Mobile technology to improve data collection after sexual violence

Abstract

Background: MediCapt is a mobile application, currently under development, that digitises a medical intake form for sexual violence survivors such that it captures and preserves court-admissible evidence. The medical intake forms currently in use tend to produce incomplete, illegible, or even inconsistent reports that are often dismissed in court. MediCapt replaces paper documents and will be designed with prompts that help doctors avoid common mistakes, remind them of the necessary information needed for a forensic medical examination, and catch inconsistencies before the form is completed. MediCapt v1.0 was piloted in Bukavu, Democratic Republic of Congo (DRC) in January, 2014, with seven clinicians, all of whom were participants in Physicians for Human Rights (PHR) trainings on forensic documentation. We then tested MediCapt in the field to gather feedback on the usability of MediCapt within the DRC that would inform ongoing development. Methods: PHR is employing a process of “collaborative design” in the development of MediCapt. This process seeks and incorporates feedback from the ultimate end-users and is in iterative process. We conducted a 3 month field test of MediCapt with seven clinicians in both North and South Kivu from March to May, 2014. During this field test, clinicians were asked to (1) provide feedback on various aspects of the app including ease of use, and (2) complete several tasks including the inputting of patient case scenarios to simulate real-life patient information. Findings: Clinicians initially reported a lack of usability, and suggested that the form on the application be shorter. They suggested enhanced features including a camera function and ability to draw on a pictogram, and that the system be able to accommodate use by not only clinicians but also others within the justice process. Interpretation: Using the lessons learned from both the pilot and field-test of the first MediCapt version reported here, we developed MediCapt v2.0, which was tested with Congolese clinicians in January, 2015. Feedback from this testing will be reflected in the next version of MediCapt due later in 2015. In addition to improving documentation of individual cases, MediCapt, when in wide use, will also address gaps in data collection. By aggregating the data from the uploaded medical forms, Physicians for Human Rights will have access to de-identified information on cases of sexual violence that can inform humanitarian responses across various regions. MediCapt will also strengthen the security of medical data, improve standardisation of forensic assessments, and enhance the quality of the forensic medical evidence to ultimately support effective prosecutions of sexual violence cases. Challenges related to the application's development include ensuring proper security standards and data encryption, developing strategies to overcome low network connectivity in end users' environments, and users' fluency with a smart-phone-based application. A robust monitoring and evaluation plan is being concurrently developed to track the early testing phases of the application. Funding: The MediCapt project receives funding from the US State Department's Bureau of International Narcotics and Law Enforcement (INL).