New Readers/Wikipedia Offline Medical Pilot/ja

新しい閲覧者
調査と結果
	成果 #1: 利用
	成果 #2: 認知度
	成果 #3: 発見
	成果 #4: 定着
	成果 #5: 連携
更新情報
よくある質問と関連ページ

目的

ナイジェリアの20のメディカルクリニックの医療提供者はこのパイロットプロジェクトを通じて「ウィキ版医学」ホットスポット (Wiki Medicine) とトレーニングを提供され、ウィキペディアやその他の知識を医療現場で使えるようになります。目的はナイジェリアにおける健康と技術面や情報分野の需要を理解すること、オフラインのウィキ版医学ホットスポットがツールとして有効かどうか判断することです。

オフラインの医学ウィキペディアの予備調査では、理論としての医学知識の有効性を判断します。短期間に成功を収めるとオフラインのウィキ版医学ホットスポットをアジアやアフリカ、南アメリカにわたって展開する方策作りに結びつくと見込まれます。また医療提供者の技能向上の取り組みに対する支援ツールとして追加でき、さらにオフラインのユーザーが他のウィキペディアのコンテンツにアクセスする道を開く事例としても使えます。

この予備調査の意義

このプロジェクトはウィキメディア運動の掲げる戦略の方向性 (訳注：サービスと公義) の両方を支持するものです。知識の平等を追求するには権力と特権の構造によって—不安定なインターネット環境を含め—取り残されてきた知識とコミュニティに注力します。サービスとして知識を提供するには診療所を実質的で影響力のある環境ととらえ、新しいインターフェースを使いオープンな知識を提供することとします。

左記に加えてこの予備調査では外部のパートナーとの協力により、目前の作業の範囲を超えて影響を発揮する能力開発という機会がもたらされ、私たちの基盤となる力を強化できます。実施に当たり、アフリカセンターと箱の中のインターネットならびにWikiProject 医学と提携し支援を受けることで、財団が単独で取り組むよりもはるかに広い範囲へと拡充します。

予備調査は「新しい読者」の重点国ナイジェリア全国で実施します。1億7千万人が暮らす同国はアフリカで最も人口が多く、公用語は英語です。国民のおよそ半数はインターネットにアクセスできることから、この予備調査には理想的な属性をそなえています。

プロジェクトの概要

この予備調査ではナイジェリアの20のメディカルクリニックにWi-fiホットスポットを配備する予定です。これらのホットスポットは Raspberry Pi 端末で、Wiki医療プロジェクトを中心に無料の情報源からの医療コンテンツを持っています。

このプロジェクトにより、ウィキメディア財団は以下を実施します。

• ナイジェリア (政府、大学、民間組織) と提携関係を築く
• データ収集法の構築
• 以下のデータを収集。
  • 使い方 (使いやすさ／回数など)
  • コンテンツの関連性 (よく閲覧する動画・音声・コンテンツを追加してほしいかどうか)
  • ホットスポット端末の設定や属性の適合性
  • 使用法
  • 利用者層
  • 双方向性と情報共有
  • ロールアウトのしかた

成功の主な尺度：医療提供者は定期的にウィキ医療情報にアクセスして今後の実施に先立ち微調整すべきものの情報を得ますが、その情報は調査と使用データによって補完された定性および定量データです。

プロジェクトの詳細

事業予算とプロジェクトの詳細は以下をご参照ください

• 場所: ナイジェリアの都市周辺コミュニティの20のメディカルクリニック。
• 時期: 2018年10月に開始し12か月実施
• 対象物: ウィキプロジェクト医療およびその他のフリーライセンスされた医学コンテンツをあらかじめ読み込んだRaspberry Pi端末
• 主催者:
  • プロジェクト実施：ウィキメディア財団、アフリカセンター（Uzo Iwaela）
  • サポート：連邦保健省、CDCナイジェリア事務所、Health Systems Consult Limited（HSCL）
  • 資料提供：Kiwix、Wiki_Project_Med/ja#箱入りネット

データ収集

• 定期的な視察の訪問を現地のプロジェクト管理者が行い、利用者のフィードバックやストーリーその他、プロジェクトのコミュニケーション資料をその現場から集める。
• 利用データはすべてのホットスポットのデータはパイロットの完了時に収集。
• 州ごとにヘルスケア提供者1名から聞き取り調査にじっくりと時間をかけ、各人のデジタルニーズ、オフラインのWiki医療ホットスポットの感想、プロジェクトの取り組み方と管理について話を聞く。時期は予備調査の最終盤。
• パートナー組織の代表者に完了の取材により成功を認識し、協同作業の改善分野を確認。

予備調査の審査

概念の証明とオフラインのWiki医療ホットスポットの成功後、成功と発見を使いビル・アンド・メリンダ・ゲイツ財団、世界銀行またはOmidyar Networkなど大規模組織に追加資金を申請します。これらの財団には国連の持続可能な開発の目標に焦点を当て、直接このプロジェクトと整合する指定助成金があります。

この予備調査により、ウィキペディアやその他のコンテンツを組み込んだオフラインのWiki 医療ホットスポットを大陸全体に配布し、安定したインターネットアクセスがない多くの地域で重要な医療情報を提供できます。最初の予備調査に続き、世界中の一流の医学部および公衆衛生教育機関とのさらなる提携の機会もあります。

Final report - 2020

This is the final report to share the outcomes, impacts, and learnings from the WOMP project. The material below condenses the multiple project reports from the duration of the project into a single summary.

Project plan

20 devices were distributed to 20 health-care sites across the six geo-political zones in Nigeria.

Some of the potential sites required an in-person visit before accepting any form of proposal, which necessitated contacting additional sites.

Three hospitals decided not to participate for the following reasons:

1. Wiki is not a medical authority.
2. Wiki cannot be cited as an academic source.
3. Medical information on Wiki has not been peer-reviewed or gone through a rigorous vetting process.
4. Most of the facilities were not fully convinced that this is absolutely free and thought there may be a hidden agenda e.g. money or some great gain for later.
5. For much bigger facilities, e.g. Federal Hospitals with over 300 medical staff, there was the concern that a single device would not be enough.
6. The cyber security of the device and the specific concern about if it can be reformatted, or hacked into by a hacker etc.

The final selection of sites included 8 public hospitals and 12 private hospitals, including 1 teaching hospital. The sites were chosen based on this criteria:

1. A legally registered clinic, hospital, university teaching hospital or pharmacy in Nigeria that

is either privately owned or state-owned.

1. Electricity and/or a generator that functions at least 50% of the time.
2. A functional computer or laptop that is available to and used by staff.
3. At least 60% of staff who are literate and own a smart phone.
4. Situated in peri-urban areas of the country.
5. A patient load that is average or above average according to Ministry of Health guidelines.

The selected sites were all initially provided with an in-person training session that gave the medical practitioners information about how to use the devices, the information within the devices, and to answer any questions.

The plan included Focus Group discussions and questionnaires at 10 of the sites, but some of the sites visited were not expecting the WOMP team despite prior notification via email and phone calls, so the questionnaires were established as the baseline survey. The practitioners were also more inclined to fill out questionnaires than to participate in focus groups due to their tight schedules.

After the site-selection, the WOMP Nigeria team visited each of the sites three times during the pilot, sent out monthly questionnaires to the practitioners via email, and also conducted bi-weekly follow-up calls with the site point-person. The bi-weekly calls asked the following questions:

• Is the device working well?
• Have medical staff been using the device?
• Are your colleagues satisfied using the device?
• Is the information on the device meeting your medical information needs?
• Is the information message style easy for you all to understand?
• Did you need to check this device while attending to a patient or a medical issue?
• Is there any issue with the device?
• Are there any questions concerning the device?

During a mid-point review, three of the sites were found to not be using their devices, so those devices were redistributed to alternative sites.

At the end of the project, the WOMP Nigeria team visited the sites and conducted 10 focus group discussions (with up to 15 practitioners in one meeting), or individual interviews at sites where there were not enough respondents available to participate in a group discussion due to work pressure or absence. Respondents varied from doctors, doctors (lab/clinical microbiology), auxiliary nurses, staff nurses, laboratory technicians, optometrists, and dentists.

Challenges, feedback, and key learnings

Technical

Over the duration of the project, some of the WOMP Devices or practitioners had a number of technical challenges, including: an inability to connect, devices not being compatible with their type of phones or network browser (e.g. Opera), IIAB (Batch B device) being too slow.

The final reports detailed these grouped comments.

1. The range of the device (20m) is too short and it should be increased.
2. The device memory of 16 GB or 32 GB is too small for the type of information it contains.
3. Device cannot update itself and outdated information is a major challenge for medicine which is a constantly evolving field.
4. The device is too small for the facility and more devices should be deployed within larger facilities.
5. The steps to log-in to the device are somewhat cumbersome.
6. Logging-in is sometimes slow.

Social

Some of the medical practitioners were difficult to contact, or expressed apathy. These issues were partially related to the heavy demands of their jobs, and partially due to the technical challenges from the devices. These challenges were responded to by halting the efforts to get device usage reports via phone or email, and instead gathering this information at the mid-term, in-person meetings with sites. The team also sent out monthly questionnaires via email, and encouraged usage through weekly phone text messages sent to 55 of the health workers.

Content

The survey questionnaires highlighted some feedback from the medical practitioners in these themes:

• It needs a wider coverage. It should contain more information outside of the medical information. It is limited.
• There should be more on medicine and drug dosage as seen on Medscape.
• Journals should be available on the device.
• A translation dictionary should be included on the devise so that words can be translated into different languages.
• The content on it is very elementary. There needs to be more depth and coverage of topics.

The final report provided these grouped comments:

1. This present device is currently too basic for advanced doctors, rather it is more suitable for clinicians who recently graduated medical school. Nurses also found the device very helpful. They would take screen shots and study later at home.
2. The information on the device uses a ‘one size fits all’ approach, but that limits engagement from more advanced health workers.
3. The device lacks higher level and specialist specific content (e.g. radiology, neurology, in-depth content on laboratory technology science, forensic medicine/pathology, patho-physiology, optometry-glaucoma, acute periodontitis, clinical microbiology, etc.)
4. Device needs content from authoritative bodies in the field of medicine.
5. Medical journals should be available on the device.
6. Range of content needs to be wider as content is limited.
7. There should be more content on medicine and drug dosage as seen on Medscape.

An additional point highlighted the impact of the device on two live medical situations:

• 4 respondents - nurses - said that the device was useful and within reach when they had a medical situation that they were not familiar with. One of these situations was a patient with an ectopic pregnancy, and another situation was a patient with vitiligo.

Recommendations

The reports gave these points as items to consider:

Future projects of a similar nature

1. How to accommodate rural areas where there is no electricity.
2. There needs to be more awareness about the device in the respective health and publicity is key in terms of health care workers using the device.
3. Some respondents felt that the acceptability of the device by health workers in general could be an issue to look out for as well.
4. It may be harmful if the device becomes public and easily accessible to everyone because the content could be misused by quack doctors and unqualified medical practitioners. Perhaps because the device is from Wikipedia, it could be an issue.
5. In the absence of computers, some health workers may not have smart phones and this limits who is able to use the device.
6. Some health practitioners would still not engage with device. This could be due to poor reading and research habits by health workers, even if the device is available and given free.
7. More effective monitoring by the organization in charge of the device to encourage health workers to use it.

Technology

1. The storage memory of the device should be 64gb or 128gb for the size of information it should contain.
2. With an increase in storage memory, the Processor should be increased as well, so the device does not become slow.
3. Provide a mechanism for the device to update itself- especially when a knowledge partner updates their information, it can update itself to accommodate that.
4. Suggested range of device should be at least 200m.
5. The device should have built in power or batteries for settings that do not have electricity.
6. In device placement and location, the device should not be placed in places where there are specialized machinery because that can interfere with the signal.
7. Battery life should be similar to that of a bank’s Token device.
8. Device should have a security system in place if it does not already.
9. Could download content from device on an App.

Content

1. Device should be made audience specific- for specialists level, for medical school and freshmen doctors, for laymen, i.e. one for each level.
2. Specialized medicine is non negotiable. More treatments (like drug dosage) should be included.
3. Content should be tailored more towards ‘academic’ content, i.e. in the form of journals.
4. Partnering with some major platforms that are medical information authorities whose content can be cited.
5. The information included in the device needs to be broader. It should contain more information outside medical information.
6. A dictionary should be placed on the device to help translate English words to the other languages, so they can use the languages as well.

Additional sources as Knowledge partners for the device:

1. WebMD
2. MEDScape
3. PUBMED
4. Mayo Clinic
5. British journal of Medicine
6. Journal of Hematology
7. NCPI database (USA)
8. AJOM – African Journal of Medicine
9. Hinari
10. The Nature
11. Medical microbiology
12. Materials from WHO Centre for Disease Control
13. National Centre for Biotechnology Information (NCBI)
14. Slide share App
15. EMDEX, DMX
16. Encyclopedia of Nursing and Allied Health
17. UpToDate
18. NICE Guidelines

Key questions during the final meetings included:

• Who are the target audiences?
• Who does WOMP want to serve?
• What does each specific audience need?

The practitioners specifically suggested:

1. Other medical authorities have something they are known for and WOMP should have something unique to offer. For example - Medscape is good with drug dosage and intervention. What does WOMP want to be known for?
2. Information on the device was not organized. During the meeting, a reference was made to Medscape and the level of organization of their content. WOMP could adopt that method.
3. Another important point was that content should focus more on the context of Nigeria, e.g. tropical medicine and its peculiar cases. It would be very helpful if the WOMP would have “content creators” instead of, or in addition to, knowledge content partners. These content creators could be experienced, long serving medical practitioners that have trained doctors and who have garnered a wealth of knowledge and experience over the course of their career. The intention would be for them to share their findings, treatments, and resource materials that they have put together from working on peculiar cases, on the WOMP platform/device, so others can have access to these resources. These contents could be from acknowledged contributors, and this exchange need not be monetary. E.g. A book on pediatrics called ‘77’ used this method. (NOTE: WOMP team was not able to find additional information on the book)

Future Distribution

1. The device would be useful for universities, academics, libraries - public or school libraries, and medical student hostels
2. Consider more rural areas who do not have access to the internet – but availability of power in such places is a major issue, so a back-up battery/power plan must be in place.
3. Useful for local maternity homes owned by nurses, because it would help them in their practice.
4. Partner with governments for efficiency and more effectiveness.
5. Device could be used at libraries through fiber so that more people have access.

The practitioners also suggested that with the challenge of electrical power supply and limited smart phones available in rural settings, the devices could be placed in Primary Healthcare Centers (PHCs). PHCs use grass roots and community-based medical approaches to provide healthcare to communities. The health workers in these centers could potentially find the device very useful, as they may not be as advanced as their colleagues in other, higher level, health facilities.

Motivation

Towards the conclusion of the project, the WOMP Nigeria team suggested gifting an "appreciation package" to the health facilities and practitioners that participated.

The team locally produced a range of Wikimedia Merchandise, including t-shirts, water bottles, mugs, notepads, pens, key-rings, and carrier bags. Certificates were also presented to a representative of the management of each Hospital.

The Wiki merchandise had an undeniable effect, as the recipients were greatly encouraged and motivated to improve participation with the device, but unfortunately the WOMP IIAB devices had to be retrieved in this stage as the pilot was over. Most Medical Directors were surprised by the package and certificate. They stated that they did not know the project was this important.

The team recommends that motivations like this should be done from project commencement, in order to get the desired results.

Usage analytics

Overview

In aggregate across all the devices the following statistics stood out:

• 8,000+ Search Term Completions
• 500+ Searches
• 2,500+ Total Non-search Page Views
• 256 Videos Viewed
• 12,000 server requests, and 4.6 gigabytes of data was transmitted to the users

Of the 30 most viewed pages listed below, none are specifically aimed at males, whereas 7 or 8 pertain principally to females.

Breakdown by Source

The Medical Wikipedia completely dominates the individual, non-search, page-views over the WikiEM web site and the Practical Action collection of materials, accounting for 95% of the server requests.

Use of videos

Altogether there were 256 instances where videos from the Medical Wikipedia were viewed. These included titles such as:

• Obsessive Compulsive Disorder
• Pregnancy
• Malaria

Other titles are included in the list below, as several of the videos were among the top 30 pages viewed.

Localized content

The Wikipedia in Hausa, Igbo, and Yoruba were included in content supplied with the Internet in a Box servers for this project. They were not much used, however, with fewer than 10 total accesses across all locations over the life of the project and most of those to the Wikipedia home page. All other content was in English.

Key analytic learnings

• It would be helpful to have keywords or categories by which to summarize usage. For example the underlying pages viewed could be searched during analysis for the occurrence of these terms.
• The tools to aggregate content access need to provide summaries by source, type, etc. as well as summaries over all devices.
• Search Term Autocompletion dominates the server response, constituting perhaps 70% or more of the total, so this needs to be isolated.
• We need to provide a means for tracking which SD cards came from which locations. SD cards have a unique serial number and we need to provide a user interface for assigning a name.
• The Unicode strings stored the awstats files need decoding. This is especially the case for content not in English.
• We should incorporate the batch analysis tools into the Admin Console so that the user could simply download a spreadsheet of statistics directly from the server.

Top 30 Pages Viewed

• MedWiki-Book:Women's_health.html
• MedWiki-Book:Infectious_disease.html
• MedWiki-Book:General_surgery.html
• MedWiki-Appendicitis.webm.160p.webm
• MedWiki-Menstrual_cycle.webm.160p.webm
• MedWiki-Malaria.webm.160p.webm
• MedWiki-Preeclampsia_&_eclampsia.webm.160p.webm
• MedWiki-Pregnancy.webm.160p.webm
• MedWiki-Malaria.html
• MedWiki-Pregnancy.html
• MedWiki-Book:Medications.html
• MedWiki-Book:Ophthalmology.html
• MedWiki-Removal_Implanon.webm.160p.webm
• MedWiki-Syphilis.webm.160p.webm
• MedWiki-Appendicitis.html
• MedWiki-Book:Psychiatry.html
• MedWiki-Erythropoietin.html
• WikiEM-Upper_gastrointestinal_bleeding.html
• MedWiki-Book:Cancer.html
• MedWiki-Bowel_obstruction.html
• MedWiki-Book:Children's_health.html
• MedWiki-Candidiasis.html
• MedWiki-Endoscopy.html
• MedWiki-Family_planning.html
• MedWiki-Indigestion.html
• MedWiki-Malaria.html
• MedWiki-Tonsil.html
• MedWiki-Celiac_disease.webm.160p.webm
• MedWiki-Contraception_How_to_Prevent_Unwanted_Pregnancy.webm.160p.webm
• MedWiki-Eczema.webm.160p.webm