Thinking Beyond the Device: An Overview of Human- and Equity-Centered Approaches for Health Technology Design.

A shift in the traditional technocentric view of medical device design to a human-centered one is needed to bridge existing translational gaps and improve health equity. To ensure the successful and equitable adoption of health technology innovations, engineers must think beyond the device and the direct end user and must seek a more holistic understanding of broader stakeholder needs and the intended context of use early in a design process. The objectives of this review article are (a) to provide rationale for the need to incorporate meaningful stakeholder analysis and contextual investigation in health technology development and biomedical engineering pedagogy, (b) to review existing frameworks and human- and equity-centered approaches to stakeholder engagement and contextual investigation for improved adoption of innovative technologies, and (c) to present case studyexamples of medical device design that apply these approaches to bridge the gaps between biomedical engineers and the contexts for which they are designing.

Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings.

BACKGROUND: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). METHODS: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. RESULTS: Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. CONCLUSIONS: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.

Traditional male circumcision in Uganda: a qualitative focus group discussion analysis.

BACKGROUND: The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs. METHODOLOGY AND MAIN FINDINGS: During 2010-11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events. CONCLUSION: This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches.

Assessment of vibrotactile feedback on postural stability during pseudorandom multidirectional platform motion.

This study uses frequency-domain techniques and stabilogram diffusion analysis (SDA) to investigate the effect of vibrotactile feedback during continuous multidirectional perturbations of a support platform. Eight subjects with vestibular deficits were subjected to two-axis pseudorandom surface platform motion while donning a multiaxis vibrotactile feedback device that mapped body tilt estimates onto their torsos via a 3-row by 16-column array of tactile vibrators (tactors). Four tactor display configurations with spatial resolutions ranging between 22.5 degrees and 90 degrees, in addition to the tactors off configuration, were evaluated. Power spectral density functions of body sway in the anterior-posterior (A/P) and medial-lateral (M/L) directions, and transfer functions between platform motion and body sway, were computed at frequencies ranging from 0.0178 to 3.56 Hz. Cross-spectral analysis revealed that the A/P responses were not significantly driven by M/L inputs, and vice versa, thus supporting the notion of independent A/P and M/L postural control. Vibrotactile feedback significantly decreased A/P and M/L spectral power, decreased transfer function gains up to a frequency of 1.8 and 0.6 Hz in the A/P and M/L directions, respectively, and increased phase leads above 0.3 Hz. SDA showed significantly decreased transition time for both A/P and M/L tilts, and decreased transition displacement and short-term diffusion coefficients for A/P tilt. However, the spatial resolution of the tactor displays did not affect subjects' performance, thereby supporting the use of a lower spatial resolution display in future device designs.