K4Health
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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.
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Browsing K4Health by Subject "Adult"
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- ItemA 21st century approach to tackling dengue: Crowdsourced surveillance, predictive mapping and tailored communication.(2016-01-06) Lwin, May O; Vijaykumar, Santosh; Fernando, Owen Noel Newton; Cheong, Siew Ann; Rathnayake, Vajira Sampath; Lim, Gentatsu; Theng, Yin-Leng; Chaudhuri, Subhasis; Foo, SchubertThis paper describes a social media system to prevent dengue in Sri Lanka and potentially in the rest of the South and Southeast Asia regions The system integrates three concepts of public health prevention that have thus far been implemented only in silos First the predictive surveillance component uses a computer simulation to forewarn health authorities and the general public about impending disease outbreaks The civic engagement component allows the general public to use social media tools to interact and engage with health authorities by aiding them in surveillance efforts by reporting symptoms mosquito bites and breeding sites using smartphone technologies The health communication component utilizes citizen data gathered from the first two components to disseminate customized health awareness messages to enhance knowledge and increase preventive behaviors among citizens The system known as Mo Buzz will be made available on a host of digital platforms like simple mobile phones smart phones and a website We present challenges and lessons learnt including content validation stakeholder collaborations and applied trans disciplinary research
- ItemAcceptability and factors associated with willingness to receive short messages for improving antiretroviral therapy adherence in China.(2014-05-15) Xiao, Yongkang; Ji, Guoping; Tian, Cuicui; Li, Hui; Biao, Wei; Hu, ZhiThis study aimed to understand the acceptability of short message service SMS as a reminder for improving antiretroviral therapy ART adherence and determine the factors associated with willingness to accept SMS among people living HIV PLH in China A total of 801 adult patients were recruited in a cross sectional survey Factors associated with willingness in unadjusted analyses 0 10 were included in a logistic regression model 88 4 of the participants owned mobile phones 49 6 read every short message and 16 2 read only if the phone number was familiar 79 5 reported daily SMS to remind taking medicine would be helpful and 68 9 were willing to receive them In the final model willingness to accept was positively associated with being young odds ratio OR 0 32 95 confidence interval CI 0 11 0 99 p 0 048 living in the middle or north region OR 2 36 95 CI 1 24 4 50 p 0 009 OR 71 79 95 CI 21 53 239 37 p Under 0 001 respectively having primary or junior or higher education OR 5 80 95 CI 2 13 15 86 p 0 001 OR 3 20 95 CI 1 20 8 58 p 0 021 respectively having serious disease condition of stage OR 10 01 95 CI 2 12 47 30 p 0 004 being a rural resident OR 2 96 95 CI 1 72 5 10 p Under 0 001 having side effect OR 4 74 95 CI 1 24 18 03 p 0 023 and taking a dose two or more hours late in the last 30 days OR 2 45 95 CI 1 26 4 78 p 0 009 SMS as a reminder for improving ART adherence is acceptable The survey results indicate that to be effective messages need to be more acceptable to elderly patients urban residents individuals with earlier stage of HIV disease and individuals not experiencing side effects Nonetheless these results suggest that for a high proportion of PLH in China reminder messages through mobile phones would be useful for increasing compliance with HIV regimens
- ItemAcceptability of delivering and accessing health information through text messaging among community health advisors.(2014-08-07) Schoenberger, Yu-Mei; Phillips, Janice; Mohiuddin, Mohammed Omar; McNees, Patrick; Scarinci, IsabelBACKGROUND Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health Studies have shown that technology such as the mobile phone short message service SMS or text messaging can be an effective health communication strategy that influences individuals health related decisions behaviors and outcomes OBJECTIVE The purpose of this study was to explore usage of communication technologies assess the acceptability of mobile technology for delivery and access of health information and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners CHARPs METHODS A mixed method design was used and a triangulation protocol was followed to combine quantitative and qualitative data Focus groups 4 focus groups n 37 and self administered surveys n 77 were conducted to determine CHARPs mobile phone and text message usage The objective was to include identification of barriers and facilitators to a mobile phone intervention RESULTS All participants were African American 37 37 100 11 37 89 were women and the mean age was 53 4 SD 13 9 focus groups and 59 9 SD 8 7 survey Nearly all 33 37 89 of focus group participants reported owning a mobile phone Of those 8 33 24 owned a smartphone 22 33 67 had a text messaging plan and 18 33 55 and 11 33 33 received and sent text messages several times a week or day respectively Similar responses were seen among the survey participants with 75 77 97 reporting owning a mobile phone and of those 22 75 30 owned a smartphone 39 75 53 had a text messaging plan and 37 75 50 received and 27 75 37 sent text messages several times a week or day The benefits of a text messaging system mentioned by focus group participants included alternative form of communication quick method for disseminating information and privacy of communication The main barriers reported by both groups to using mobile technology to receive health information were cost and not knowing how to text message Ways to overcome barriers were explored with focus group participants and education was the most proposed solution Majority of CHARPs were in favor of receiving a weekly text message that would provide cancer health information CONCLUSIONS The findings from this study indicate that CHARPs are receptive to receiving text messages focusing on cancer health information and would be likely to engage in mobile health research These findings represent the first step in the development of an interactive mobile health program designed to provide cancer health information and a support network for the Deep South Network Community Health Advisors as Research Partners DSN CHARPs
- ItemActors and intentions in the development process of a mobile phone platform for self-management of hypertension.(2014-06-24) Ranerup, Agneta; Hallberg, IngerAim The aim of this study was to enhance the knowledge regarding actors and intentions in the development process of a mobile phone platform for self management of hypertension Methods Our research approach was a 14 month longitudinal real time ethnography method of description and analysis Data were collected through focus groups with patients and providers patient interviews and design meetings with researchers and experts The analysis was informed by the concepts of actors and inscriptions in actor network theory ANT Results Our study showed that laypersons scientific actors as well as technology itself might influence development processes of support for self management of hypertension The intentions were inscribed into the technology design as well as the models of learning and treatment Conclusions The study highlighted important aspects of how actors and intentions feature in the development of the mobile phone platform to support self management of hypertension The study indicated the multifacetedness of the participating actors including the prominent role of technology The concrete results of such processes included questions in the self report system learning and treatment models
- ItemAn adaptive physical activity intervention for overweight adults: a randomized controlled trial.(2013-12-18) Adams, Marc A; Sallis, James F; Norman, Gregory J; Hovell, Melbourne F; Hekler, Eric B; Perata, ElyseBACKGROUND Physical activity PA interventions typically include components or doses that are static across participants Adaptive interventions are dynamic components or doses change in response to short term variations in participant s performance Emerging theory and technologies make adaptive goal setting and feedback interventions feasible OBJECTIVE To test an adaptive intervention for PA based on Operant and Behavior Economic principles and a percentile based algorithm The adaptive intervention was hypothesized to result in greater increases in steps per day than the static intervention METHODS Participants N 20 were randomized to one of two 6 month treatments 1 static intervention SI or 2 adaptive intervention AI Inactive overweight adults 85 women M 36 9 9 2 years 35 non white in both groups received a pedometer email and text message communication brief health information and biweekly motivational prompts The AI group received daily step goals that adjusted up and down based on the percentile rank algorithm and micro incentives for goal attainment This algorithm adjusted goals based on a moving window an approach that responded to each individual s performance and ensured goals were always challenging but within participants abilities The SI group received a static 10 000 steps day goal with incentives linked to uploading the pedometer s data RESULTS A random effects repeated measures model accounted for 180 repeated measures and autocorrelation After adjusting for covariates the treatment phase showed greater steps day relative to the baseline phase pUnder 001 and a group by study phase interaction was observed p 017 The SI group increased by 1 598 steps day on average between baseline and treatment while the AI group increased by 2 728 steps day on average between baseline and treatment a significant between group difference of 1 130 steps day Cohen s d 74 CONCLUSIONS The adaptive intervention outperformed the static intervention for increasing PA The adaptive goal and feedback algorithm is a behavior change technology that could be incorporated into mHealth technologies and scaled to reach large populations TRIAL REGISTRATION ClinicalTrials gov NCT01793064
- ItemAddressing medication nonadherence by mobile phone: development and delivery of tailored messages.(2014-12-03) Gatwood, Justin; Balkrishnan, Rajesh; Erickson, Steven R; An, Lawrence C; Piette, John D; Farris, Karen BBACKGROUND Medication nonadherence remains a significant public health problem and efforts to improve adherence have shown only limited impact The tailoring of messages has become a popular method of developing communication to influence specific health related behaviors but the development and impact of tailored text messages on medication use is poorly understood OBJECTIVES The aim of this paper is to describe an approach to developing theory based tailored messages for delivery via mobile phone to improve medication adherence among patients with diabetes METHODS Kreuter s five step tailoring process was followed to create tailored messages for mobile phone delivery Two focus group sessions using input from 11 people and expert review of message content were used to adapt the survey instrument on which the messages were tailored and edit the developed messages for the target population RESULTS AND CONCLUSIONS Following established tailoring methods a library of 168 theory driven and 128 medication specific tailored messages were developed and formatted for automated delivery to mobile phones Concepts from the Health Belief Model and Self Determination Theory were used to craft the messages and an algorithm was applied to determine the order and timing of messages with the aim of progressively influencing disease and treatment related beliefs driving adherence to diabetes medication The process described may be applied to future investigations aiming to improve medication adherence in patients with diabetes and the effectiveness of the current messages will be tested in a planned analysis
- ItemAligning health information technologies with effective service delivery models to improve chronic disease care.(2014-08-06) Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, PatriciaOBJECTIVE Healthcare reforms in the United States including the Affordable Care and HITECH Acts and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology HIT and the integration of general medical and mental health services These developments which aim to improve chronic disease care have largely occurred in parallel with little attention to the need for coordination In this article the fundamental connections between HIT and improvements in chronic disease management are explored We use the evidence based collaborative care model as an example with attention to health literacy improvement for supporting patient engagement in care METHOD A review of the literature was conducted to identify how HIT and collaborative care an evidence based model of chronic disease care support each other RESULTS Five key principles of effective collaborative care are outlined care is patient centered evidence based measurement based population based and accountable The potential role of HIT in implementing each principle is discussed Key features of the mobile health paradigm are described including how they can extend evidence based treatment beyond traditional clinical settings CONCLUSION HIT and particularly mobile health can enhance collaborative care interventions and thus improve the health of individuals and populations when deployed in integrated delivery systems
- ItemAre medical school students ready for e-readers?(2013-02-11) Atlas, Michel CCollege textbook publishers are planning to make college and professional education textbooks available online to be downloaded to personal communication devices e g smartphones digital audio players e g iPods and digital readers e g Kindles The current literature on the attitudes of current students to this technological change especially as it relates to medical school students is reviewed A short survey attempted to determine how ready the first year medical students at the University of Louisville are to accept this change in their study habits
- ItemAsk, don't tell - mobile phones to improve HIV care.(2013-11-07) Lester, Richard T
- ItemAssessing the applicability of e-therapies for depression, anxiety, and other mood disorders among lesbians and gay men: analysis of 24 web- and mobile phone-based self-help interventions.(2014-07-05) Rozbroj, Tomas; Lyons, Anthony; Pitts, Marian; Mitchell, Anne; Christensen, HelenBACKGROUND Lesbians and gay men have disproportionately high rates of depression and anxiety and report lower satisfaction with treatments In part this may be because many health care options marginalize them by assuming heterosexuality or misunderstand and fail to respond to the challenges specifically faced by these groups E therapies have particular potential to respond to the mental health needs of lesbians and gay men but there is little research to determine whether they do so or how they might be improved OBJECTIVE We sought to examine the applicability of existing mental health e therapies for lesbians and gay men METHODS We reviewed 24 Web and mobile phone based e therapies and assessed their performance in eight key areas including the use of inclusive language and content and whether they addressed mental health stressors for lesbians and gay men such as experiences of stigma related to their sexual orientation coming out and relationship issues that are specific to lesbians and gay men RESULTS We found that e therapies seldom addressed these stressors Furthermore 58 14 24 of therapies contained instances that assumed or suggested the user was heterosexual with instances especially prevalent among better evidenced programs CONCLUSIONS Our findings and a detailed review protocol presented in this article may be used as guides for the future development of mental health e therapies to better accommodate the needs of lesbians and gay men
- ItemAssessing the internal and external validity of mobile health physical activity promotion interventions: a systematic literature review using the RE-AIM framework.(2013-10-07) Blackman, Kacie Ca; Zoellner, Jamie; Berrey, Leanna M; Alexander, Ramine; Fanning, Jason; Hill, Jennie L; Estabrooks, Paul ABACKGROUND Mobile health mHealth interventions are effective in promoting physical activity PA however the degree to which external validity indicators are reported is unclear OBJECTIVE The purpose of this systematic review was to use the RE AIM reach effectiveness adoption implementation and maintenance framework to determine the extent to which mHealth intervention research for promoting PA reports on factors that inform generalizability across settings and populations and to provide recommendations for investigators planning to conduct this type of research METHODS Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process ie queries of three online databases and reference lists of eligible articles and met inclusion criteria ie implementation of mobile technologies target physical activity and provide original data Two researchers coded each article using a validated RE AIM data extraction tool reach efficacy effectiveness adoption implementation maintenance Two members of the study team independently abstracted information from each article inter rater reliability 90 and group meetings were used to gain consensus on discrepancies RESULTS The majority of studies were randomized controlled trials n 14 The average reporting across RE AIM indicators varied by dimension reach 53 3 2 67 5 effectiveness efficacy 60 0 2 4 4 adoption 11 1 0 7 6 implementation 24 4 0 7 3 maintenance 0 0 3 While most studies described changes in the primary outcome effectiveness few addressed the representativeness of participants reach or settings adoption and few reported on issues related to maintenance and degree of implementation fidelity CONCLUSIONS This review suggests that more focus is needed on research designs that highlight and report on both internal and external validity indicators Specific recommendations are provided to encourage future mHealth interventionists and investigators to report on representativeness settings delivery agents for planned interventions the extent to which protocol is delivered as intended and maintenance of effects at the individual or organizational level
- ItemAssessing the quality and usability of smartphone apps for pain self-management.(2014-06-26) Reynoldson, Charmian; Stones, Catherine; Allsop, Matthew; Gardner, Peter; Bennett, Michael I; Closs, S José; Jones, Rick; Knapp, PeterOBJECTIVE To evaluate smartphone apps intended for self management of pain using quality assessment criteria and usability testing with prospective users DESIGN 1 Survey and content analysis of available apps and 2 individual usability study of two apps SETTING University of Leeds United Kingdom PARTICIPANTS Forty one participants aged 19 59 years with experience of chronic or recurrent pain episodes METHODS We undertook a survey content analysis and quality appraisal of all currently available mobile phone apps for self management of pain Two apps were then selected and assessed with usability testing RESULTS Twelve apps met the inclusion criteria The quality assessment revealed wide variation in their clinical content interface design and usability to support self management of pain Very little user or clinician involvement was identified in the development of the apps From the usability testing participants stated a preference for an interface design employing a lighter color scheme and particular text font Although very few participants were aware of pain reporting apps prior to participation many would consider use in the future CONCLUSIONS Variation in app quality and a lack of user and clinician engagement in development were found across the pain apps in this research Usability testing identified a range of user preferences Although useful information was obtained it would be beneficial to involve users earlier in the process of development as well as establishing ways to merge end user requirements with evidence based content to provide high quality and usable apps for self management of pain
- ItemAssessing user preferences for e-readers and tablets.(2013-02-11) Le Ber, Jeanne M; Lombardo, Nancy T; Honisett, Amy; Jones, Peter Stevens; Weber, AliceLibrarians purchased 12 e readers and six tablets to provide patrons the opportunity to experiment with the latest mobile technologies After several train the trainer sessions librarians shared device information with the broader health sciences community Devices were cataloged and made available for a two week checkout A limited number of books and applications apps were preloaded for all the devices and patrons were allowed to download their own content Each tablet has Google Books iBooks Kindle and Nook apps available to allow choice in reading e books Upon return patrons were asked to complete a ten question survey to determine preferences for device use
- ItemAn assessment of the iPad 2 as a CT teleradiology tool using brain CT with subtle intracranial hemorrhage under conventional illumination.(2013-07-09) Park, Joon Bum; Choi, Hyuk Joong; Lee, Jeong Hun; Kang, Bo SeungWe examined the potential of the iPad 2 as a teleradiologic tool for evaluating brain computed tomography CT with subtle hemorrhage in the conventional lighting conditions which are common situations in the remote CT reading The comparison of the clinician s performance was undertaken through detecting hemorrhage by the iPad 2 and the clinical liquid crystal display LCD monitor We selected 100 brain CT exams performed for head trauma or headache Fifty had subtle radiological signs of intracranial hemorrhage ICH while the other 50 showed no significant abnormality Five emergency medicine physicians reviewed these brain CT scans using the iPad 2 and the LCD monitor scoring the probability of ICH on each exam on a five point scale Result showed high sensitivities and specificities in both devices We generated receiver operating characteristic curves and calculated the average area under the curve of the iPad 2 and the LCD 0 935 and 0 900 Using the iPad 2 and reliable internet connectivity clinicians can provide remote evaluation of brain CT with subtle hemorrhage under suboptimal viewing condition Considering the distinct advantages of the iPad 2 the popular out of hospital use of mobile CT teleradiology would be anticipated soon
- ItemAutomatic identification of apnea through acoustic analysis for at-home screening.(2011-07-19) Nasu, Yasuhiro; Ashida, Nobuyuki; Yamakawa, Miyae; Makimoto, Kiyoko; Tsuji, MasatsuguOBJECTIVE Although many studies have analyzed breathing sounds in the diagnosis of obstructive sleep apnea syndrome the recording of snoring sounds at home is hampered by the various background noises of daily life Recordings also frequently include talking during sleep which may infringe the privacy of patients MATERIALS AND METHODS A recording system used a bone conduction microphone to record snoring sounds This microphone reduced background noise A simple system transmitted recorded breathing sound data for screening at a hospital as envelope data instead of complete sound recordings thereby decreasing data volume and protecting privacy RESULTS In periods in which blood oxygen levels SpO were drastically decreased the probability of apnea as deduced from the envelope curve of breathing sounds was consistent with SpO values CONCLUSIONS This method provides a basis for telemonitoring of sleep apnea syndrome
- ItemBarriers to the implementation of mobile phone reminders in pediatric HIV care: a pre-trial analysis of the Cameroonian MORE CARE study.(2014-11-14) Bigna, Jean J; Noubiap, Jean J; Plottel, Claudia S; Kouanfack, Charles; Koulla-Shiro, SinataBACKGROUND Mobile health mhealth has emerged as a powerful resource in the medical armamentarium against human immunodeficiency virus HIV infection We sought to determine among adult caregivers of HIV exposed infected children the extent of mobile phone ownership the ability to communicate in Cameroon s national official languages NOL and the refusal to receive such reminders METHODS We conducted a pre trial analysis of potentials participants of the MORE CARE trial MORE CARE took place from January through March 2013 in three geographic locations in Cameroon We included caregivers aged 18 years or older Written communication was assessed by the ability to read and understand information presented in the consent form Verbal communication was assessed during a two way conversation and in a discussion about HIV infection A question about mobile phone ownership and another about refusal to receive reminders via mobile phone were phrased to allow Yes or No as the only possible reply A p Under0 05 was considered statistically significant RESULTS We enrolled 301 caregivers of HIV exposed infected children from rural n 119 semi urban n 142 and urban n 40 areas of Cameroon The mean caregiver age was 42 9 years SD 13 4 and 85 were women A fifth of our study population overall had at least one of the three obstacles to mobile phone reminders By region 39 5 in rural 6 3 in semi urban and 7 5 in urban setting had at least one obstacle with significant differences between the rural and urban settings pUnder0 001 and the rural and semi urban settings pUnder0 001 The acceptability of SMS was 96 3 and of mobile phone calls 96 p 0 054 The ability to communicate in NOL orally was 89 7 and 84 4 in writing p 0 052 Mobile phone ownership pUnder0 001 p 0 03 and the ability to communicate in an NOL orally pUnder0 001 p 0 002 or in writing both pUnder0 001 were significantly lower in rural compared to semi urban and urban settings respectively CONCLUSIONS The use of mHealth was limited in about one fifth of our population The greatest obstacle was the inability to use oral or written NOL followed by non ownership of a mobile phone These impediments were higher in a rural setting as compared to urban or semi urban areas
- ItemThe benefit of smart phone usage in liver organ procurement.(2011-04-04) Croome, Kris P; Shum, Jeff; Al-Basheer, Mamoun A; Kamei, Hideya; Bloch, Michael; Quan, Douglas; Hernandez-Alejandro, RobertoA 56 year old man was on the transplant list with end stage liver disease secondary to hepatitis C when a donor liver became available at a location 545 km away The procurement team consisting of a senior and junior fellow went on the retrieval while the staff surgeon remained in the hospital with the recipient At the time of organ procurement a suspicious lesion was identified in the left lateral lobe The transplant fellows took intraoperative pictures of the lesion with a smart phone and sent them to the staff surgeon for advice A teleconsultation facilitated by images sent from the smart phone took place over the next 22 min The decision was made to proceed with the transplant as it was felt that the lesion could be resected from the liver allograft Had the fellows not been able to interact with the staff surgeon in real time during the surgery there is a high likelihood that the organ would have been rejected by the staff surgeon due to the unexpected finding The patient s postoperative course was relatively uneventful with no evidence of infection The patient was discharged from hospital and continues to do well We expect that the role of smart phones in remote consultation will continue to expand in future
- ItemBeyond reminders: a conceptual framework for using short message service to promote prevention and improve healthcare quality and clinical outcomes for people living with HIV.(2012-02-22) Coomes, Curtis M; Lewis, Megan A; Uhrig, Jennifer D; Furberg, Robert D; Harris, Jennie L; Bann, Carla MThe availability of effective antiretroviral therapy has altered HIV from being an acute disease to being a chronic manageable condition for many people living with HIV PLWH Because of their ubiquity and flexibility mobile phones with short message service SMS offer a unique opportunity to enhance treatment and prevention for people managing HIV To date very few US studies using SMS for HIV self management have been published In this article we review the published SMS based intervention research that aimed to improve healthcare quality and outcomes for PLWH and other chronic health conditions and propose a conceptual model that integrates the communication functionality of SMS with important psychosocial factors that could mediate the impact of SMS on health outcomes We posit that an SMS based intervention that incorporates the elements of interactivity frequency timing and tailoring of messages could be implemented to encourage greater medication adherence as well as impact other mutually reinforcing behaviors and factors e g increasing patient involvement and social support reducing risk behaviors and promoting general health and well being to support better healthcare quality and clinical outcomes for PLWH We recommend that future studies explore the potential linkages between variations in SMS characteristics and these mediating factors to determine if and how they influence the larger outcomes
- ItemCell phone text messaging may boost smoking quit rates.(2011-09-14) Snider, Janice
- ItemClinical unity and community empowerment: the use of smartphone technology to empower community management of chronic venous ulcers through the support of a tertiary unit.(2013-11-22) Quinn, Edel Marie; Corrigan, Mark A; O'Mullane, John; Murphy, David; Lehane, Elaine A; Leahy-Warren, Patricia; Coffey, Alice; McCluskey, Patricia; Redmond, Henry Paul; Fulton, Greg JBACKGROUND Chronic ulcers affect roughly 60 000 Irish people at a total cost of 600 000 000 or 10 000 per patient annually By virtue of their chronicity these ulcers also contribute a significant burden to tertiary outpatient vascular clinics OBJECTIVE We propose utilizing mobile phone technology to decentralise care from tertiary centres to the community improving efficiency and patient satisfaction while maintaining patient safety METHODS Bespoke mobile software was developed for Apples iPhone 4 platform This allowed for the remote collection of patient images prospectively and their transmission with clinical queries from the primary healthcare team to the tertiary centre Training and iPhones were provided to five public health nurses in geographically remote areas of the region Data were uploaded securely and user end software was developed allowing the review and manipulation of images along with two way communication between the teams Establishing reliability patients were reviewed clinically as well as remotely and concordance analysed Qualitative data were collected through focus group discussion RESULTS From October to December 2011 eight patients 61 83 yrs mean 75 3 yrs with chronic venous ulceration and their five public health nurses were recruited Data were transmitted using 3 G Edge GPRS and WiFi at a mean speed of 69 03 kps Concordance was 100 for wound bed assessment 80 for skin integrity colour and 60 for exudate assessment Focus group analysis explored the concept practicalities and future applications of the system CONCLUSIONS With an evolving national data network the secure transmission of clinical images is a safe alternative to regular clinic appointments for patients with chronic venous ulceration With further development and packaged as a freely downloadable application this has the potential to support the community care of chronic wounds