Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review

Jung-Ah Lee,Natalie Jiang,Mona Choi,Sang A Lee

doi:10.1186/s12911-018-0591-0

Abstract

BackgroundMobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management.MethodsRelevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion.ResultsOf the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system.ConclusionsFindings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

Highlights

Mobile health has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases
Operational definitions of the terms used in this review Studies on feasibility assess whether or not an intervention is appropriate for further testing, whereas studies on acceptability determine how recipients react to that intervention [20]
A study conducted by Kristjánsdóttir et al was published as part 1 [22] and part 2 [23], which corresponded to short-term and long-term follow-ups, respectively

Summary

Introduction

Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management. Over 40% of the population aged 15 years or older had a chronic disease condition in the European Union countries [5] and chronic diseases accounted for a substantial proportion of deaths throughout Southeast Asia [6]. Behavioral interventions using mobile applications (apps) on smartphones or tablet computers in enhancing self-management for patients with chronic diseases, such as heart failure [13] or diabetes [14], have been studied [9, 12]. A food intake diary, physical activity monitoring, and home blood sugar monitoring via mHealth systems are commonly used for diabetes management [14,15,16] while monitoring of weight, symptoms, and physical activity are common features of heart failure interventions [13, 17]

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