Rohana B. Marasinghe

Effect of mobile phone-based psychotherapy in suicide prevention: a randomized controlled trial in Sri Lanka.

We conducted a randomized controlled trial to test whether a Brief Mobile Treatment (BMT) intervention could improve outcomes relative to usual care among suicide attempters. The intervention included training in problem solving therapy, meditation, a brief intervention to increase social support as well as advice on alcohol and other drugs, and mobile phone follow-up. The effect of the intervention was measured in terms of a reduction in suicidal ideation, depression and self-harm at Baseline, six and 12 months. A wait-list control group received usual care. A total of 68 participants was recruited from a Sri Lankan hospital following a suicide attempt. Participants who received the intervention were found to achieve significant improvements in reducing suicidal ideation and depression than those receiving usual care. The BMT group also experienced a significant improvement of social support when compared to the control group. However, the BMT group did not demonstrate a significant effect in reducing actual self-harm and most substance use, and differential effects on alcohol use were restricted to men. Although the present study was limited in revealing which component of the intervention was more effective in preventing suicide, it showed its efficacy in reducing suicide as a whole.

A review of telemedicine interventions in diabetes care

We reviewed the literature concerning the use of telemedicine interventions in diabetes care. The PubMed database was searched for randomized controlled trials concerning the use of telemedicine for patients with type 1 or type 2 diabetes. A total of 27 articles (studies) met the inclusion criteria. The interventions concerned videoconferencing (n = 8), mobile phones (n = 10) and telephone calls (n = 9). There was metabolic improvement in 23 studies, which was significant in 12 out of 23 (44%). Only two studies (8%) reported a negative clinical outcome. The majority of the studies (n = 19; 70%) employed behavioural therapy as the key intervention. The medium used for interaction in behavioural therapy intervention was videoconferencing (n = 7), mobile phone (n = 4), telephone calls (n = 8), feedback letters (n = 2). Telemedicine appears to be a promising alternative to conventional therapy.

Medical Students' Knowledge in E-Health in Developing Countries: a Survey in Sri Lanka

It is believed that the use of information and communication technologies (ICT) can be a potential alternative to address some of the daunting problems in healthcare sector in developing countries. Knowledge, skills and acceptance of e- health by health professionals are essential attributes of a successful integration of this new tool. This study investigates the knowledge of medical students in Sri Lanka in regard to e-health. We also examined the barriers which impede them to develop knowledge and skills in e-health within their medical curriculum. A questionnaire focusing on the knowledge and attitudes of medical students towards e-health was distributed to all final year students (n=136) at the Faculty of Medicine, Sri Jayewardenepura University, Sri Lanka. 100 surveys (74%) were completed and returned. Fifty one per cent rated their knowledge of e-health applications as minimal. The majority (88%) admitted that they had no e-health education or training of any kind. Similar number of respondents (80%) thought that e-health had an important role to play in health sector, particularly in developing countries. We also found that respondents had very poor access to computers and Internet use was rare. A large number of respondents (77%) admitted that their medical curriculum did not provide them knowledge and skills in e-health.

A snapshot of e-health activity in Sri Lanka

The health-care system in Sri Lanka is similar to those in other developing countries and access to health services for remote communities is extremely limited. We reviewed the literature about e-health in Sri Lanka. The use of information and communication technologies (ICTs) in private hospitals is more common than in public hospitals. The use of ICT in general practice is increasing. A number of international organizations have initiated various pilot projects, including disaster relief efforts, education initiatives and telemedicine. In addition, several institutions and organizations are dedicated to the promotion of e-health and a range of Web-based health consultancy services have begun. Although e-health seems to have a limited role in Sri Lanka at present, there is growing interest in the opportunities it may offer in terms of improving the delivery and access to services, especially in remote locations.

Development and implementation of a web-based continuing professional development (CPD) programme on medical genetics.

We developed, implemented and evaluated a web-based continuing professional development (CPD) programme on medical genetics. Development of the CPD programme followed the ADDIE model, i.e. Analysis, Design, Develop, Implement and Evaluation. An invitation to participate in a needs analysis survey was sent to all doctors on the email list of the Sri Lanka Medical Association. A total of 129 completed surveys was received (57% of the 228 who accessed the online survey). The average age of respondents was 42 years (range 27-81). The male: female ratio was approximately 2 : 1. Almost all respondents (96%) selected web-based CPD programmes, or web-based and conventional lectures, as their preferred method of learning. The programme was piloted on a group of 10 doctors. The average pre-knowledge score was 40.3 and the post-knowledge score was 62.1 marks out of 100 (P = 0.002). We conclude that a web-based CPD programme on medical genetics is feasible in Sri Lanka.

A pilot health information management system for public health midwives serving in a remote area of Sri Lanka.

We developed an electronic Health Information Management System (HIMS) for Public Health Midwives (PHMs) in Sri Lanka. We conducted a needs analysis amongst 16 PHMs, which found that they spent most of their time managing health records. The HIMS was designed so that it could accept data from the PHMs, and generate reports which could be used by the PHMs themselves as well as by their supervisors. The HIMS was trialled by a group of 16 PHMs in a remote area of the Ratnapura district of Sri Lanka. Mini-laptops with the software were distributed to the PHMs and they were given the necessary training. They started entering historical data from the registers into the system by themselves. Nearly 10,000 public health records were generated in the first three months. In a subsequent survey, the PHMs all gave positive answers indicating that they were happy with the pilot system, they would like to continue using it to enhance their service and they wanted to see it expanded across the whole of Ratnapura district. The system seems to be a practical solution for the field activities of PHMs in Sri Lanka.