Thursday, 28 February 2013

Scaling Up mHealth: Where Is the Evidence? PLoS Med essay (c/o HIFA2015)

Dear HIFA members,

An essay in the open-access journal PLoS Medicine discusses the evidence base for mHealth and makes recommendations for scale-up. Below is the citation, summary points, selected extracts and recommendations for scale-up. The full text is available here:

Best wishes,
Neil Pakenham-Walsh
HIFA moderator
[ HIFA2015: Healthcare Information For All by 2015 ]

CITATION: Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC (2013) Scaling Up mHealth: Where Is the Evidence? PLoS Med 10(2): e1001382. doi:10.1371/journal.pmed.1001382

- Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth.
- We discuss what constitutes appropriate research evidence to inform scale up.
- Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base.
- We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth.

'A recent World Bank report tracked more than 500 mHealth studies, and many donor agencies are lining up to support the 'scaling up' of mHealth interventions [7]. Yet, after completion of these 500 pilot studies, we know almost nothing about the likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives...  mHealth is in a period very similar to the early days of the Internet: not creating robust, interoperable platforms will ensure failure for mHealth initiatives to be scaled to improve health outcomes for at least the next decade.'

- Existing standards for research should be reconsidered in order to provide guidance as to when scale up is appropriate.
- mHealth interventions should be guided by a plausible theory of behaviour change and should use more than one technique depending on the targeted behaviour [38].
- We need to establish an open mHealth architecture based on a robust platform with standards for app development which would facilitate scalable and sustainable health information systems.
- Implementation strategies such as factorial designs that are able to test the multiple features of interventions must be explored, in order to provide the necessary evidence base.
- Scale-up of mHealth in LAMICs should be preceded by efficacy and effectiveness trials so that they are founded on an appropriate evidence base.
Governments, funders, and industry must cooperate in order to set standards to create a self-governing commercially viable ecosystem for innovation.

Monday, 25 February 2013

Finding space in Hay-on-Wye: Complexity & healthcare - book

This time last week I was in Hay-on-Wye the book town on the border of England and Wales. February is still pretty cold, a good excuse to really browse.

complexity and healthcare - book cover
Amongst some great finds were three books on complexity in primary care and medicine.

I am sure that the way complexity can be woven within Hodges' model are manifold. On page 4 of Sweeney & Griffiths: 
Using the idea of multidimensional phase space can help us understand categories of disease without clear boundaries. Instead of thinking of a person's illness as a walled off and separate pigeon hole, it can be useful to think of it as a point within a multidimensional illness space.

Kieran Sweeney, Frances Griffiths (eds). (2002) Complexity and healthcare: an introduction. Radcliffe Medical Press Ltd.

Saturday, 23 February 2013

A Nurse at the Front - book

The First World War Diaries of Sister Edith Appleton
Book cover: A nurse at the Front

This book, the second in a series of four unique War Diaries produced in conjunction with the Imperial War Museum, will tell a story that is rarely heard: the experiences of a nurse working close to the Western Front in the First World War. Incredibly, Edith Appleton served in France for the whole of the conflict. Her bravery and dedication won her the Military OBE, the Royal Red Cross and the Belgian Queen Elisabeth medal among others.

Her diary details with compassion all the horrors of the 'war to end wars', including the first use of poison gas and the terrible cost of battles such as Ypres, but she also records what life was like for nurses and how she spent her time off-duty. There are moments of humour amongst the tragedy, and even lyrical accounts of the natural beauty that still existed amidst all the destruction. [Publisher's description]

Cognitive continua ( ... just a sentence of promise)

The idea of a cognitive continuum has much to offer nurses and its potential has yet to be fully exploited. p.136.

Thompson, C. (2001) JAN Forum: Clinical decision making in nursing: theoretical perspectives and their relevance to practice - a response to Jean Harbison. Journal of Advanced Nursing, 35(1), 134-137.

Thursday, 21 February 2013

Journal of Learning Analytics - inaugural issue

ISSN 1929-7750 (online)
Contact:  jla.editorial at

Submission deadline (inaugural issue): April 30, 2013

Journal of Learning Analytics is a peer-reviewed, open-access journal, disseminating the highest quality research in the field. The journal is the official publication of the Society for Learning Analytics Research (SoLAR). With an international Editorial Board comprising leading scholars, it is the first journal dedicated to research into the challenges of collecting, analysing and reporting data with the specific intent to improve learning and teaching practice. “Learning” is broadly defined across a range of contexts, including informal learning on the internet, formal academic study in institutions (primary/secondary/tertiary), and workplace learning.

The journal seeks to connect researchers and developers with practitioners, creating and disseminating new tools and techniques, studying transformations, and providing ongoing evaluation and critique of the conceptual, technical, and practical outcomes. The interdisciplinary focus of the journal recognizes that computational, pedagogical, institutional, policy and social domains must be brought into dialogue with each other to ensure that interventions and organizational systems serve the needs of all stakeholders. The journal seeks to bring into dialogue the intersection of the fields of Education, Computation and Sensemaking.
Journal of Learning Analytics welcomes papers that either describe original research or offer a review of the state of the art in a particular area. The journal also welcomes practice-focused papers that detail Learning Analytics applications in real-world settings, provided that they offer innovative insights for advancing the field (see the About section).

Focus and Scope
The following topics are indicative of the journal’s scope:

- Connections between learning analytics and the learning sciences
- Personalization and adaptation in the learning process
- Educational research methods
- Learner modeling
- The study of emotion, flow, and affective data

- Social network analysis
- Web science, the Semantic Web, and linked data
- Data mining and machine learning techniques
- Natural language processing and text mining
- Recommendation engines

- Visualization and user experience
- Data and multimedia literacy
- Decision-support
- Organizational dynamics
- Ethical issues

Research Papers
Journal of Learning Analytics welcomes papers that either describe original research or offer a review of the state of the art in a particular area of learning analytics. No submission, or substantially overlapping submission, be published or be under review elsewhere.  Submissions that extend previously published conference papers are welcome provided that the journal submission has sufficiently been extended (at least 25-30% of new contribution).

The Reflective Practitioner Section
This section of the Journal of Learning Analytics is peer-reviewed and  covers the application of learning analytics across a diversity of contexts. This section spotlights trends and practices; provides new insights and ideas; and analyzes the implications of learning analytics. This section is not intended as an avenue for publication of research articles.

- Shane Dawson, University of South Australia, Australia
- Dragan Gasevic, Athabasca University, Canada
- Phillip Long, University of Queensland, Australia

Editor of the Reflective Practitioner Section
- John Campbell, West Virginia University, USA

Tuesday, 19 February 2013

Every incredible view...

The Shard, London, UK

Every incredible view, whether achieved 
by natural, artificial or conceptual means
relies upon a structure, a framework.

Image source: The view from The Shard

Friday, 15 February 2013

Inaugural Symposium on Person-centredness in the Curriculum May 2nd - 3rd

Thursday 2 May and Friday 3 May 2013
(starting at lunch time on 2 May with a full day on 3 May)

Loughview Suite, Jordanstown campus, University of Ulster, Northern Ireland

The School of Nursing at Ulster has a strong tradition of national and international leadership in the field of person-centred practice. The Institute of Nursing and Health Research at Ulster incorporates the Person-centred Practice Research Centre directed by Professor Brendan McCormack. Against this backdrop the School has been developing a programme of work with a focus on person-centredness in nursing education. It is our contention that in order to achieve maximum effect in practice, person-centredness should be embedded within and across all programmes of education for health care professionals.

This year the School of Nursing at Ulster will host its Inaugural International Symposium on Person-Centredness in Nursing Education. The one and a half day symposium will include presentations and workshops that will appeal to those involved in nursing education in academic and practice settings.

Symposium themes 
The three key themes of the symposium are:

• To explore ways of infusing a culture of person-centredness through effective, contemporary higher education
• To share innovative approaches to the facilitation of person-centredness in practice learning
• To reflect upon how the experiences of teaching teams and service users and to consider how these can shape educational approaches and teaching strategies

Target audience
The symposium will be of interest to colleagues who have an interest in promoting person-centred practice through education in practice or academic settings.

£70 (includes car parking, lunch and refreshments on both days)

To reserve a place or for further information please contact:
Julie Cummins at the Institute of Nursing and Health Research
Email: j.cummins1 AT Telephone: +44 (0) 28 7012 4094


I plan to attend this event on a topic central to h2cm.

Saturday, 9 February 2013

Manet & the art of nursing - never unresolved: (and The Francis report)

Yesterday I travelled to London for a nurse related meeting and used the opportunity from 8pm - 11pm to take in the Manet exhibition at the Royal Academy of Arts. Brilliant! It is a great event. There really is no comparison apart from the very high resolution close examination that our technology makes possible; but then that is a difference experience, a different purpose.

Manet's work at the RA includes paintings that do appear unfinished. Areas of the canvas being unresolved brings home the relationship and dependency of the artist with the subject, and the artist's approach to portraiture. Manet was quite demanding on his subjects apparently and while not completely averse, he did not routinely rely on the new opportunities that photography afforded. Here are some thoughts from the Art Fund website:
'Summer' or 'The Amazon', by Edouard Manet
Manet was a great risk-taker and critics of day rallied against his inconsistent approach, as you will see many of the works seem 'unresolved' or 'unfinished' but one of Manet's great skills was this ability to stop painting at the right moment, and it is this technique which gives the works a sense of movement and life.

Manet once said to his friend Antonin Proust, 'I must be seen whole. Don't let me go piecemeal into the public collections; I would not be fairly judged.' This exhibition, which brings together the largest selection of works by the artist to be exhibited together in a UK museum, is a great opportunity to judge Manet's extraordinary talent as a 'whole'.
In nursing we are accustomed to impatient patients. Many though have no choice but to 'sit' and 'lie'. They are static, not able to walk or run away.

Unconscious patients - we speak to them: redrawing the outlines. Searching verbally where we cannot go, reaching for the centers of personhood. We sculpt them back to their optimal health. Sometimes the brush strokes are urgent, sometimes we improvise with touch.

All the time an ideal: a portrait of care. No matter how busy we are basic nursing care should never remain unresolved.

That part of the canvas is always completed. The outline is integrated. The horizon, foreground, middle and background may be sketchy in the extreme cases, but the real mission critical bases are covered.

What we should never countenance, collude, or indirectly sanction are the cutting of those bases.

If we do the work of art is not just unfinished: it is corrupt.

The Francis Report

Anagram graphic c/o Wordsmith

Manet's 'The Amazon' from:

Wednesday, 6 February 2013

Extrasolar planets, x-phi and The Francis report

I'm sure there is a planet out there - extrasolar - with the physical make-up such that be it an incredible water fall, tidal surge, or rolling polished mega-rocks - the noise, could we hear it, would do far more than make your ears bleed.

Today, here in England there is a legal, health and political media event of very serious import. The ruckus in health and political circles might also make for more than bleeding noses and definitely thousands of continuing broken hearts.

The Francis report will be published today. Further insights and findings will be revealed c/o the Public Inquiry with recommendations on the Mid Staffordshire NHS Foundation Trust health care debacle.

In Philosophy Now Jan/Feb 2013 Tibor Fischer's editorial mentions the need for marketing within philosophy and literature, with the suggestion of placing x-phi on a T-shirt.

'X-phi' of course reads as experimental philosophy.

In health care, nursing and social care evidence counts for everything (and for h2cm too). Evidence based practice that is founded upon research is essential. Experiments are needed that can be reproduced, extended, validated. ...

Today is a profoundly sad day for everyone in the NHS, as many commentators have already predicted. The future constantly beckons, but today reflect we must that in the clamour for evidence based care, does this mean we must don T-shirts?:

Have we forgotten the principles of what it is to care: compassion - our duty of care?

No, but amid the cacophony of technology, technical care, the targets, statistics, budget cuts, the challenges to morale and nursing's values we need to be ever more vigilant.

We must learn how to x-listen and x-shout in the 21st century health care environment(s).

But experiments in how to listen, how to blow a whistle? Surely not.

Well yes: as clearly here basic care systems did not work they failed terribly: individually, organisationally and across the FIVE care domains of h2cm.