Effectiveness Of mHealth Interventions Research Articles

Effectiveness and Appropriateness of mHealth Interventions for Maternal and Child Health: Systematic Review

BackgroundThe application of mobile health (mHealth) technology in reproductive, maternal, newborn, and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventions have not been reviewed systematically.ObjectiveA systematic review and meta-analysis of studies of mHealth interventions for RMNCH around the world were conducted to investigate their characteristics as well as the features and effectiveness of mHealth interventions.MethodsStudies of mHealth interventions for RMNCH between January 2011 and December 2016 were retrieved from 6 databases (PubMed, EMBASE, Global Health, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang Data Knowledge Service Medium). Comparable studies were included in a random-effects meta-analysis for both exclusive breastfeeding (EBF) and antenatal checks (ANC). Descriptive analyses were conducted for mHealth studies with a range of study designs.ResultsAnalyses of 245 studies were included, including 51 randomized controlled trials (RCTs). Results showed that there are increasing numbers of studies on mHealth interventions for RMNCH. Although 2 meta-analysis, one with 2 RCTs on EBF (odds ratio [OR] 2.03, 95% CI 1.34-3.08, I2=25%) and the other with 3 RCTs on ANC (OR 1.43, 95% CI 1.13-1.79, I2=78%), showed that mHealth interventions are more effective than usual care, almost half (43%) of RCTs showed negative or unclear results on mHealth interventions. Functions described in mHealth interventions were diverse, and the health stages covered were broad. However, single function or single stage appeared to be dominant among mHealth interventions compared with multiple functions or stages.ConclusionsMore rigorous evaluations are needed to draw consistent conclusions and to analyze mHealth products with multiple functions, especially those popular in the app markets.

Effectiveness of mHealth Interventions for Asthma Self-Management: A Systematic Review and Meta-Analysis.

To assess the effectiveness of mHealth interventions for asthma self-management, we conducted a systematic review and meta-analysis of relevant studies identified by a search of English and Chinese databases. 18 studies were included in meta-analysis, and the results showed that mHealth interventions (vs routine care) improved the level of asthma control and adherence to treatment, and reduced exacerbation rate and admission rate. Evidence from this study shows that mobile health-based interventions may be useful tools for asthma self-management.

Identifying effective components for mobile health behaviour change interventions for smoking cessation and service uptake: protocol of a systematic review and planned meta-analysis

BackgroundMobile health (mHealth) interventions for smoking cessation have been shown to be associated with an increase in effectiveness. However, interventions using mobile phones to change people’s behaviour are often perceived as complex interventions, and the interactions between several components within them may affect the outcome. Therefore, it is important to understand how we can improve the design of mHealth interventions using mobile phones as a medium to deliver services.MethodsRandomised controlled trials (RCTs) of mHealth interventions to support smoking cessation or uptake of smoking cessation services for smokers will be included in this systematic review. A search will be performed by searching MEDLINE, MEDLINE(R) In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, Web of Science, and CINAHL. A search for new publications will be conducted 3 months prior to submission for publication as mHealth is an emerging area of research.A random-effects meta-analysis model will be used to summarise the effectiveness of mHealth interventions. The risk ratio will be used for the primary outcome, self-reported or verified smoking abstinence, and any binary outcomes for uptake of smoking cessation services. The standardised mean difference using Hedges’ g will be reported for continuous data. Heterogeneity will be assessed using I2 statistics.Where feasible, meta-regression analysis using random-effects multilevel modelling will be conducted to examine the association of pre-specified characteristics (covariates) at the study level with the effectiveness of interventions. Publication bias will be explored using Egger’s test for continuous outcomes and Harbord and Peters tests for dichotomous outcomes. The funnel plot will be used to evaluate the presence of publication bias. The Cochrane Risk of Bias Tool will be used to assess differences in risks of bias.DiscussionThe results of this systematic review will provide future research with a foundation for designing and evaluating complex interventions that use mobile phones as a platform to deliver behaviour change techniques.Systematic review registrationPROSPERO CRD42016026918.

Analysis: Mobile Health Approaches to Non-Communicable Diseases in Rwanda

Rwanda is affected by a substantial dual burden of a rapid epidemiological rise in non-communicable diseases (NCDs) against the backdrop of high infectious disease rates. The Global Burden of Disease study showed that premature deaths due to NCDs such as diabetes and hypertension are increasing, accounting for 30% of all deaths in Rwanda in 2010. The usefulness of mHealth interventions has been shown for reducing adverse effects of diabetes and hypertension. Because Rwanda RapidSMS system is already successfully operating in maternal, neonatal and child health, it would be cost-effective to leverage this infrastructure and adapt it for the NCD domain. However, rigorous evaluations of the efficacy of mHealth intervention in the area of NCDs are limited. Hence, developing a robust mHealth intervention study is urgent through a contextual combination of quantitative and qualitative study designs.This paper highlights the significance of the problem of NCDs, usefulness of mHealth interventions for stemming diabetes and hypertension, and an urgent need for research on using mHealth interventions for prevention of NCDs in Rwanda. Carefully conducted research on the efficacy and effectiveness of mHealth intervention will have ramifications for the evidence based policy, decision making, practice and research in other LMICs.Key words: NCDs, Diabetes, Hypertension, mHealth intervention, Africa, Rwanda

Analysis: Mobile Health Approaches to Non-Communicable Diseases in Rwanda

Rwanda is affected by a substantial dual burden of a rapid epidemiological rise in non-communicable diseases (NCDs) against the backdrop of high infectious disease rates. The Global Burden of Disease study showed that premature deaths due to NCDs such as diabetes and hypertension are increasing, accounting for 30% of all deaths in Rwanda in 2010. The usefulness of mHealth interventions has been shown for reducing adverse effects of diabetes and hypertension. Because Rwanda RapidSMS system is already successfully operating in maternal, neonatal and child health, it would be cost-effective to leverage this infrastructure and adapt it for the NCD domain. However, rigorous evaluations of the efficacy of mHealth intervention in the area of NCDs are limited. Hence, developing a robust mHealth intervention study is urgent through a contextual combination of quantitative and qualitative study designs.This paper highlights the significance of the problem of NCDs, usefulness of mHealth interventions for stemming diabetes and hypertension, and an urgent need for research on using mHealth interventions for prevention of NCDs in Rwanda. Carefully conducted research on the efficacy and effectiveness of mHealth intervention will have ramifications for the evidence based policy, decision making, practice and research in other LMICs. Key words : NCDs, Diabetes, Hypertension, mHealth intervention, Africa, Rwanda

Influence of mhealth interventions on gender relations in developing countries: a systematic literature review

IntroductionResearch has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women’s empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities.MethodsA systematic literature review was conducted to examine the empirical evidence of changes in men and women’s interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study’s characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences.ResultsOut of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple’s health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women’s decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women’s participation.ConclusionEfforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed.