Tumi App Mobile application to gamify adherence to TB treatm

TB is a cone-shaped infectious disease that kills millions of people every year worldwide, especially young women in economically vulnerable situations. In Latin America, hundreds of thousands of cases are reported each year, with Colombia being one of the countries most affected by the disease, particularly in the department of Cauca due to its low development index and difficult socio-economic situation. Generally, the regions that are most affected by the disease, especially in Cauca, involve people belonging to various ethnic groups or mix raced communities, such as Afro-descendants, indigenous people and peasants. In addition, these communities have low scholarity, limiting skills such as reading or writing.

On the other hand, health systems have tried to alleviate the consequences of TB through treatments that ensure a better quality of life for patients, as well as raising awareness among their families and large communities. However, many patients find it difficult to successfully follow treatments and physicians’ recommendations that contribute to self-care. This is due to several factors including: lack of education about the disease or how to properly take care of themselves, lack of access to health services, lack of resources to access treatment, and lack of emotional and social support. For this reason, tools are urgently needed to knock down barriers, especially technological ones, given the geographical difficulties that patients in these regions may face.

Nevertheless, due to the rise in Information Technology and its exponential development during the last decades, there are more people who have access to mobile device allowing them to not only communicate with their families but also be in contact with the exterior world. In this sense, tools for mobile devices (apps) have shown themselves to be promising alternatives that allow users to interact with the most modern trends related to various issues but especially in relation to the monitoring, treatment and support of a chronic disease. In the case of this project, mobile technology becomes an instrument to improve and strengthen the results of a follow-up and monitoring program, as well as the possibility of providing greater adherence to treatments in general. Studies developed in India, Africa, the USA, the UK and Moldova, among other countries, show that the use of mobile applications has improved anti-tuberculosis treatments and self-care.

The TumiApp is an innovative solution to address the problem of the lack of TB literacy in the rural region of the department of Cauca, especially in areas with a high density of vulnerable communities. This application seeks to improve the self-care of TB patients and their families through the effective use of gamification and visual interaction with a virtual character called Tumi who follows the concept of a kind of Tamagotchi, which means that he requires constant care and attention from the user, thereby creating an emotional bond. Through interaction with Tumi, patients and their families can learn about TB, preventive measures, the importance of treatment compliance and self-care. In addition, TumiApp allows patients to be accompanied and their quality of life and that of their families to be improved indirectly.

 It is worth to mention that the Tumi character has been conceived without any particular ethnic or gender affiliation, which makes it more adaptable to a community without any distinction and can generate greater sense so belonging without being intrusive to the socio-cultural environment of the patients and their close circle. Furthermore, the application itself allows for inclusivity in the sense that it has been conceived for people with literacy limitations through the effective use of images, graphic symbols, audio, and animations.

TumiApp is designed for TB patients and their families living in the municipalities of the department of Cauca: (1) Santander de Quilichao, (2) Villarrica, (3) Puerto Tejada, (4) Caldono and (5) Piendamó. It should be noted that both patients and their families face a number of challenges such as limited access to information about the disease, little understanding of the importance of treatment, difficulties in complying with supervised treatment and lack of knowledge about self-care, in addition to limitations in literacy skills.

Thus, TumiApp offers a solution to the above problems by providing clear and accessible information related to TB, its causes, symptoms, diagnosis, treatment and self-care measures during the course of the disease and disease remission conditions. The app also offers medication reminders, schedules for check-ups and medical appointments, as well as tools for monitoring treatment progress and psycho-emotional support when needed.

 Also, the use of Artificial Intelligence for gamification allows the application to be more interactive and attractive to patients with limited reading and writing skills, which generates a better understanding and participation in the treatment, as well as activities designated by the program agent for self-care. In addition to the above, the application increases the local capacity of hospitals covering the rural environment of the region, favors interaction with health professionals, patients can more easily adapt to self-care interventions, and increases the quality of treatment adherence monitoring in patients with low health system coverage who are located in fragile contexts, thus improving health outcomes at the primary care level. Specifically, TumiiApp can have a significant impact on the lives of patients and their families by improving understanding of the disease and increasing adherence to treatment, improving health outcomes, strengthening the self-care capacities of patients, their families and neighbors through word of mouth communication about TB self-care knowledge and health practices, bringing health services closer to the communities and reducing the cost of health care as well as the burden of disease in rural and dispersed areas of the department of Cauca, becoming a pilot and a national benchmark.

The team has experience in application development, research and creation projects, as well as in design and programming of mobile applications, user experience, interface design, user research, digital illustration, animation and software development methodologies with researchers from the CAMALEÓN research group of the Universidad del Valle and the Information Technology R&D Group -GTI- of the Universidad del Cauca.

 In relation to research experience in Public Health, particularly in TB, there are professors and researchers from the CEDETES and CALIMET groups of the Universidad del Valle and GIS of the Universidad del Cauca, as well as support from the staff responsible for the departmental TB program and the municipalities considered in this proposal, who will contribute to the development of thematic elements, The program is also supported by the staff responsible for the departmental TB program and the municipalities considered in this proposal, who will contribute to the development of thematic, technical and conceptual elements of TB, the causal agent, risk factors and behaviors treatment and the importance of treatment to cut the chain of TB transmission and self-care measures during the disease and condition of remission of the disease.

 The team will be responsible for establishing a baseline in relation to the knowledge of the subject in patients and their close circle, as well as the characteristics of connectivity (individual and georeferenced) and access to mobile units through a mixed study. For the development of the application, user research will be carried out and, based on task scripts, mental models will be discovered with the aim of defining conceptual models according to their particularities based on Experience Design.

 In addition to the above, the team ensures the development of the application and its adaptation following the premises of User-Centred Design and Accessibility taking into account literacy limitations. Summarising, the steps of the "Design Research Process" (DRP) will be considered as a valid methodology of scientific research and development of application projects, composed of 6 phases; 1) identification of the problem according to the results of the interdisciplinary diagnosis and the assessment with a group of experts in the problem, 2) establishing objectives of the solution, 3) design and implementation, 4) piloting, 5) measurement and 6) communication.

In measuring or testing the usability and functionality of the TumiApp tool, medium and high-fidelity prototypes will be used, as well as User eXperience -UX- evaluation methods.

 For the implementation and measurement phase, the Secretariat of Health of the Department of Cauca and researchers from the CEDETES, CALIMET, GIS and GTI and CAMALEON groups would be involved in a heuristic evaluation based on a checklist. In addition, the coordinating staff of the departmental programmes and institutions with tuberculosis programmes would be the overseers of the implementation and those who, in the future, would provide sustainability to TumiApp, allowing the literacy program to be linked to the Central Program for TB Control in Health Services.

TumiApp está diseñada para pacientes con TB y sus familias que viven en los municipios del departamento del Cauca: (1) Santander de Quilichao, (2) Villarrica, (3) Puerto Tejada, (4) Caldono y (5) Piendamó. Cabe señalar que tanto los pacientes como sus familias enfrentan una serie de desafíos como el acceso limitado a la información sobre la enfermedad, la poca comprensión de la importancia del tratamiento, las dificultades para cumplir con el tratamiento supervisado y la falta de conocimiento sobre el autocuidado, además a las limitaciones en las habilidades de alfabetización.

 Thus, TumiApp offers a solution to the above problems by providing clear and accessible information related to TB, its causes, symptoms, diagnosis, treatment and self-care measures during the course of the disease and disease remission conditions. The app also offers medication reminders, schedules for check-ups and medical appointments, as well as tools for monitoring treatment progress and psycho-emotional support when needed.

Also, the use of Artificial Intelligence for gamification allows the application to be more interactive and attractive to patients with limited reading and writing skills, which generates a better understanding and participation in the treatment, as well as activities designated by the program agent for self-care. In addition to the above, the application increases the local capacity of hospitals covering the rural environment of the region, favors interaction with health professionals, patients can more easily adapt to self-care interventions, and increases the quality of treatment adherence monitoring in patients with low health system coverage who are located in fragile contexts, thus improving health outcomes at the primary care level.

Specifically, TumiApp can have a significant impact on the lives of patients and their families by improving understanding of the disease and increasing adherence to treatment, improving health outcomes, strengthening the self-care capacities of patients, their families and neighbors through word of mouth communication about TB self-care knowledge and health practices, bringing health services closer to the communities and reducing the cost of health care as well as the burden of disease in rural and dispersed areas of the department of Cauca, becoming a pilot and a national benchmark.

The WHO End-TB strategy envisions a world free of TB deaths and diseases by 2035. However, program indicators show management deficiencies resulting in lower recovery rates, recurrent contagions, and a significant increase of new cases. Hence, the evident lack of an effective TB treatment has led to the implementation of multidrug-resistant TB (MDR-TB) in fragile contexts, including underserved communities, such as young and adult women, ethnic minorities, people with disabilities and seniors, which are usually the part of the population most affected in low- and middle-income countries, including Colombia. These indicators show wide variations in different geographical areas of the country, associated with low human development indices.

The biggest challenges that the presented proposal has lie in the conditions of the territory to be benefited, since the government neglect for telecommunication structures, places the population in a place of technological precariousness, which consolidates at the same time cultural affectations in terms of access to information.

The participation of the patient and their family environment is fundamental for the achievement of the program’s objectives. TumiApp is a mobile application that uses Artificial Intelligence with the ability to gamify the self-care of patients and families with limited literacy skills in rural areas. The current proposal focuses on the design, implementation and measurement of a mobile application that strengthens the knowledge of users for the prevention of the disease, such as self-care of their health through the implementation of playful and educational activities as well as facilitating adherence to TB treatment and professional supervision. The use of Artificial Intelligence is expected to personalize the content and adapt the level of difficulty to the needs of each user, resulting in a more fluid and effective interaction with the patient. This will strengthen the patient's knowledge of their disease, the importance of complying with treatment and how to prevent reinfections and infections in their environment and self-care.

TumiApp offers a solution to the above problems by providing clear and accessible information related to TB, its causes, symptoms, diagnosis, treatment and self-care measures during the course of the disease and disease remission conditions. The app also offers medication reminders, schedules for check-ups and medical appointments, as well as tools for monitoring treatment progress and psycho-emotional support when needed.

Also, the use of Artificial Intelligence for gamification allows the application to be more interactive and attractive to patients with limited reading and writing skills, which generates a better understanding and participation in the treatment, as well as activities designated by the program agent for self-care. In addition to the above, the application increases the local capacity of hospitals covering the rural environment of the region, favors interaction with health professionals, patients can more easily adapt to self-care interventions, and increases the quality of treatment adherence monitoring in patients with low health system coverage who are located in fragile contexts, thus improving health outcomes at the primary care level.

Target 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

The TumiApp is an innovative solution to address the problem of the lack of TB literacy in the rural region of the department of Cauca, especially in areas with a high density of vulnerable communities. This application seeks to improve the self-care of TB patients and their families through the effective use of gamification and visual interaction with a virtual character called Tumi who follows the concept of a kind of Tamagotchi, which means that he requires constant care and attention from the user, thereby creating an emotional bond. Through interaction with Tumi, patients and their families can learn about TB, preventive measures, the importance of treatment compliance and self-care. In addition, TumiApp allows patients to be accompanied and their quality of life and that of their families to be improved indirectly.

 It is worth to mention that the Tumi character has been conceived without any particular ethnic or gender affiliation, which makes it more adaptable to a community without any distinction and can generate greater sense so belonging without being intrusive to the socio-cultural environment of the patients and their close circle. Furthermore, the application itself allows for inclusivity in the sense that it has been conceived for people with literacy limitations through the effective use of images, graphic symbols, audio, and animations.

The TumiApp is an innovative solution to address the problem of the lack of TB literacy in the rural region of the department of Cauca, especially in areas with a high density of vulnerable communities. This application seeks to improve the self-care of TB patients and their families through the effective use of gamification and visual interaction with a virtual character called Tumi who follows the concept of a kind of Tamagotchi, which means that he requires constant care and attention from the user, thereby creating an emotional bond. Through interaction with Tumi, patients and their families can learn about TB, preventive measures, the importance of treatment compliance and self-care. In addition, TumiApp allows patients to be accompanied and their quality of life and that of their families to be improved indirectly.

 It is worth to mention that the Tumi character has been conceived without any particular ethnic or gender affiliation, which makes it more adaptable to a community without any distinction and can generate greater sense so belonging without being intrusive to the socio-cultural environment of the patients and their close circle. Furthermore, the application itself allows for inclusivity in the sense that it has been conceived for people with literacy limitations through the effective use of images, graphic symbols, audio, and animations.

Research centers of public universities made up of teachers and students from different departments