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From Solution Traps to Solution Patchwork: Easing Tensions in Designing Digital Health in the Global Context.

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Empowering Community Health Workers With Scripted Medicine: Design Science Research Study.

Dario Staehelin1,2, Damaris Schmid2, Felix Gerber3,4,5

  • 1Department for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland.

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Summary

Scripted Medicine empowers community health workers (CHWs) with medical and counseling knowledge via algorithms and social scripts. This novel approach addresses healthcare worker shortages in the Global South by enabling CHWs to take on broader noncommunicable disease care responsibilities.

Keywords:
Scripted Medicinealgorithmic managementcollaboration engineeringcommunity health workerscommunity-based health caredigital healthempowermentmHealthmobile healthtask shifting

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Area of Science:

  • Health Services Research
  • Digital Health
  • Human-Computer Interaction

Background:

  • Global health systems face a projected shortage of 14 million health workers by 2030, disproportionately impacting the Global South.
  • Community health workers (CHWs) offer a potential solution to mitigate professional healthcare worker shortages, particularly in noncommunicable disease (NCD) care.
  • Existing challenges in task-shifting NCD services to CHWs include high attrition rates and variable performance, often linked to inadequate organizational support.

Purpose of the Study:

  • To develop and evaluate 'Scripted Medicine,' a novel approach designed to empower CHWs to assume expanded roles in NCD care.
  • To leverage medical algorithms and ThinkLets (social scripts) to impart essential medical and counseling knowledge to CHWs.
  • To address structural issues in community-based healthcare and facilitate task-shifting through insights from collaboration engineering.

Main Methods:

  • A design science research approach was employed to implement a mobile health-supported, community-based intervention in Lesotho.
  • Medical algorithms and ThinkLets were developed based on collaboration engineering and algorithmic management literature.
  • A field study within the ComBaCaL project involved 10 newly recruited CHWs, including 2 weeks of training and 12 weeks of field experience, with data collected through surveys, interviews, and observations.

Main Results:

  • Scripted Medicine effectively transferred necessary medical and counseling knowledge to CHWs using medical algorithms and ThinkLets.
  • Medical algorithms significantly enhanced CHWs' perception of structural empowerment, while ThinkLets positively influenced their psychological empowerment.
  • Variations in CHW perceptions between the two districts underscored the critical role of cultural and economic context in intervention effectiveness.

Conclusions:

  • Scripted Medicine is proposed as an innovative strategy, drawing from collaboration engineering and algorithmic management, to empower CHWs.
  • This approach expands the scope of mobile health-supported community-based healthcare by integrating both medical and counseling expertise into social interactions.
  • Scripted Medicine empowers CHWs to manage broader responsibilities, offering a viable solution to the escalating shortage of healthcare professionals in the Global South.