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International Health

Health Systems Program

Date: Jul 2018

Data for Health Update: Mobile Health Surveys in Tanzania


In early July, researchers from the Health Systems Program went to Tanzania to help conduct focus group sessions on the challenges and successes of using a SMS survey to assess non-communicable disease (NCD) risk factors within the country. Assistant scientist Dustin Gibson and research coordinator Hannah Selig went as part of the Data for Health Initiative (BD4HI), a project funded by Bloomberg Philanthropies which aims to help government officials and public health leaders make informed decisions on health care priorities by collecting public health data.

The Johns Hopkins Bloomberg School of Public Health (JHSPH) is a partner organization in BD4HI that is leading the research and development component of the NCD arm of the Initiative. Researchers in the Health Systems Program and Department of International Health at JHSPH are evaluating the viability and helping to optimize performance of mobile phone surveys to gather NCD risk factor information, such as tobacco and alcohol use, physical inactivity and unhealthy diet.

The goals of the focus group session were to learn how the participants interacted with a text message survey and gauge their comprehension of the question wording and intent, and to measure the logistical aspects of the survey, such as how long it took participants to complete and if they struggled to understand the questions. The focus group sessions were a collaborative effort with JHSPH partner organization, Ifakara Health Institute (IHI), who conducted and analyzed the data from the focus group sessions and will be leading survey efforts in Tanzania.

The SMS survey included 15 questions aimed at assessing major NCD risk factors and touched upon topics such as reducing salt intake in one’s diet, blood pressure screening, and tobacco and alcohol use. JHSPH and IHI used international technology providers Viamo to implement the survey, and Datavision, a Dar-es-Salaam-based call center and recording studio for the audio files (where the questions are recorded in Swahili).

The focus group sessions revealed challenges such as more difficulty for older participants to read the questions and complete, and a longer length of time overall to finish the survey. Following the focus group sessions, IHI researchers made adjustments for the length in time by having participants input a number instead of a worded response and made the questions easier to respond to.

The focus group sessions were a key step in the process to collect risk factor information, as now the JHSPH group will move on to the next phase, which is implementing the survey to approximately 1,500 respondents. Incentives in varying amounts will be provided to all participants. This phase will provide essential data on the presence of NCD risk factors in Tanzania, the viability of collecting surveillance data using mobile technology, and will help inform policy decisions for country health officials. 

Going forward, the JHSPH research team will conduct comparable surveys in additional countries that have partnered with the Data for Health Initiative, such as Bangladesh, Colombia and Uganda.

For more information on using mobile health surveys to collect NCD data, read the Special Issue published in the Journal of Medical Internet Research.


Building Bioethics Capacity: The Johns Hopkins Fogarty African Bioethics Consortium


The need for enhanced capacity in international research ethics and global bioethics is important, especially in low- and middle-income countries where there are huge leaps in health systems research but not as much parallel work on ethical implications. The Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) aims to improve bioethics capacity development for institutions within Africa.

FABTP is an in-depth bioethics training program that is funded by the National Institutes of Health Fogarty International Center and directed by Drs. Adnan Hyder and Nancy Kass. The program includes bioethics training at Johns Hopkins University, independent research in the recipient’s home country, and a scholarly exchange at a different FABC member institution in Africa.

Gershom Chongwe from the University of Zambia and Dan Kaye from Makerere University were the 2018 FABTP recipients. During their stay in Baltimore from January-May they took courses in the Department of International Health at Johns Hopkins Bloomberg School of Public Health (JHSPH) and the Johns Hopkins Berman Institute of Bioethics. In May they went home to collect data and will return in August to continue their courses and analyze the data.

Dr. Chongwe has a background in medicine and public health at the University of Zambia, specifically focusing on adaptive trial designs, an emerging field of epidemiology sometimes seen as controversial because of the ethical issues surrounding it. Adaptive trial designs allow for greater flexibility and efficiency by incorporating modifications during the trial based on the data. An increase in the use of adaptive trial designs has caused a debate about whether the trials offer any significant methodological advantage compared to traditional randomized trials, as well as whether they are ethically justified.

Dr. Chongwe’s aim while studying at JHSPH is to use applied skills from the coursework to frame the right questions and clarify the ethical issues surrounding adaptive trial designs. Also an instructor at the University of Zambia, Dr. Chongwe teaches his students how to conduct clinical trials and wants to apply the insights gained through his bioethics research while in Baltimore to his lessons back home in Zambia.

Dr. Kaye is a member of the Institutional Review Board (IRB) in Uganda and is taking training that will help him improve his performance in looking up literature and analyzing and interpreting data with a focus on ethical issues, literature review, communicating findings and the informed consent process. Dr. Kaye aims to focus on the ethical questions surrounding randomized control trials (RCTs), as they are not up to standard in his home country of Uganda.

Dr. Kaye’s courses provide insight on how one can ensure an ethical conduct of research and how to avoid research misconduct. This will help him to understand the different ways in which ethical principles are applied to research and how the context of emergency care informs the consent process for RCTs, and also demonstrates the different ways ethical issues are contextualized and analyzed.

"The Fogarty African Bioethics Training Program is an excellent opportunity to foster a new cohort of researchers in bioethics research from countries where it is needed most," states director Dr. Adnan Hyder.

The coursework, research and fieldwork facilitated by FABTP will help both fellows contribute to standards and procedures back home in Uganda and Zambia, and will allow them both to lead others through instruction and mentorship.