Abstract
BackgroundMobile health (mHealth) has huge potential to deliver preventative health services. However, there is paucity of literature on theoretical constructs, technical, practical, and regulatory considerations that enable delivery of such services.ObjectivesThe objective of this study was to outline the key considerations in the development of a text message-based mHealth program; thus providing broad recommendations and guidance to future researchers designing similar programs.MethodsWe describe the key considerations in designing the intervention with respect to functionality, technical infrastructure, data management, software components, regulatory requirements, and operationalization. We also illustrate some of the potential issues and decision points utilizing our experience of developing text message (short message service, SMS) management systems to support 2 large randomized controlled trials: TEXT messages to improve MEDication adherence & Secondary prevention (TEXTMEDS) and Tobacco, EXercise and dieT MEssages (TEXT ME).ResultsThe steps identified in the development process were: (1) background research and development of the text message bank based on scientific evidence and disease-specific guidelines, (2) pilot testing with target audience and incorporating feedback, (3) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms, and (4) legal and regulatory considerations. Additional considerations in developing text message management systems include: balancing the use of customized versus preexisting software systems, the level of automation versus need for human inputs, monitoring, ensuring data security, interface flexibility, and the ability for upscaling.ConclusionsA merging of expertise in clinical and behavioral sciences, health and research data management systems, software engineering, and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials. This research provides broad principles that may assist other researchers in developing mHealth programs.
Highlights
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The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries
Close to 60% of participating countries in the high-income group reported treatment compliance initiatives, compared to approximately 30% for the other income groups. These results are consistent with the literature review, which found a concentration of studies from high-income countries such as Canada, the United Kingdom, and United States with treatment compliance programmes using short messaging service (SMS), mobile phone applications, web browsing and e-mail for chronic diseases such as diabetes, asthma, and obesity [12,13,14,15,16,17,18,19,20]
Summary
Governments are expressing interest in mHealth as a complementary strategy for strengthening health systems and achieving the health-related Millennium Development Goals (MDGs) in low and middleincome countries.1 This interest has manifested into a series of mHealth deployments worldwide that are providing early evidence of the potential for mobile and wireless technologies. The field’s potential is recognized by the United Nations (UN) and World Health Organization (WHO) The former included mHealth as a key innovation to achieve the goals outlined in the new Global Strategy for Women’s and Children’s Health launched in New York on 22 September 2010. The latter included a module on mHealth in the 2009 Global eHealth survey. MHealth involves the use and capitalization on a mobile phone’s core utility of voice and short messaging service (SMS) as well as more complex functionalities and applications including general packet radio service (GPRS), third and fourth generation mobile telecommunications (3G and 4G systems), global positioning system (GPS), and Bluetooth technology
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