Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 29, 2020
Date Accepted: Oct 30, 2020
Assessing the effectiveness of a mobile-based influenza-like illness surveillance system (FluMob) among healthcare workers in Singapore: A two-year surveillance study
ABSTRACT
Background:
Existing studies have suggested that Internet-based participatory surveillance systems are a valid sentinel for influenza-like illness (ILI) surveillance. However, there is limited scientific knowledge on the effectiveness of mobile-based ILI surveillance systems. Studies also adopted a passive surveillance approach and have not fully investigated the effectiveness of the systems and its determinants.
Objective:
This research presents the efficiency of a mobile-based surveillance system of ILI, termed FluMob, among healthcare workers (HCWs) from a targeted surveillance approach. Particularly, this study evaluates the effectiveness of the system for ILI surveillance pertaining to its participation engagement and surveillance power. Also, the study aims to identify factors that can moderate the effectiveness of the system.
Methods:
The FluMob system was launched in two large hospitals in Singapore from April 2016 to March 2018. Six hundred and ninety clinical and non-clinical hospital staffs participated in the study for 18 months and were prompted via application notifications to submit a survey listing eighteen acute respiratory symptoms (e.g., fever, cough, sore throat) on a weekly basis. There was a study disruption due to the downtime of the system for unexpected maintenance and the end of the participation incentive between May and July in 2017.
Results:
On average, the individual submission rate was 41.4% (SD = 24.3%), with the rate of 51.8% (SD = 26.4%) before the study disruption and that of 21.5% (SD = 30.6%) after. The multivariable regression analysis showed that the adjusted individual submission rates were higher for participants who are at older age (<30, 31.4%; 31-40, 40.2%, P < .001; 41-50, 46.0%, P < .001; >50, 39.9%, P = .01), ethnic Chinese (Chinese, 44.4%; non-Chinese, 34.7%, P < .001), and vaccinated against flu in the past year (vaccinated, 44.6%; non-vaccinated, 34.4%, P < .001). In addition, weekly ILI incidence was 1.07% on average. The Pearson’s r correlation between ILI incidence estimated by FluMob and that reported by Singapore Ministry of Health (MOH) was 0.04 (P = .75) with all data, and 0.38 (P = .006) with only data before the study disruption. Samples with higher risks of ILI and influenza such as females, non-Chinese, allied health staffs, and those who had children in their households, not vaccinated against influenza, and reported allergy demonstrated higher surveillance correlations.
Conclusions:
This research found that mobile-based ILI surveillance systems among HCWs can be effective. However, proper operation of the mobile system without major disruptions is vital for the engagement of participants and the persistence of surveillance power. Also, the effectiveness of the mobile surveillance system can be moderated by participants’ characteristics, which highlights the importance of targeted disease surveillance that can reduce the cost of recruitment and engagement.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.