This time the text messages received were not to promote offers, events, parties, or invite recipients to vote in a television or music contest.
They were something else. A presence that seeks to accompany, offer confidence, tear down myths and fears, teach... a tone sounding support.
Nursing graduate and Master in Health Informatics Xaily Gavilondo Mariño is convinced. Speaking to Granma International, she shared the results of research involving technologies in care management, specifically of people living with HIV.
According to the assistant professor at the National School of Public Health, and deputy coordinator of the Cuban Nursing Informatics Network, “If there is one element that has encompassed almost all areas of human interest, it is precisely information and communication technologies, which in this case have become essential facilitators, and health has not been left out of this process.”
Who can deny how revolutionary innovations - such as digital microscopes, computerized axial tomography, or the laser scalpel - have turned out to be for the functioning and quality of healthcare services, to give just a few examples.
Electronic health (eHealth) applications are among the most widely used today, many of which are well known and used in Cuba, the interviewee explained, noting, “This is not the same case with mobile health (mHealth), which as a way of accessing population sectors remains little studied.”
The World Health Organization (WHO) defined the term eHealth in 2005 as “the cost-effective and secure use of information and communication technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education.”
Herein lies the novelty of the research we have developed, Gavilondo noted, as mobile health is one of its key focuses.
In a review article, published in the Revista Cubana de Enfermería, Vol.32 No. 1, January-March, 2016, entitled “Mobile Health: Challenges and prospects for application in Cuba,” authors Gavilondo and researcher María Niurka Vialart Vidal highlight that “Mobile Health is recognized as an alternative of proven effectiveness to address subjects of interest to health professionals and the recipients of their services. In Cuba, despite the fact that ideal conditions do not exist for its full exploitation, it is possible to introduce the variant of a health issues text messaging service.”
Based on this assessment, the authors proposed a nursing intervention aimed at using mobile health techniques in care management, for people living with HIV/AIDS, as this is “a chronic disease that in Cuba has a high survival rate, where the ages of highest incidence coincide with those of greatest cell phone use, reported at the international and national levels.
“Following diagnosis, people living with HIV/AIDS must acquire new lifestyles that contribute to their well-being and safety, and also that of those with whom they interact. Health personnel, specifically nursing staff, can not neglect this process of relearning of lifestyles, which will from this point onwards be permanent for each patient,” the authors emphasize in the same article.
The two researchers note that in Cuba there are different programs for the prevention and treatment of HIV/AIDS, beginning at the primary care level (counseling services, family planning consultations, preconception risk, etc.) with procedures rigorously and constantly monitored. They also point out that the country has a center dedicated to controlling the spread of this pandemic, the National STI/HIV/AIDS Prevention Center, with over a decade of experience and internationally recognized results.
HELP IS JUST AN SMS MESSAGE AWAY
“The introduction of mHealth in the work of health teams does not replace in any way the traditional methods of approaching these patients, on the contrary, it provides a new way of acting that contributes to greater proximity between nursing professionals and patients with HIV/AIDS through the use of ICT,” the article continues.
What was just a year ago an initiative or proposal, has materialized in a new study that has already borne fruit.
This non-traditional research, using technology as a support, “was based on the search for cognitive needs, that is, what to learn from people living with HIV, regarding how they take care of themselves once they are diagnosed with the disease,” Gavilondo explained.
These patients must modify their lifestyles, taking care of their health, while these experiences will serve them throughout their lifetime, as such: “This search for needs could not be self-directed by researchers, in terms of I’ll tell you what you need to know, but rather these same people must express what they need to know,” the interviewee clarified.
Hence, the specialist noted, four groups were interviewed in the research: one composed of people recently diagnosed with HIV, who typically have many questions and require information; and another group of patients who have had the condition for 15 years or more, and thus have successful life experience, having changed their lifestyles at various points due to the evolution of the disease.
A third group was also interviewed by experts from the National STI/HIV/AIDS Prevention Center, the institution sponsoring this study; and a fourth group by nurses working at the Pedro Kourí Institute of Tropical Medicine (IPK), who have worked with people living with HIV for more than ten years, and thus have experience of recurring care errors and have served as mediators of necessary changes of attitude.
Based on the fundamental cognitive needs identified in these four groups, and the particular and converging experiences of each, several categories emerged, on which the messages we developed would be focused. That way we created 65 SMS messages sent to the mobile phones of people who subscribed to the service free of charge, and at least twice a week they received texts with health advice, Gavilondo explained.
“However, this is not the typical advice along the lines of ‘protect yourself, use condoms,’ but rather goes further, with more information, and is more practical regarding why a change of conduct is crucial. Behaviors are more likely to change when the person knows exactly how this benefits their care, rather than only offering instructions,” the interviewee added.
As part of the research itself, she noted, 28 messages have been sent to more than 160 people across the country, since the process began in June.
According to the assistant professor, approaching nursing care management through the use of technology is a novel field, in which Cuba has limited experience, but which offers multiple potentialities.
“The messages were developed among the researchers, a group of volunteers from the HIV/AIDS Support Line, and experts from the National STI/HIV/AIDS Prevention Center, in conjunction with specialists from the communications department of this institution. Consistent with the emerging categories of research, these SMS messages address issues such as family support. We talk about how to tell one’s family that you have been diagnosed with HIV, as there are those whose families are unaware as they have not dared tell them; or there are people who did not want to subscribe to the service, saying: because I can’t receive that on my phone, since no one out at home or at work can find out,” Gavilondo noted.
The messages are diverse, she added, ranging from the importance of good nutrition, following treatment, and condom use, to texts about rights and duties as citizens, and to reinforce self-esteem, as a person does not stop being themselves just because they have been diagnosed HIV positive.
The future idea is for these messages to reach beyond people living with HIV. Within the group that subscribed during the investigation were also people who we call “sero-affective,” who do not have HIV, and many of whom do not even have a relative with this disease, but who are sensitized and support the campaign, Gavilondo explained.
During the months of November and December, during which Cuba will be celebrating the Responding to HIV event, the mobile health service offering text messages on these issues will be reactivated, offering free of charge subscription by sending a text message reading “lazo adentro” to the number 8000.
A good opportunity for all to engage, so that this mobile health application is strengthened, and to better know an enemy such as AIDS.