Abstract
BackgroundIn a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established.ObjectiveThe aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa.MethodsA scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA.ResultsWe retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training.ConclusionsThe use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings.
Highlights
IntroductionMobile health (mHealth), defined as “the provision of health services and information via mobile technologies” (p.8; [1]), has gained widespread recognition as an innovative way of improving health care access especially in low-resource settings [2]
Significance of mobile health (mHealth)Mobile health, defined as “the provision of health services and information via mobile technologies” (p.8; [1]), has gained widespread recognition as an innovative way of improving health care access especially in low-resource settings [2]
Record-Keeping (DESIRE) [26], CommCare [27], mPneumonia [28], Basic Antenatal Care Information System (Bacis) [29], TBTech [30], txt2MEDLINE [31], New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH) [32,33], electronic Integrated Management of Childhood Illness [34,35,36], Text Messaging of Malaria Guidelines [37,38,39], and Quality of Maternal and Prenatal Care (QUALMAT) [40,41,42,43,44,45,46]). These studies were conducted in 7 sub-Saharan African countries: Kenya, Nigeria, Ghana, Tanzania, Burkina Faso, Botswana, and South Africa
Summary
Mobile health (mHealth), defined as “the provision of health services and information via mobile technologies” (p.8; [1]), has gained widespread recognition as an innovative way of improving health care access especially in low-resource settings [2]. It is increasingly incorporated in behavioral change interventions for patients and health workers, patient monitoring, data collection, and health information systems [3,4,5]. The extent to which mobile clinical decision support systems (mCDSS) have been adopted in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings
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