Abstract
BackgroundWith rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases.ObjectiveThe aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation.MethodsWe systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study.ResultsA total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective.ConclusionsWe provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care.
Highlights
Burden of Disease and Health System in ChinaIn the last decade, China has undergone a continuing epidemiological transformation from infectious diseases to chronic and noncommunicable diseases (NCDs) [1,2]
The World Health Organization (WHO) definition is medical and public health practice supported by mobile devices, such as mobile phones, personal digital assistants (PDAs), and other wireless devices [6]. mobile health (mHealth) involves the use of a wide range of functionalities incorporated by such mobile devices, including standard voice, short message service (SMS), Web browsing, and applications on different operating systems
The most common disease focus was on NCDs (n=15) [22,25,26,29,30,34,37,38,39,42,45,46,52,56,57], whereas 12 studies focused on infectious diseases [33,41,51,53,54,58,59,60,61,62,63,64] and 8 studies were designed for maternal and child health [36,40,43,47,48,49,55,65]
Summary
Burden of Disease and Health System in ChinaIn the last decade, China has undergone a continuing epidemiological transformation from infectious diseases to chronic and noncommunicable diseases (NCDs) [1,2]. Despite the four major rounds of health care reforms since mid-1980s in China, many health equity and system level challenges remain [4,5]. Responding to those challenges, the health system needs to be adjusted to provide more effective solutions. All articles using mobile technology for health care management were included in the study. Conclusions: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care
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