mHealth innovations as health system strengthening tools: 12 common applications and a visual framework
01 Aug 2013-Global health, science and practice (The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs)-Vol. 1, Iss: 2, pp 160-171
TL;DR: This new framework lays out 12 common mHealth applications used as health systems strengthening innovations across the reproductive health continuum and describes how these applications can be applied in the context of a women's health care system.
Abstract: This new framework lays out 12 common mHealth applications used as health systems strengthening innovations across the reproductive health continuum.
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TL;DR: This paper presents a meta-modelling framework for estimating the modeled response of the immune system to various types of injury and shows clear patterns of decline in response to certain types of injuries.
Abstract: Samiksha Nayak,†,§ Nicole R. Blumenfeld,†,§ Tassaneewan Laksanasopin,‡ and Samuel K. Sia*,† †Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, United States ‡Biological Engineering Program, Faculty of Engineering, King Mongkut’s University of Technology Thonburi, 126 Pracha Uthit Road, Bang Mod, Thung Khru, Bangkok 10140, Thailand
369 citations
TL;DR: Given the large‐scale adoption and deployment of mobile phones by health services and frontline health workers (FHW), the evidence on the feasibility and effectiveness of mobile‐based services for healthcare delivery is reviewed and synthesised.
Abstract: Objectives
Given the large-scale adoption and deployment of mobile phones by health services and frontline health workers (FHW), we aimed to review and synthesise the evidence on the feasibility and effectiveness of mobile-based services for healthcare delivery.
Methods
Five databases – MEDLINE, EMBASE, Global Health, Google Scholar and Scopus – were systematically searched for relevant peer-reviewed articles published between 2000 and 2013. Data were extracted and synthesised across three themes as follows: feasibility of use of mobile tools by FHWs, training required for adoption of mobile tools and effectiveness of such interventions.
Results
Forty-two studies were included in this review. With adequate training, FHWs were able to use mobile phones to enhance various aspects of their work activities. Training of FHWs to use mobile phones for healthcare delivery ranged from a few hours to about 1 week. Five key thematic areas for the use of mobile phones by FHWs were identified as follows: data collection and reporting, training and decision support, emergency referrals, work planning through alerts and reminders, and improved supervision of and communication between healthcare workers. Findings suggest that mobile based data collection improves promptness of data collection, reduces error rates and improves data completeness. Two methodologically robust studies suggest that regular access to health information via SMS or mobile-based decision-support systems may improve the adherence of the FHWs to treatment algorithms. The evidence on the effectiveness of the other approaches was largely descriptive and inconclusive.
Conclusions
Use of mHealth strategies by FHWs might offer some promising approaches to improving healthcare delivery; however, the evidence on the effectiveness of such strategies on healthcare outcomes is insufficient.
335 citations
Cites background from "mHealth innovations as health syste..."
...[28] Table 1 summarises these mHealth functions and health domains to which they were applied....
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25 Dec 2018
TL;DR: The PA dose, scope and validity, which may lead to clinically significant changes in the health status of individuals, should continue to examine innovative behavior modification techniques and also improve the access and duration of PA interventions.
Abstract: Regular physical activity is one of the most important activities you can do for your health. Because you're afraid of being harmed, moderate-intensity aerobic activities, such as brisk walking, are generally safe for people if you're not sure you're activated or increased your physical activity. This study; why we should do physical activity, risks of inactive behavior, frequency of physical activity, benefits of physical activity and suggestions for physical activity, aims to create more active people. A high level overview of the reviews of published literature. A systematic search of Web of Science, Medline, Pub-Med, and SPORTDiscus, Physical Education Index was employed to find all relevant studies focusing on human participants. Search terms included “Active People ”, “inactivity”, " Prevalence of Physical Activity " and “physical activity”. It has been suggested that regular PA health-related diseases have an effective primary and secondary preventive strategy against at least 25 chronic medical conditions with 20-30% risk reduction. Approximately 75% of adults act according to the recommended PA guidelines, while women, adolescents, and older adults have been found to have lower levels of PA-making than men. It was found that there were consistent relationships between PA and motivation, self-efficacy and self-regulation. The PA interventions show that small changes in the PA show a major impact on young people and adults. In conclusion: In studies related to PA, mechanisms that directly affect health and cause positive results should be determined. The PA dose, scope and validity, which may lead to clinically significant changes in the health status of individuals, should continue to examine innovative behavior modification techniques and also improve the access and duration of PA interventions.
325 citations
Cites background from "mHealth innovations as health syste..."
...These rates increase with economic development due to changing transportation patterns, technology usage, urbanization and cultural values (Labrique et al., 2013)....
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TL;DR: The identified economic evaluations varied by disease or condition focus, economic outcome measurements, perspectives, and were distributed unevenly geographically, limiting formal meta-analysis.
Abstract: Background Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Methods Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Results Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62–100, STD 14.18) and the top quartile reported 91.3–100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Conclusions Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of intervention effectiveness of a health-related outcome and reported economic data, many did not report all recommended economic outcome items and were lacking in comprehensive analysis. The identified economic evaluations varied by disease or condition focus, economic outcome measurements, perspectives, and were distributed unevenly geographically, limiting formal meta-analysis. Further research is needed in low and low-middle income countries and to understand the impact of different mHealth types. Following established economic reporting guidelines will improve this body of research.
319 citations
TL;DR: Most studies of mHealth for MNCH in LMIC are of poor methodological quality and few have evaluated impacts on patient outcomes and there is modest evidence that interventions delivered via SMS messaging can improve infant feeding.
Abstract: Objective To assess the effectiveness of mHealth interventions for
maternal, newborn and child health (MNCH) in low– and middle–
income countries (LMIC).
Methods 16 online international databases were searched to identify
studies evaluating the impact of mHealth interventions on MNCH
outcomes in LMIC, between January 1990 and May 2014. Comparable
studies were included in a random–effects meta–analysis.
Findings Of 8593 unique references screened after de–duplication,
15 research articles and two conference abstracts met inclusion criteria,
including 12 intervention and three observational studies. Only
two studies were graded at low risk of bias. Only one study demonstrated
an improvement in morbidity or mortality, specifically decreased
risk of perinatal death in children of mothers who received
SMS support during pregnancy, compared with routine prenatal care.
Meta–analysis of three studies on infant feeding showed that prenatal
interventions using SMS/cell phone (vs routine care) improved rates
of breastfeeding (BF) within one hour after birth (odds ratio (OR)
2.01, 95% confidence interval (CI) 1.27–2.75, I2 = 80.9%) and exclusive
BF for three/four months (OR 1.88, 95% CI 1.26–2.50, I2 = 52.8%)
and for six months (OR 2.57, 95% CI 1.46–3.68, I2 = 0.0%). Included
studies encompassed interventions designed for health information
delivery (n = 6); reminders (n = 3); communication (n = 2); data
collection (n = 2); test result turnaround (n = 2); peer group support
(n = 2) and psychological intervention (n = 1).
Conclusions Most studies of mHealth for MNCH in LMIC are of poor
methodological quality and few have evaluated impacts on patient
outcomes. Improvements in intermediate outcomes have nevertheless
been reported in many studies and there is modest evidence that
interventions delivered via SMS messaging can improve infant feeding.
Ambiguous descriptions of interventions and their mechanisms
of impact present difficulties for interpretation and replication. Rigorous
studies with potential to offer clearer evidence are underway
295 citations
References
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TL;DR: The chief virtue of the WHO report lies in the challenges it poses for its critics within the health services research community, and it is fair to query whether, on balance, so precarious an undertaking does more good than harm.
Abstract: Here WHO attempts no less than to rank the vastly different health systems of 191 nations on two one-dimensional measures of performance: (a) ‘‘level of health,’’ represented by disability-adjusted life expectancy (DALE) and (b) an ‘‘index of overall health system performance’’. The latter is calculated as a weighted average of scores on five distinct dimensions: (1) the country’s DALE, (2) the ‘‘distribution of health’’ (based on child mortality distributions within countries), (3) the health system’s ‘‘responsiveness’’ to what people seek from it in terms of ‘‘prompt attention, dignity, autonomy, confidentiality,’’ and so on, (4) an index of the distribution of that ‘‘responsiveness’’ among socioeconomic classes, and (5) the degree of ‘‘fairness’’ with which the health system is financed. The weights for these five measures going into the ‘‘overall health system performance index’’ were culled from a survey of 1006 experts from 125 countries, about half of them on the staff of WHO. The final rankings of countries on both of the two performance measures are not based on the actual values achieved by the nation, but on the ratios of the achieved values to the values that ought to have been achieved, given the country’s educational attainment and spending on health care. The denominator in this ratio was derived from an empirically estimated mathematical relationship that predicts, for any combination of national health spending and national educational attainment, the level of performance that would have been achieved by an efficiently run health system. Because the ultimate rankings emerging from this study are the products of a whole series of inherently subjective analytic judgements on the specific measures of systems performance, on the weights to be attached to each measure and on the model used to compare actual with ideal performance, it is fair to query whether, on balance, so precarious an undertaking does more good than harm. Before addressing that question in regard to the WHO report, it is well to keep in mind that the decision-makers in the socalled ‘‘real world’’ do prefer to have complex phenomena collapsed into one-dimensional indexes. Even professors at top universities despair of multi-line academic transcripts and prefer to see a student’s entire and often varied academic career collapsed into the single, highly dubious measure of the grade point average. Gross domestic product (GDP) is a similarly crude, flawed, onedimensional indicator for national economic performance, as is quarterly earnings per share for a giant corporation. All of these simple measures are the products of whole hosts of precarious assumptions. Yet they are widely used, on the assumption that doing so does more good than harm. Can that assumption be made for the WHO report as well? The chief virtue of the WHO report lies in the challenges it poses for its critics within the health services research community. Could these critics have done better? If so, precisely how? Or can these critics argue that quantitative assessments of this sort are never worth undertaking? In other words, are we stuck in a rut that allows physicians or politicians in every country to proclaim that theirs is ‘‘the best health system in the world’’ without being challenged by data? If that be the verdict of the research community, it would be good to have it flushed out into the open, and on paper. On the other hand, there is reason to wonder whether more good than harm will have been done by the fanfare with which this report was injected into the public media and thence into the world of policy-making. Two requirements should have been met before the report was ready for a major media campaign. First, the WHO research team should have been sure that their estimates are robust. Can they, in good conscience, make that claim? An artificially high ranking, for example, could take the wind out of the sails of desirable health-reform efforts. Similarly, an artificially low ranking could assign a bad grade to past reform efforts that were actually commendable. Rumour in the health services research community has it that France’s no.1 rank was driven in part by a flawed measure of national educational attainment. Under the methodology used by WHO, the more the level of educational attainment or of health spending is underestimated for a country, the higher will be the ratio of actual to ideal performance for that country and the higher will be the nation’s ranking. Second, if the report is addressed to policy-makers, one must judge it poorly written. To be sure, it has a number of fascinating, if chatty, chapters; but these are only loosely connected to the actual work underlying this study. To see what was actually done, one must plough through the cryptic commentary that accompanies the tables in the Annex or dig up and read sundry sources cited in the references. Few policymakers and even fewer journalists will go to that trouble. To be useful as a policy analysis, the report ought to have started with the crisp executive summary that is now de rigueur among policy analysts, certainly in the United States. That summary would have presented the main conclusions emerging from the study and described, in layman’s terms, the methodology that was used to reach these conclusions. Most important of all, the executive summary should have contained the many caveats that must, in good conscience, accompany ambitious analyses of this sort. n
2,573 citations
TL;DR: Patients who received SMS support had significantly improved ART adherence and rates of viral suppression compared with the control individuals, suggesting mobile phones might be effective tools to improve patient outcome in resource-limited settings.
1,053 citations
"mHealth innovations as health syste..." refers background in this paper
...engage 1 or more actors (such as a pregnant woman, a husband, family, community)—influences health behaviors, such as adherence to medication or use of health services.(3,14) The...
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01 Jan 2010
TL;DR: In this article, a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial is presented, which is based on a randomized trial.
Abstract: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya (R T Lester MD, A Kariri BSc, S Karanja BSc, E Ngugi PhD, L J Gelmon MD, J Kimani, MBChB); Department of Medical Microbiology, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada (R T Lester, T B Ball PhD, L J Gelmon, J Kimani, Prof F A Plummer MD); Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (R T Lester); School of Kinesiology and Health Sciences, Department of Psychology, York University, York, ON, Canada (P Ritvo PhD); Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada (E J Mills PhD); Department of Global Health, University of Washington, Seattle, WA, USA (M H Chung MD); Department of Economics (W Jack DPhil) and Georgetown Public Policy Institute (J Habyarimana PhD), Georgetown University, Washington, DC, USA; Collaboration for Outcome Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada (M Sadatsafavi MD, M Najafzadeh MSc, C A Marra PharmD); University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya (B Estambale MBChB); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Eff ects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial
1,003 citations
Book•
01 Jan 2005
TL;DR: The World Health Report 2005 – Make Every Mother and Child Count, says that this year almost 11 million children under five years of age will die from causes that are largely preventable.
Abstract: The World Health Report 2005 – Make Every Mother and Child Count, says that this year almost 11 million children under five years of age will die from causes that are largely preventable. Among them are 4 million babies who will not survive the first month of life. At the same time, more than half a million women will die in pregnancy, childbirth or soon after. The report says that reducing this toll in line with the Millennium Development Goals depends largely on every mother and every child having the right to access to health care from pregnancy through childbirth, the neonatal period and childhood.
986 citations
TL;DR: Control trials of mobile technology interventions to improve health care delivery processes show that current interventions give only modest benefits and that high-quality trials measuring clinical outcomes are needed.
Abstract: Caroline Free and colleagues systematically review controlled trials of mobile technology interventions to improve health care delivery processes and show that current interventions give only modest benefits and that high-quality trials measuring clinical outcomes are needed.
898 citations