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Type Journal Article - Annals of the American Association of Geographers
Title Validating a GPS-based approach to detect health facility visits against maternal response
Author(s)
Volume 106
Publication (Day/Month/Year) 2016
Page numbers 489-502
URL http://jogh.org/documents/issue202001/jogh-10-010602.pdf
Abstract
Introduction: Common approaches to measure health behaviors rely on participant responses and are subject to bias. Technology-based alternatives, particularly using GPS, address these biases while opening new channels for research.
This study describes the development and implementation of a GPS-based approach to detect health facility visits in rural Pune district, India.
Methods: Participants were mothers of under-five year old children within the
Vadu Demographic Surveillance area. Participants received GPS-enabled smartphones pre-installed with a location-aware application to continuously record
and transmit participant location data to a central server. Data were analyzed
to identify health facility visits according to a parameter-based approach, optimal thresholds of which were calibrated through a simulation exercise. Lists of
GPS-detected health facility visits were generated at each of six follow-up home
visits and reviewed with participants through prompted recall survey, confirming visits which were correctly identified. Detected visits were analyzed using
logistic regression to explore factors associated with the identification of false-positive GPS-detected visits.
Results: We enrolled 200 participants and completed 1098 follow-up visits over
the six-month study period. Prompted recall surveys were completed for 694
follow-up visits with one or more GPS-detected health facility visits. While the
approach performed well during calibration (positive predictive value (PPV)
78%), performance was poor when applied to participant data. Only 440 of
22251 detected visits were confirmed (PPV 2%). False positives increased as
participants spent more time in areas of high health facility density (odds ratio
(OR)=2.29, 95% confidence interval (CI)=1.62-3.25). Visits detected at facilities other than hospitals and clinics were also more likely to be false positives
(OR=2.78, 95% CI=1.65-4.67) as were visits detected to facilities nearby participant homes, with the likelihood decreasing as distance increased (OR=0.89,
95% CI=0.82-0.97). Visit duration was not associated with confirmation status.
Conclusions The optimal parameter combination for health facility visits simulated by field workers substantially overestimated health visits from participant GPS data. This study provides useful insights into the challenges in detecting health facility visits where providers are numerous, highly clustered
within urban centers and located near residential areas of the population which
they serve.
Andrew Marsh, Siddhivinayak Hirve , Pallavi Lele , Uddhavi Chavan , Tathagata Bhattacharjee , Harish Nair , Harry Campbell , and Sanjay Juvekar. "Validating a GPS-based approach to detect health facility visits against maternal response." Annals of the American Association of Geographers (2016).
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