MHealth Technology as a Tool to Promote Blood Donation

Joélia Rodrigues da Silva

, Christina César Praça Brasil

, Bruno Praça Brasil

Larissa Barbosa Paiva

, Vinicius Freire de Oliveira

, José Eurico de Vasconcelos Filho

and Francisco Wandemberg Rodrigues dos Santos

Postgraduate Program in Public Health, Universidade de Fortaleza, Ave. Washington Soares, Fortaleza-CE, Brazil

School of Medicine, Universidade de Fortaleza, Ave. Washington Soares, Fortaleza-CE, Brasil

Information Technology Application Center, Universidade de Fortaleza, Ave. Washington Soares, Fortaleza –CE, Brazil

Keywords: Blood Bonation, Health Promotion, Mobile Applications.

Abstract: The blood donation scenario and its effect on the treatment of patients with hematological diseases and in

emergency situations is a constant concern in the health area, requiring guided actions that allow

improvements in the donor recruitment and retention processes, and therefore, the increase and maintenance

of blood donation. To meet this social demand, an exploratory, qualitative study was carried out with the

objective of creating a cell phone application that supports blood donor recruitment and fidelization through

prevalent and interactive communication and technological resources, generating social engagement. The new

information technologies have been increasingly disseminating in the several social settings as a way of

collecting, recording, producing, processing and sharing data and information. A research was carried out to

identify the existence of applications that support the activities of the Brazilian blood donation units,

integrated to the database and with gamification resources, with none being identified with these

characteristics. The proposed tool has differential characteristics in relation to the applications available in

the market and may be effective in blood donor recruitment and in supporting health promotion. The

application has a deadline of November 2017 to start being used.

1 INTRODUCTION

Blood donation is discussed worldwide as a social

strategy for the maintenance of collective health. It

must be exercised voluntarily, altruistically and

anonymously to minimize the risks of contamination

and transfusion reaction in patients assisted by the

health system.

According to the World Health Organization-

WHO (Brasil, 2016), only 1.8% of the world's

population donates blood, whereas the ideal would be

3 to 5%. In Brazil, this percentage was 1.73% in 2014

and showed a decrease of 0.15% in 2015, showing a

percentage of 1.58%. These calculations were based

on the demographic projection of the Instituto

Brasileiro de Geografia e Estatística - IBGE

(Brazilian Institute of Geography and Statistics) for

the period of the year 2000 to the year 2030 (IBGE,

2016).

Accentuating this scenario, data from the Ministry

of Health-MH declare that between 2003 and 2013

there was a 84% increase in the number of organ

transplants in the country (Brasil, 2014). Some

indexes of concern focus on diseases such as cancer,

which require blood infusion as part of the treatment.

According to global estimates by the International

Agency for Research on Cancer (IARC / WHO), in

2012 there were 14.1 million new cases and a total of

8.2 million cancer deaths worldwide (Brasil, 2014).

By 2030, the projected global burden is 21.4 million

new cases of cancer and 13.2 million deaths

worldwide due to the disease. The MH points out an

increase of 6.89% in the number of transfusions in

2014 in relation to the previous year (Brasil, 2015).

Other relevant data are related to the health care

network in the country, which includes the increase in

the number of hospital beds, resulting in an increase

in the high-complexity number of procedures and,

consequently, of transfusions. Between 2003 and

2013, the number of emergency and elective surgeries

Silva, J., Brasil, C., Brasil, B., Paiva, L., Oliveira, V., Filho, J. and Santos, F.

MHealth Technology as a Tool to Promote Blood Donation.

DOI: 10.5220/0006597804710477

In Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2018) - Volume 5: HEALTHINF, pages 471-477

ISBN: 978-989-758-281-3

471

in the country increased by 619%, going from 12.3

million to 88.9 million, and emergency care increased

from 898.2 million to 9.1 billion procedures,

corresponding to an increase of 627% (Brasil, 2014).

The problematic of hemotherapy assistance

increases as the population increases and grows older,

and morbidity cases increase. It is necessary to

increase investments in the blood donation promotion

area, to stimulate the habitual practice of this

voluntary gesture. Additionally, more effective

communication is required, aiming to promote the

citizens’ awareness and engagement in the process of

maintaining the stock of blood supply in the blood

banks.

Some technological resources have become

important in the field of communication and started

being used as strategies of social engagement, such as

applications for smartphones.

It is believed that the implementation of the

mobile (mHealth) technology in the health area can

increase its dissemination in the population within the

context of blood donation, favoring the recruitment of

blood donors and the fidelization of the donor public;

in addition to meeting the users' wishes and needs,

which include health care directives, social

involvement, citizenship promotion and humanitarian

campaigns (Online publisher, 2016).

A balanced blood supply guarantees the

prevention of mortality and clinical complications. It

is also the achievement of collective health actions,

through the promotion of blood donation, both

consciously and effectively.

Considering the information above, the present

study aims to design a smartphone-type mobile

application that can support blood donation and the

promotion of public health through innovative

resources and database integration.

2 METHODS

This is an applied, exploratory study that used the

qualitative approach. The implementation of this

research was held in four stages.

The project started in September 2015 and has

already completed the first three stages, of the four

stages predicted for the delivery of the technological

artifact: (1) design and development of the

application in the laboratory; (2) application usability

testing with users; (3) in-app adjustments, design and

(re) design; (4) validation test with hemotherapy

specialists.

The first phase, carried out at the Information

Technology Application Center - NATI, of the

Universidade de Fortaleza - UNIFOR (University of

Fortaleza), in the city of Fortaleza, Ceará, Brazil, had

weekly meetings of a group consisting of a

multidisciplinary team that comprised undergraduate

students from the medical and software engineering

areas, a master's degree student in the area of public

health, an information technology doctorate student,

plus the support and help of a professional from the

public blood bank of the city of Fortaleza-Ceará,

currently responsible for the care of all 284

municipalities of the state, assisted by the Sistema

Único de Saúde - SUS (Brazilian Unified Health

System). Throughout the process of the application

creation, the team could count on the guidance of

professor doctors from both areas.

Set up as an information-gathering process for the

tool design, the initial stage of the project utilized the

brainstorming technique for surveying the

requirements, as well as searching for similar

applications in the Android and iOS application stores

using the following descriptors, in Portuguese and

English: donation, donation of blood, blood, donor,

blood donor and its equivalents in Portuguese.

Finally, the literature review was carried out by the

master's degree student, and a rich scenario of

possibilities for the tool design was identified.

The Human-Computer Interaction (HCI)

methodology focused on User-Centered Participatory

Design (Rogers et al., 2013) was adopted, aiming to

contemplate users’ needs and desires, as well as

offering interactivity throughout the application

development process, to improve it for personalized

use and compatible with institutions and society.

This process is characterized as iterative because

the product cannot become ready for use

immediately, requiring comings and goings,

exchange of experiences, assessments and tests to

complete the cycle and allow for continuous

improvement.

Also, according to Rogers, Sharp and Preece

(2013) the Interaction Design is divided into four

Figure 1: Life cycle of the Interaction Design. Source:

Rogers, Sharp and Preece (2013).

HEALTHINF 2018 - 11th International Conference on Health Informatics

472

activities (Figure 1): identification of the user needs

and establishment of requirements, creation of the

solution design and (where necessary) redesign,

creation of an interactive version (app prototype) and

evaluation by users.

The Participatory Design (Rogers et al., 2013), as

a methodology, was also applied in 2016 in another

research entitled "mHealth Technology as a Vocal

Health Promotion Tool", through which an

application (VoiceGuard) was conceived and

developed, with the objective of assisting teachers in

effective care with vocal health. It is noteworthy that

this project was coordinated by some researchers who

are also involved in the design and development of

the application DoeSangue.

The evaluation of VoiceGuard by speech-

language specialists was very positive and

demonstrated their interest and expectation for the

developed tool. This application was considered as an

innovative resource for the vocal health promotion

due to its unique approach, gathering knowledge,

technology and social participation in favor of the

monitoring and management of vocal health in real

time by the teachers and other professionals who use

voice as a work tool (Carlos et al., 2016). In addition,

VoiceGuard has been awarded and recognized by

national and international institutions and is available

in mobile application stores for smartphones, in both

Android and iOS platforms.

All this allows us to believe that this

methodological approach to design and develop new

technologies focused on the user´s view and settled

on a triangular model - knowledge, technology and

society - can be an effective strategy for the creation

of new solutions aimed at health promotion. Based on

this and other experiments, the researchers found

support to proceed with the creation of DoeSangue

application.

The usability test was applied in the second stage,

which aims to evaluate the application efficiency

regarding its functionality: easy to use, understand

and interaction (Barbosa and Silva, 2010). Ten

volunteer blood donors from the public blood bank of

Fortaleza-Ceará participated of this stage.

The usability test was carried out in November,

2016, in the NATI/UNIFOR laboratory, an adequate

environment to guarantee the effective participation

of volunteers, as recommended by Rogers, Sharp and

Preece (2013). The test was applied by the application

development team and accompanied by the project

researcher.

Each participant received a smartphone with the

installed application and, through an activity script,

recorded their impressions about the application in a

standard form. All participants signed the Free and

Informed Consent form to ensure total

appropriateness during the process.

In the third stage of the study, we evaluated the

relevance of the participants’ considerations,

captured during the usability test, to meet the

proposed requirements. Also, considering the

Symbolic Interactionism (Blumer, 1969), the analysis

of the expressions, the gestures and the phrases

recorded through the filming performed throughout

the test was also carried out.

A new scenario was established based on the data

analysis, suggesting the implementation of

improvements in the application interface, thus

Table 1: Comparison of mobile technologies available on the market versus necessary requirements.

APPLICATIONS

REQUIREMENTS

1. Blooder

2. BloodConnect

3. Blooddonor

4. Blooddonor +

5. BloodHero

6. Doação de sangue reminder

7. Doe +

8. Don duSang 2.0

9. Eu curto doar

10. Hemoliga

11. Heroes

12. I amDonor

13. MyBlood for you

14. Sangue do bem

Legend: The "x" symbol specifies the existence of the function in the application. Source: The researcher.

MHealth Technology as a Tool to Promote Blood Donation

473

corroborating the User-Centered Interaction Design

(Rogers et al., 2013).

The adjustments were implemented until May

2017 by NATI / UNIFOR. After the adjustments are

made, the application will be validated again by the

multidisciplinary team and will continue onto the

fourth and last step of the research.

The research ethical and legal procedures follow

the norms contained in Resolution 466, of December

12, 2012, of the National Health Council, which

indicates the Guidelines and Norms Regulating

Research Involving Human Beings (Brasil, 2013). It

is noteworthy that the project has already obtained

approval from the Ethics Committee of the

Universidade de Fortaleza - UNIFOR (University of

Fortaleza) under opinion n. 2.110.185.

3 RESULTS

The first result obtained in the research was the

conception of a technological apparatus that will meet

the needs of the identified problem, which was

denominated “DoeSangue” (“DonateBlood”). This

idea, conceptually and methodologically supported

by the Participatory Interaction Design and

brainstorming meetings with the multidisciplinary

team (health, technology and communication)

generated the list of the requirements to be

implemented to meet the needs of donors and public

blood banks.

Here are some of these requirements (application

only): 1) register the donor; 2) schedule the blood

donation; 3) identify unfitness for donation and report

cessation of unfitness to the donor; 4) calculate and

remember the date of next blood donation; 5) show

the collection site closest to the donor; 6) make an

invitation to donate blood, by blood type, by locality

and in situations of rare phenotypes; 7) allow the

donor to send an invitation to friends to be donors; 8)

provide continuous communication with the citizen in

the area of social responsibility, campaigns and

events through short messages; 9) allow posting of

awareness videos and in-app testimonials; 10)

provide information about the blood bank (location,

contacts, opening hours); 11) allow registration in the

Blood Bank Relationship Programs; 12) use

gamification resources in the application (points,

badges, among others) and persuasive design; 13)

offer notification resources; 14) provide reports of

serological test results (negative results) after

donation; 15) offer information on automated

donation, special donations (autologous) and

clarification on myths and frequent questions; 16)

integrate the application to the blood bank database.

Based on the definition of the functional

requirements for the application being created, it was

possible to develop the project and obtain the second

research result, through a comparative study of the

mobile technologies available in the market versus

the requirements necessary for the study object (Table

1). This analysis identified a favorable scenario for

the application creation, as some requirements were

identified as absent in 14 evaluated applications,

among them:

• make an invitation for specific donation of

blood, in situations of rare phenotypes;

• engage citizens in blood bank campaigns on

social networks;

• allow posting of awareness videos and in-app

testimonials;

• allow registration in the Relationship

Programs of the blood bank;

• make results of serological tests available

(negative results);

• offer automated donation information;

• offer information on special donations

(autologous);

• integrate the application with the blood bank

database.

Another relevant data obtained in the research is

that there is no application that offers integration with

the blood bank database in this market niche,

allowing access to the donor's history, news and

messages from the blood bank itself. Additionally, the

existing applications do not include the gamification

features and persuasive design that comprise strong

strategies to encourage the effective use of the tool.

As a third result, based on the literature review in

world databases, 3,497 articles on blood donation

were identified. Many articles focus on public

policies related to hemotherapy services, including

reports of mild technologies and strategies for

improving service in several countries.

Regarding the use of mobile technology in the

context of blood donation, publications about

applications were identified, but the tools’

interactivity is an aspect that needs to be better

described.

None of the identified publications deals with

gamification and integration with the information

systems of the blood banks, which are innovative

concepts of this research.

The fourth and final result of this study, obtained

through the usability test carried out with donors,

consisted in identifying the level of overall

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satisfaction of the test participants, whose objectives

were: (1) to evaluate whether the indicated tasks were

performed; (2) measure the time each donor took to

complete the tasks; (3) identify whether users were

able to understand each of their accesses to the

system; and (4) identify the problems that donors

experienced while using the tool.

The usability test consisted of performing eight

tasks of greater relevance, obeying the script pre-

defined by the researchers, which are: (1) access the

application as an anonymous "user"; (2) learn how the

blood donation process works; (3) verify what the

main information on blood donation is; (4) visit the

application doubt clarification area; (5) create an

account in the application; (6) schedule a donation at

a blood bank of the city; (7) find out the nearest

donation site; and (8) exit the application.

The tasks that showed better performance by the

users were: making the login (90.9%), accessing the

application anonymously (81.8%), finding the main

information about blood donation (72.7%), visiting

the application doubt clarification area (72, 7%),

identifying the nearest donation site (63.6%), exiting

the application (63.6%) and scheduling donation at a

blood bank of the city (54.5%).

However, 45.5% of test participants had difficulty

finding information about the registered user and

54.5% asked for help to complete this task. When

trying to access the area with information about the

blood donation process, only 36.4% did not have any

difficulties; 27.3% asked for help; 18.2% were slow

to perform this task and 18.1% were unable to

perform the task.

Regarding the application design, 9.1% of the

participants indicated that they did not like the design

and approximately 90% thought the design was

beautiful and pleasant. Regarding the information

contained in the application, 72.7% of the users

approved the content and, finally, it was verified that

all participants were able to perform the task of

accessing the application as an anonymous "user" and

only 18.2% found difficulty performing this task.

4 DISCUSSION

According to eMarketer research (2014), citizens

spend six times as much time on mobile applications

as on mobile sites, and it is estimated that 56% of

people who use mobile phones have smartphones, the

technology needed to use apps. Regarding Internet

Table 2: Interfaces of the DoeSangue application, year 2017.

1 - Login

2 - Registering

3 - Main menu

4 -Where to donate

5 - Donation guide

6 - Did you know?

7 - Scheduling the

donation

8 - Donor’s user

9 - Donor’s history

10 - Donor’s goals

Source: The researcher.

MHealth Technology as a Tool to Promote Blood Donation

475

access, data from the Instituto Brasileiro de Geografia

e Estatística - IBGE (Brazilian Institute of Geography

and Statistics) (PNAD, 2016) indicate that 57.8% of

households have Internet access, and of these, 92.1%

access the Internet through cell phones.

Regarding the health area, it is worth emphasizing

that the health care practice, as well as educational

and intervention actions that seek to promote health

care, exceed the technical knowledge. Health

programs need to understand the meaning and the

sense of "being healthy" for the individual (Brasil,

2015).

Within this approach, mHealth technologies have

offered a range of possibilities for interaction with the

population that can facilitate actions to encourage

health care, according to the Symbolic Interactionism

approach (Blumer, 1969), considering the meanings

and senses attributed to the health issues by the public

to be dealt with.

Only by identifying the universe of meanings of

the human being and of the different population

groups, it is possible to sponsor effective health

promotion actions, internalizing healthy habits. These

actions can be optimized through mHealth

technology.

Regarding the application of the User-Centered

Interaction Design methodology, it can be observed

that the multidisciplinary team worked scrupulously,

respecting all stages of the life cycle represented in

Figure 1, guaranteeing the use of continuous

improvement in the processes of creation and

development of the laboratory application.

The results found in the literature review and

information survey stages with the multidisciplinary

team and blood bank professionals reinforce the need

to create new communication media that are more

adequate to the current reality of social relationships

and that generate interest in the cause of blood

donation, mobilizing the population for this purpose.

The tool was developed using the principles and

objectives of Google's Material Design, with a visual

language of its own for users of the Android platform.

Material Design synthesizes the classic principles of

good design, with innovation and the possibility of

linking technology and science (Google, 2014).

The creation of the high-fidelity technological

artifact was completed, with prototypes that already

include the typography, iconography and color palette

that will be used in the final version. The application

consists of ten main interfaces, as shown in table 2.

Meeting the requirement for implementation of

gamification resources and persuasive design, the

application illustrates on screen 9 (Donor’s history)

the effective participation of the user in the blood

donation process, which, prior to the existence of this

application, could only be accessed through the

donor's social security number at the Blood Bank.

This interface reinforces the donor's interest in

acquiring information from the collection center and

staying connected. Still on this screen, the users can

track their badges and share them on social networks.

As for Screen 10 (Donor’s goals), it shows the

elements that stimulate the donor's participation in

blood donation promotion, control of donations per

semester and the measurement of their participation

in the blood bank’s campaigns. Another interesting

persuasion feature is the possibility to keep track of

how friends are engaged and how many friends the

user has convinced to embrace this cause, positively

stimulating people's change of posture toward blood

donation.

Finally, the users will always have the information

on the time remaining until their next donation,

providing their empowerment and involvement with

blood donation.

5 CONCLUSION

The overture of this research is based on the scientific

evidence available in the databases and the imminent

need to generate interactive communication strategies

with the mobilization power that strengthens the

engagement of blood donors. Additionally, it intends

to reinforce global trends regarding the growth of

mobile health technologies.

In the context of health communication strategies,

the use of the mHealth technology is recommended to

achieve these objectives, based on the high potential

of social engagement that this type of tool provides.

Based on the premise that blood donation is

essential for public health promotion and

maintenance, it is presumed that the creation of the

application will result in new strategies that can boost

blood donation and support collective health

promotion. The artifact shows great monitoring

potential and can facilitate the understanding of

scenarios, contributing to strategic management.

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