Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work?

Background Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders. Design Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications. Results There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects. Conclusions Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.

[1]  Daniel A. Fletcher,et al.  Quantitative Imaging with a Mobile Phone Microscope , 2014, PloS one.

[2]  Virgilio Galdo,et al.  Preventing dengue through mobile phones: evidence from a field experiment in Peru. , 2014, Journal of health economics.

[3]  L. Lynen,et al.  Community-Based Active Tuberculosis Case Finding in Poor Urban Settlements of Phnom Penh, Cambodia: A Feasible and Effective Strategy , 2014, PloS one.

[4]  Blair T. Johnson,et al.  Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials , 2014, PloS one.

[5]  S. Lund,et al.  Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial , 2014, BMC Pregnancy and Childbirth.

[6]  V. H. Abdulayev,et al.  MOBILE APPLICATIONS FOR HEALTH , 2014 .

[7]  Paul A. Fontelo,et al.  Evaluation of generic medical information accessed via mobile phones at the point of care in resource-limited settings , 2014, J. Am. Medical Informatics Assoc..

[8]  R. Snow,et al.  Using mobile phone text messaging for malaria surveillance in rural Kenya , 2014, Malaria Journal.

[9]  C. Wiysonge,et al.  Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review , 2013, BMC Infectious Diseases.

[10]  C. Toumazou,et al.  Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. , 2013, The lancet. Diabetes & endocrinology.

[11]  K. L'Engle,et al.  There are some questions you may not ask in a clinic: Providing contraception information to young people in Kenya using SMS , 2013, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[12]  L. Jennings,et al.  Influence of mhealth interventions on gender relations in developing countries: a systematic literature review , 2013, International Journal for Equity in Health.

[13]  Garrett Mehl,et al.  mHealth innovations as health system strengthening tools: 12 common applications and a visual framework , 2013, Global Health: Science and Practice.

[14]  Sudipto Ghosh,et al.  Cell Phone-Based System (Chaak) for Surveillance of Immatures of Dengue Virus Mosquito Vectors , 2013, Journal of medical entomology.

[15]  J. Walley,et al.  Using no-cost mobile phone reminders to improve attendance for HIV test results: a pilot study in rural Swaziland , 2013, Infectious Diseases of Poverty.

[16]  Julian C. Jamison,et al.  Mixed Method Evaluation of a Passive Mhealth Sexual Information Texting Service in Uganda , 2013 .

[17]  Jon Bird,et al.  A matter of life and death: practical and ethical constraints in the development of a mobile verbal autopsy tool , 2013, CHI.

[18]  M. McCarthy Handheld device for counterfeit drug detection to be tested in Africa , 2013, BMJ : British Medical Journal.

[19]  Tassaneewan Laksanasopin,et al.  Mobile device for disease diagnosis and data tracking in resource-limited settings. , 2013, Clinical chemistry.

[20]  Arul Chib,et al.  Vulnerabilities in mHealth implementation: a Ugandan HIV/AIDS SMS campaign , 2013, Global health promotion.

[21]  J. Florez-Arango,et al.  Decreasing workload among community health workers using interactive, structured, rich-media guidelines on smartphones. , 2013, Technology and health care : official journal of the European Society for Engineering and Medicine.

[22]  Dustin G Gibson,et al.  The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya. , 2013, Vaccine.

[23]  V. Chongsuvivatwong,et al.  Effects of a Phone Call Intervention to Promote Adherence to Antiretroviral Therapy and Quality of Life of HIV/AIDS Patients in Baoshan, China: A Randomized Controlled Trial , 2013, AIDS research and treatment.

[24]  A. Haines,et al.  The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis , 2013, PLoS medicine.

[25]  C. Kovarik,et al.  Mobile teledermatology in sub-Saharan Africa: a useful tool in supporting health workers in low-resource centres. , 2013, Acta dermato-venereologica.

[26]  A. Binagwaho,et al.  Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda , 2012, The Pan African medical journal.

[27]  Jeremiah Scholl,et al.  LabPush: A Pilot Study of Providing Remote Clinics with Laboratory Results via Short Message Service (SMS) in Swaziland, Africa , 2012, PloS one.

[28]  S. Lund,et al.  Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster‐randomised controlled trial , 2012, BJOG : an international journal of obstetrics and gynaecology.

[29]  Seth C. Kalichman,et al.  Recent Advances (2011-2012) in Technology-Delivered Interventions for People Living with HIV , 2012, Current HIV/AIDS Reports.

[30]  T. Kelly,et al.  Information and communications for development 2012 : maximizing mobile , 2012 .

[31]  J. Creswell,et al.  Engaging the private sector to increase tuberculosis case detection: an impact evaluation study. , 2012, The Lancet. Infectious diseases.

[32]  David Amadi,et al.  Evaluation of an Android-based mHealth system for population surveillance in developing countries , 2012, J. Am. Medical Informatics Assoc..

[33]  Jessica E Haberer,et al.  High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study , 2012, BMC Medical Informatics and Decision Making.

[34]  Holley A. Wilkin,et al.  You Have an Important Message! Evaluating the Effectiveness of a Text Message HIV/AIDS Campaign in Northwest Uganda , 2012, Journal of health communication.

[35]  Christina Synowiec,et al.  E-health in low- and middle-income countries: findings from the Center for Health Market Innovations. , 2012, Bulletin of the World Health Organization.

[36]  Masatake Yamamichi,et al.  Mobile applications for the health sector , 2012 .

[37]  F. Esamai,et al.  Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision , 2012, BMC Pregnancy and Childbirth.

[38]  G. Rutherford,et al.  Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. , 2012, The Cochrane database of systematic reviews.

[39]  Gaetano Borriello,et al.  Improving community health worker performance through automated SMS , 2012, ICTD.

[40]  V. Odigie,et al.  The mobile phone as a tool in improving cancer care in Nigeria , 2012, Psycho-oncology.

[41]  Kathleen Armstrong,et al.  Evaluation of txt2MEDLINE and development of short messaging service-optimized, clinical practice guidelines in Botswana. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[42]  M. Mars,et al.  Retrospective return on investment analysis of an electronic treatment adherence device piloted in the Northern Cape Province. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[43]  Aileen Y. Chang,et al.  Use of mobile learning by resident physicians in Botswana. , 2012, Telemedicine journal and e-health.

[44]  Agnes Binagwaho,et al.  Cell Phone-Based and Internet-Based Monitoring and Evaluation of the National Antiretroviral Treatment Program During Rapid Scale-Up in Rwanda: TRACnet, 2004–2010 , 2012, Journal of acquired immune deficiency syndromes.

[45]  A. Labrique,et al.  Pregnancy registration systems can enhance health systems, increase accountability and reduce mortality , 2012, Reproductive health matters.

[46]  T. Vos,et al.  Cost-effectiveness of various tuberculosis control strategies in Thailand. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[47]  Nicolas Chevrollier,et al.  Data and Image Transfer Using Mobile Phones to Strengthen Microscopy-Based Diagnostic Services in Low and Middle Income Country Laboratories , 2011, PloS one.

[48]  Arul Chib,et al.  Midwives' Cell Phone Use and Health Knowledge in Rural Communities , 2011, Journal of health communication.

[49]  Robert W Snow,et al.  The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial , 2011, The Lancet.

[50]  A. Dayal,et al.  The need for better data about counterfeit drugs in developing countries: a proposed standard research methodology tested in Chennai, India , 2011, Journal of clinical pharmacy and therapeutics.

[51]  Steven J. Reynolds,et al.  Impact of a mHealth Intervention for Peer Health Workers on AIDS Care in Rural Uganda: A Mixed Methods Evaluation of a Cluster-Randomized Trial , 2011, AIDS and Behavior.

[52]  C. Kovarik,et al.  Use of mobile telemedicine for cervical cancer screening , 2011, Journal of telemedicine and telecare.

[53]  Jiajie Zhang,et al.  Performance factors of mobile rich media job aids for community health workers , 2011, J. Am. Medical Informatics Assoc..

[54]  Carrie Kovarik,et al.  Mobile teledermatology in the developing world: implications of a feasibility study on 30 Egyptian patients with common skin diseases. , 2011, Journal of the American Academy of Dermatology.

[55]  E. Doheny United States Agency for International Development , 2011 .

[56]  W. Jack,et al.  Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial , 2010, The Lancet.

[57]  M. Zolfo,et al.  Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings , 2010, AIDS research and therapy.

[58]  Jaranit Kaewkungwal,et al.  Application of mobile-technology for disease and treatment monitoring of malaria in the "Better Border Healthcare Programme" , 2010, Malaria Journal.

[59]  E. Katabira,et al.  Using Mobile Phones to Improve Clinic Attendance Amongst an Antiretroviral Treatment Cohort in Rural Uganda: A Cross-sectional and Prospective Study , 2010, AIDS and Behavior.

[60]  N. Mahmud,et al.  A text message-based intervention to bridge the healthcare communication gap in the rural developing world. , 2010, Technology and health care : official journal of the European Society for Engineering and Medicine.

[61]  P. Byass,et al.  Verbal autopsy: methods in transition. , 2010, Epidemiologic reviews.

[62]  Arul Chib,et al.  The Aceh Besar midwives with mobile phones project: Design and evaluation perspectives using the information and communication technologies for healthcare development model , 2010, J. Comput. Mediat. Commun..

[63]  Daniel Sigulem,et al.  The impact of short message service text messages sent as appointment reminders to patients' cell phones at outpatient clinics in São Paulo, Brazil , 2010, Int. J. Medical Informatics.

[64]  Mark Tomlinson,et al.  The use of mobile phones as a data collection tool: A report from a household survey in South Africa , 2009, BMC Medical Informatics Decis. Mak..

[65]  S. Cousens,et al.  60 million non‐facility births: Who can deliver in community settings to reduce intrapartum‐related deaths? , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[66]  David N Breslauer,et al.  Mobile Phone Based Clinical Microscopy for Global Health Applications , 2009, PloS one.

[67]  Ada Verloren The United Nations Children's Fund , 2009 .

[68]  Alexander K Rowe,et al.  A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. , 2009, American journal of public health.

[69]  James P. Hughes,et al.  Bmc Medical Informatics and Decision Making Handheld Computers for Self-administered Sensitive Data Collection: a Comparative Study in Peru , 2007 .

[70]  Cellular telephone networks in developing countries , 2008, The Lancet.

[71]  P. Byass,et al.  Evaluation of a computerized field data collection system for health surveys. , 1991, Bulletin of the World Health Organization.