How To Use A Paper Questionnaire With A Computer Or Tablet (Or Both)

Public Health Computing

Dept. Epidemiology & Public Health

Tablet computers and Open Data Kit for

electronic data capture

Nicolas Maire, Sven Meury

Andreas Steiner

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Open Data Kit (ODK) ODK extensions

ODK@SwissTPH

Outline

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Electronic data capture as a replacement for paper

questionnaires

Guidance for interviewer

Skip logic

Input constraints

Adequate data storage (1-N relationships)

Potential cost savings

Printing, copying, shipping, archiving paper Data entry, cleaning

Requirement by some funders

Near-time availability of data

Secure and central storage

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A dynamic field…

Episurveyor (Palm, J2ME), openXData (J2ME), EpiCollect (iOS, Android),…

Open Data Kit (ODK)

Open source software suite (Univ. Washington, Google.org)

Large user community, active developer community (including Swiss TPH) Open standard compliant

Android phones or tablets

Technology options

Open Data Kit: Architecture and Workflow

Publish form Upload_Data

ODK Collect

Download Form

Questionnaire design

Intuitive and simple, but powerful through optional definitions Transformation to renderable XForm

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Case study: FEVERKIN (2011)

– Cross sectional urban malaria survey in the city of Kinshasa, DRC

– Possession and use of bed nets

– 7 days training / 2 days pre-testing / 30 days data collection

– 8 teams (1 interviewer and 1 lab technician each)

– >2500 HH interviewed

– GPS coordinates of all HH

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Feedback from project teams

Challenges

Requires infrastructure (mobile devices and server) Requires more careful planning

Dependence on expert IT support

Advantages

Fast and efficient way to collect data Better quality data

What’s the evidence?

Some:

Studies comparing costs, time/delay, reliability of various electronic

data capture methodologies indicate advantages or non-inferiority

Shortcomings:

Lack of good studies to compare data quality against traditional

paper-based forms

ODK validation study

Interview Catalogue) interview for influenza vaccine acceptance

• 3 teams of 2 conducting 96 interviews with both paper and tablet devices

• Field work in Pune, India • Debriefing assessment of

interviewers’ experience in

administering the interview with given device

• Tablet-paper discrepancy analysis with reference to authoritative

Recurring roles for each of the field research

assistants over the course of the study

This cycle of respective roles in each interview repeats for the two field research assistants on each team using paper (P) or tablet (T) device, and functioning as interviewer (Lead, L) or follower (coder only, F).

Results

• (Discoverable) error rates comparable for tablet and paper (2%)

• Interviewers indicate either no preference, or prefer tablet

• Tablets more cost-effective if sample size > 100

• Additional objective: to acquire experience with qualitative data, using available features of hand writing recognition

ODK and qualitative research

Workflow integration with analysis software possible (MAXQDA), with room for further improvements

Data capture a challenge

Strategies for direct digitization of notes (eliminating paper)

Strategies for more efficient processing of audio recordings (e.g. timestamps, automated transcription)

Beyond the paper-questionnaire analogy

Additional data types (GPS, barcodes, diagnostic devices, time stamps…) Support for system-wide unique ids

Near-time quality control (openhds & su2)

Monitoring and planning (su2 & ODK_planner)

ODK: beyond cross-sectional surveys

• Longitudinal follow-up requires extension of the ODK system (at present)

• In particular, system-wide, referencable ids are a key requirement • Our (and others) approach is integration of ODK with other software

Health and Demographic Surveillance Systems (HDSS)

openHDS

A set of field and computing operations to handle the longitudinal follow-up of well-defined entities or primary subjects (individuals, households, and residential units) and all related demographic and health outcomes within a clearly circumscribed geographic area

46 HDSS sites for INDEPTH over 46 years

In 24 countries Each with unique health systems www.indepth-network.org

Primary goal can be routine

surveillance in the absence of a vital registration system

Platform to provide essential

denominator data for epidemiological and demographic research

An operational challenge, in particular the data management

A functional data collection and management platform is a key requirement: OpenHDS

Open Data Kit: Architecture and Workflow

Publish form Upload_Data

ODK Collect

Download Form

openHDS/ODK integration

SOLARMAL HDSS experience

Rusinga Island

First update completed 2 days before 2nd annual SOLARMAL workshop Data presented at workshop

BUT:

Su2: the surveillance surveillant

odk_planner

History

Bagamoyo, Tanzania : paper-based forms

Long delays for “data capture”, difficult overview Started using ODK for all data entry

Missing parts: implemented odk_planner

1. Overview ODK/odk_planner 2. TB-Dar study 3. TB-Pharm study 4. Availability 5. Live demo Outline

odk_planner : Overview

Build forms

Aggregate

ODK Collect

MySQL Database

odk_planner

odk_planner

Study planning Data review Data Upload

SMS reminder

odk_planner : Why? Planning!

TB-Dar study

• Tuberculosis cohort

• 500 cases per year, + controls • 21 forms, complicated flow

• Doctors, field workers, secretaries, … • X-rays, CRFs, lab results, …

ODK Aggregate

odk_planner : Why? Automation!

odk_planner : How?

1) Find it

2) Read

• Open source code

• Extensive documentation

3) Apply

• TPH : Experimental add-on service for ODK instances, just ask • Use it, extend _{it !}

odk_planner : Live demo

•Download/upload forms •Help

Swiss TPH: requesting ODK hosting and support

• Meaningful subject (e.g. Application for ODK server) • Order as early as possible

Required information

• Project name abbreviation (up to 12 alphanumeric characters) • Cost center

• Starting date of the project • Expected end date of project

What is included in the service

• An URL https://odk.tph.unibas.ch/ODK<yourproject> to send your data to • A trusted SSL certificate to keep the data transfer securely

• Unlimited server space

• Daily backup of your server based ODK data • Setup and maintenance of your ODK instance

Costs

• for setup

• maintenance per year

Process

• Ticket is reviewed (check for completeness) • Approval request to cost center owner

• Database setup by IT

• ODK instance setup by Public Health Computing group

• Default 2 users: Form Manager + Data collector

• Invoice

Tablets

Separate order by mail to [email protected]

• Requirements of the tablets (display size, mobile broadband module 3G/4G) • Specific model (normally only available for short time)

Advisory capacity

• Depending on needs and capacity

- Advisory support for form design and field processes - Support for data manipulation/export for data analysis

Coming soon: [email protected]

Acknowlegdements

A. Di Pasquale, R. Mitra, J. Giduthuri, M. Weiss, L. Fenner, J. Hella ODK core developers