59: Is mobile penetration higher than we think?

noreply@blogger.com (James BonTempo) — Tue, 01 Mar 2011 20:15:00 +0000

In the article, Are Mobile Phone Penetration Rates in Sub-Saharan Africa Really As Low As They Seem?, Russell Southwood makes the case that mobile penetration among adults in sub-Saharan Africa (SSA) may actually be incredibly high. Here's why...

Current penetration rates are calculated as a percentage of the total population but in many SSA countries those under 15 make up a sizable portion of the population. Recalculating mobile penetration against the percentage of the population over 15 (i.e., the "addressable market") can change the figures dramatically. For example, in Liberia, in 2009, the mobile penetration rate calculated as a percentage of the total population was 31% but a recalculation based on the proportion of the population over 15 pushed the number to 60% -- almost twice as high as originally thought.

So, what's the relevance to ICT4D? Chances are mobile ownership and access in many countries -- even outside of SSA -- is even higher than we think, especially among adult target populations, making mHealth and mLearning interventions even more feasible and desirable.

What I Didn't Know Yesterday #58: Categorizing the computer nerds

noreply@blogger.com (James BonTempo) — Mon, 28 Feb 2011 23:10:00 +0000

Some time ago I stumbled across the ACM's Computing Curricula 2005: The Overview Report, but I hadn't gotten around to reading through it. Well, I finally had a chance to check it out today and it was actually really helpful. It gives a rather clear description of the difference between undergraduate programs in computer engineering, computer science, information systems, information technology, and software engineering. And it describes them both in terms of content covered in a program as well as the competencies students will develop.

I didn't study any sort of computing as an undergraduate -- I have a BS in Biology -- but I did my graduate MS work in computational linguistics. And I have over 15 years of practical experience in ICT across various fields. Applying the criteria from the report, I'd say I'm equal parts software engineer and information systems person, with a little bit of computer science (from graduate school) and information technology (from a few years doing technical support) thrown in for good measure :)

What I Didn't Know Yesterday #57: The craft fair is cool

noreply@blogger.com (James BonTempo) — Sun, 27 Feb 2011 07:14:00 +0000

The craft fair in Baltimore is pretty cool. Alex and I went down there to see some friends of her family that had a booth there. Their work (silk scarves) was great and there was a lot of interesting stuff there. It may have even been worth the $14 per person :P

What I Didn't Know Yesterday #56: Give up, move on

noreply@blogger.com (James BonTempo) — Sun, 27 Feb 2011 07:11:00 +0000

I still don't think I've learned when to give up an idea. I often argue a position, sometimes with really good evidence, but afterward I realize it wasn't worth the effort. If people are that dead-set against you from the start, maybe it's not worth the fight. Maybe you should just move on. Somebody else will probably take you up on it...

What I Didn't Know Yesterday #55: Everett Rogers, meet Kentaro Toyama

noreply@blogger.com (James BonTempo) — Fri, 25 Feb 2011 05:45:00 +0000

[BTW, I use the "!" convention from coding to mean "not." So, for example, "!capacity" means "without or lacking capacity." Sorry, once a coder always a coder :) In the whiteboard image below I use the negation symbol from mathematical logic that I don't have access to on my iPhone keyboard.]

While talking with a colleague about behavior change (a topic I find thoroughly fascinating) I realized he was drifting dangerously close to Toyama-esque "capacity and intent" territory. And as we chatted I found myself drawing a two-by-two square with capacity and !capacity down the side and intent and !intent across the top.

What we realized is that the initial behavior change will be realized in the upper-left quadrant were capacity and intent exist. Then I asked, "What's easier, developing capacity or intent?," to which my co-worker said "developing capacity." So, we decided that change would occur next in the lower-left quadrant where intent existed but capacity did not. After that comes the upper-right quadrant where capacity exists but intent does not. And, finally, the lower-right quadrant where neither capacity nor intent are present.

But, while this work with the quadrants was happening I was also drawing another picture -- Everett Rogers' diffusion of innovations curve. I couldn't help myself and suddenly realized the link between Toyama and Everett...

Capacity and intent = innovators and early adopters.
!Capacity but intent = early majority.
Capacity but !intent = late majority.
!Capacity and !intent = laggards.

What do you think, can we map Toyama's "capacity and intent" ideas to Everett Rogers' diffusion of innovations in the way I've done here?

What I Didn't Know Yesterday #54: Need != desire

noreply@blogger.com (James BonTempo) — Thu, 24 Feb 2011 23:22:00 +0000

I was at a meeting this morning and people were talking about designing mHealth interventions that met a known need. But I felt compelled to speak up and add that while needs are important, so are desires. In fact, I'm not sure which one is more powerful and has more of an effect on the potential success of a project. All I do know is that the two are not the same, and when they're not aligned you can run into significant implementation challenges.

What I Didn't Know Yesterday #53: Watson to tackle healthcare

noreply@blogger.com (James BonTempo) — Wed, 23 Feb 2011 04:48:00 +0000

I guess now that IBM's Watson AI has won Jeopardy it's time to put the technology to better use. The next frontier? Healthcare and clinical decision-making. I guess it makes sense seeing as most clinical diagnoses are actually the result of pattern recognition and data mining. Now, if they could compress the same system so that it would fit on a phone -- maybe an Android device -- that would be awesome. I imagine it's only a matter of time...

What I Didn't Know Yesterday #52: A recipe for eHealth success

noreply@blogger.com (James BonTempo) — Tue, 22 Feb 2011 04:23:00 +0000

To those of us who have been working in systems development for a long time none of this really comes as too much of a shock -- we've always known it intuitively. But it can be rather useful when someone puts a structured framework around one's implicit approaches. That's what I found today in an article about the barriers to implementing eHealth initiatives. The four major categories of stumbling blocks based on the normalization process theory used in the analysis: disruptions to provider-client interactions (existing work flows), challenges to relationships between groups and cadres (established roles and responsibilities, hierarchies), incongruence with skill set (technological capacity), and divergence with organizational goals, leadership and resources (operating environment). I think at one time or another I've run into all of these -- sometimes more than one at the same time! You'd do well to keep your eye out for them and do your best to plan ahead for their eventuality...

What I Didn't Know Yesterday #51: The US federal budget - be informed!

noreply@blogger.com (James BonTempo) — Mon, 21 Feb 2011 04:50:00 +0000

There's actually some fairly accessible material online that will allow you to get a decent idea of what, at a high level, the government spends all of our money on. As a first step, check out the budget Summary Tables for FY11. This information is particularly relevant as we wade into a budget showdown that could result in the temporary shutting down of the government. It's been a while since we had to do that...

What I Didn't Know Yesterday #50: Check the date

noreply@blogger.com (James BonTempo) — Mon, 21 Feb 2011 04:40:00 +0000

Before you drive across town and park in an expensive car garage make sure that the event you're headed to isn't actually slated to start the next day. We were supposed to meet a Huff family friend at the big craft fair in the Convention Center, but we got all the way down there to find the thing didn't actually start until tomorrow! it doesn't hurt to check your tickets before you leave the house ;) Good thing the play we went to later was actually happening...

What I Didn't Know Yesterday #49: eHealth, what is it good for?

noreply@blogger.com (James BonTempo) — Sat, 19 Feb 2011 15:36:00 +0000

As published in a PLoS Medicine systematic review of systematic reviews of eHealth interventions last December, there really isn't a lot of evidence out there to suggest that they (e.g., EHR, CPOE, CDSS, etc.) lead to significant improvements in health service quality and/or safety. In fact, in some cases, the experience of implementing an eHealth system actually created more challenges than previously existed. And the downward spiral of ICT4D criticalness continues...

What I Didn't Know Yesterday #48: Roll with it

noreply@blogger.com (James BonTempo) — Fri, 18 Feb 2011 05:04:00 +0000

Things change. A lot. Especially when you're talking about an ICT4D project that you're leading remotely, from half-way around the world. We have a team on the ground, but sometimes it's so hard to get them to focus on the work we need them to do. And it seems they enjoy changing up the way they do things, almost on a whim -- which is really nerve-racking when you're trying to conduct research and need consistency in data and approach in order to be able to do an effective analysis later on. In the end, I'm doing my best to roll with it and be flexible enough to change up the plan on-the-fly (as long as ultimately we can still achieve our initial objectives).

The best laid plans...

What I Didn't Know Yesterday #47: Explaining mHealth has gotten a lot easier

noreply@blogger.com (James BonTempo) — Thu, 17 Feb 2011 03:38:00 +0000

Today I co-facilitated an mHealth session for MCHIP grantees as part of a multi-day meeting on operations research. What I was struck with afterwards was that as we went through our presentation I was easily able to slot in very specific examples for different types of interventions. When I started doing this two or so years ago with my partner-in-crime, David Cantor from ICF, we didn't necessarily have many really solid examples to back up the range of potential applications we wanted to cover. I guess that just means we've come a long way in a short time. And that's great because all these ideas become more meaningful and grounded when there are very specific examples to back them up.

What I Didn't Know Yesterday #46: Teaching can really be facilitating

noreply@blogger.com (James BonTempo) — Wed, 16 Feb 2011 04:01:00 +0000

Today I taught a session for a course at Johns Hopkins University on eHealth and mHealth in lower- and middle-income countries. The specific focus was on mHealth and technology "readiness." But that's not the interesting part.

I decided to approach this like other adult learning situations and provide plenty of opportunities for participants to bring their own experiences and ideas to the session. Well, it worked out pretty well and I spent most of the time simply guiding the conversation, providing opportunities for students to share their thoughts, giving feedback and building on ideas, answering a few questions along the way, and filling in gaps where necessary. But the session was really driven by the students themselves.

I've read many times about how the role of the teacher needs to change to be more one of facilitator and guide and how the teacher shouldn't be the "sage on the stage." But today was my opportunity to get some experience with the approach in a university setting rather than with practicing faculty, clinicians and technologists. And I'm happy to say that it works!

I think the session went very well and there was great participation from the students. I hope they got something out of it -- I know I did!

Oh, BTW, Kentaro Toyama came up yet again. I framed the "capacity and intent" idea as one of "readiness" -- the idea being that you're more likely to have a successful ICT intervention if the stakeholders and users have the necessary abilities and the desire to effectively participate. In some sense, being "ready" means that your users are competent and motivated and in a position to leverage the opportunity of technology.

What I Didn't Know Yesterday #45: The cure for what ails you

noreply@blogger.com (James BonTempo) — Tue, 15 Feb 2011 03:42:00 +0000

A good hug is a powerful thing -- it can make everything alright.