TRUMP: A Trusted Mobile Platform for the Self-Management of Chronic Illness in Rural Areas

Chronic diseases are now the leading causes of death in both developing and developed countries. Such conditions include diabetes, asthma, arthritis, heart failure, COPD, dementia and a range of disabling psychological conditions such as depression. In the UK the cost of care of people with chronic conditions consumes the majority of health and social care resources, for example, accounting for over 80% of GP consultations. While the UK and India have very different practices and structures for healthcare delivery, the effective management of chronic illness is a priority for both countries. Patients in rural areas, however, present particular challenges that neither country's healthcare systems are well configured to address. This issue is particularly relevant to India with 71% of the population in rural areas. While less than 1 in 5 of the UK population are rural dwellers, large parts of the country are sparsely populated; for example in Scotland, 29% of the population live in rural areas. Rural healthcare inequality in both countries arises from a number of factors, including transport costs and the inaccessibility of specialist services.

The goal of the TRUMP project is to explore the potential of mobile technologies in the development of a platform to support chronic disease management by simultaneously considering the needs of rural areas of India and the UK. Trust in such systems is vital if they are be accepted by patients and health workers alike, and this issue will form a central part of the development of the platform. Two common chronic conditions, diabetes and depression, have been chosen as exemplars for the development of the platform and its evaluation.

TRUMP is a multidisciplinary project involving academic researchers from the UK and India, together with partner organisations drawn from the business and community sectors. Working together, this team will: perform a detailed analysis of the healthcare context, design sustainable technology solutions compatible with local and national healthcare policies; incorporate existing proven chronic management programmes and training. This implies support for novel patient record systems, mechanisms for tracking the patient (symptoms and behaviour), as well as patient awareness of self-management.

Patients, Families & Medical Practitioners
An essential element of the research programme proposed is engagement with real patients, their families and medical practitioners in both the UK and India. This is an important means to evaluate the research being conducted, but also presents key opportunities to develop effective relationships with important stakeholders. There is an opportunity for the research to influence professional practice in healthcare regarding the use of m-health solutions through an understanding of the applicability of technological interventions, the clinical benefits of these interventions, and their cost effectiveness and sustainability.

Influencing Policy
Underpinning this research is the goal to influence public policy such that m-health interventions are considered beneficial and cost effective. This is a rationale behind the membership of the advisory board summarised in the proposal. The project team has an excellent track record in this area; for example, the proposed research dovetails with a multidisciplinary protocol development group, encompassing researchers and health care consumers, funded by the Scottish Chief Scientist's Office and led by applicant Cameron.

Developing Capacity
A number of Indian NGOs will be working closely with academic and research staff to run pilot studies; this will directly contribute to enhancing the research skills within those organisations. Commercial software partners will be exposed through the project to expertise in a range of non-technical disciplines, increasing their awareness of the clinical, technical and socio-economic challenges facing m-health deployments, and enhancing their ability to deliver effective solutions; they will also be exposed to a range of emerging technologies through close working with academic partners.

Wider Public
There is a great deal of public anxiety about electronic patient record (EPR) systems in the UK; for example the recent Royal Academy of Engineering report Privacy and Prejudice noted: "Young people have significant concerns regarding EPRs. These arise due to the perceived weaknesses of an EPR system, including both the robustness (or not) of the technology and the potential errors that will be made by the users." There is thus an opportunity through TRUMP to engage with this complex socio-technical issue. Project team members in India have good links with the e-government and national identity card initiatives, and will use these forums to engage with the wider rural community across the different states to educate the citizens on the benefits of m-health.

Research Staff Development
The interdisciplinary nature of the research proposed will provide valuable opportunities for research staff employed on the project to develop and understanding of the research questions and challenges of other disciplines as well as different methods and techniques used. Specific and generic training, including ethics training, offered by each participating institution and by the research team itself will support this. The international dimension of the project will also benefit the development of researchers by exposing them to different research cultures and perspectives.

Commercialisation
The project is supported by the involvement of IBM in both the UK and India, and by ZMQ in India. This both aids the research, and provides an important means to commercialise and exploit the technologies developed within the project. As stated by Dr Peter Waggett (IBM Hursley) in his supporting letter "the inclusion of [his] involvement in this research programme will ensure that the transition route will be accelerated and grounded in best practice from industry". Similarly, ZMQ Software, as highlighted in their supporting letter, will bring significant expertise in the deployment of mobile-based solutions for development, introducing a route for exploitation in the context of their "Mobile for Development" initiative.