mHealth Initiatives Research Articles

Disparities in mobile phone access and maternal health service utilization in Nigeria: A population-based survey

BackgroundMobile communication technologies may reduce maternal health disparities related to cost, distance, and infrastructure. However, the ability of mHealth initiatives to accelerate maternal health goals requires in part that women with the greatest health needs have access to mobile phones. ObjectiveThis study examined if women with limited mobile phone access have differential odds of maternal knowledge and health service utilization as compared to female mobile phone users who are currently eligible to participate in maternal mHealth programs. MethodsUsing household survey data from Nigeria, multivariable logistic regressions were used to examine the odds of maternal knowledge and service utilization by mobile phone strata. ResultsFindings showed that in settings with unequal access to mobile phones, mHealth interventions may not reach women who have the poorest maternal knowledge and care-seeking as these women often lacked mobile connectivity. As compared to mobile users, women without mobile phone access had significantly lower odds of antenatal care utilization (OR=0.48, 95%CI: 0.36–0.64), skilled delivery (OR=0.56, 95%CI: 0.45–0.70), and modern contraceptive use (OR=0.50, 95%CI: 0.33–0.76) after adjusting for demographic characteristics. They also had significantly lower knowledge of maternal danger signs (OR=0.69, 95%CI: 0.53–0.90) and knowledge of antenatal (OR=0.46, 95%CI: 0.36–0.59) and skilled delivery care benefits (OR=0.62, 95%CI: 0.47–0.82). No differences were observed by mobile phone strata in uptake of emergency obstetric care, postnatal services, or breastfeeding. ConclusionsAs maternal mHealth strategies are increasingly utilized, more efforts are needed to improve women's access to mobile phones and minimize potential health inequities brought on by health systems and technological barriers in access to care.

Identifying Awareness, Use, and Perceptions of text4baby among Family Medicine and Obstetrics and Gynecology Practitioners at the University of Kansas Medical Center

Background. Low income minority women who receive inadequate or no prenatal care have greater infant morbidity and mortality in the postnatal period. Mobile health or mHealth initiatives such as text4baby are presumed to be a means to reach underserved pregnant and postpartum women to increase their use of prenatal and postnatal care. Providers are an important referral source for mHealth initiatives. It is important, therefore, to assess the awareness, use, and perceptions of the text4baby program among Family Medicine and Obstetrics/Gynecology (Ob/Gyn) providers to determine the means to increase referrals and improve outcomes for pregnant mothers and infants. Methods. Family medicine and Ob/Gyn providers (attending physicians, residents, nurse practitioners, nurses, and medical assistants) at the University of Kansas Medical Center (KUMC) completed a survey assessing awareness of use and perceived utility of text4baby as well as experience with technology and reservations about mHealth in general. Results. Seventy-eight providers (38 in Family Medicine and 40 in Ob/Gyn) responded to the survey. Awareness of text4baby among all providers was 18%. Among the 14 providers who knew about text4baby, one individual stated he/she regularly refers patients to text4baby and 11 agreed that text4baby is a useful tool for the care of pregnant patients. Comparison of text4baby awareness by demographic factors showed no significant differences between any of the groups. Providers who knew of mHealth applications were more likely to know about text4baby (p = 0.04). Older providers were less likely to have reservations about using mHealth in their practice (p = 0.02). There was widespread agreement (87%) that providing evidence to clinicians that text4baby improves outcomes would increase use of the service in clinical practice. Conclusions. Awareness of text4baby among practitioners at KUMC is minimal; use is negligible. Our study identified lack of awareness of the text4baby service and of supporting evidence about its effectiveness as the primary barriers to referral.

Prospects of mHealth services in Bangladesh: recent evidence from Chakaria.

IntroductionBangladesh has a serious shortage of qualified health workforce. The limited numbers of trained service providers are based in urban areas, which limits access to quality healthcare for the rural population. mHealth provides a new opportunity to ensure access to quality services to the population. A recent review suggested that there are 19 mHealth initiatives in the country. This paper reports findings on people's knowledge, perception, use, cost and compliance with advice received from mHealth services from a study carried out during 2012–13 in Chakaria, a rural sub-district in Bangladesh.MethodsA total of 4,915 randomly-chosen respondents aged 18 years and above were interviewed.ResultsHousehold ownership of mobile phones in the study area has increased from 2% in 2004 to 81% in 2012; 45% of the respondents reported that they had mobile phones. Thirty-one percent of the respondents were aware of the use of mobile phones for healthcare. Very few people were aware of the available mHealth services. Males, younger age group, better educated, and those from richer households were more knowledgeable about the existing mHealth services. Among the respondents who sought healthcare in the preceding two weeks of the survey, only 2% used mobile phones for healthcare. Adherence to the advice from the healthcare providers in terms of purchasing and taking the drugs was somewhat similar between the patients who used mobile phone for consultation versus making a physical visit.ConclusionsThe high penetration of mobile phones into the society provides a unique opportunity to use the mHealth technology for consulting healthcare providers. Although knowledge of the existence of mHealth services was low, it was encouraging that the compliance with the prescriptions was almost similar for advice received through mobile phone and physical visits. The study revealed clear indications that society is looking forward to embracing the mHealth technology.

Text messaging intervention for teens and young adults with diabetes.

Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and this population has difficulty achieving optimal diabetes management. Goal setting and self-efficacy are 2 factors in the management of diabetes. We examined the feasibility of a healthy lifestyle text messaging program targeting self-efficacy and goal setting among adolescents and young adults with diabetes. Participants, ages 16-21, were assigned to either a text messaging group, which received daily motivational messages about nutrition and physical activity, or a control group, which received paper-based information about healthy lifestyle. Both groups set goals for nutrition and physical activity and completed a measure of self-efficacy. Participants' mean age was 18.7 ± 1.6 years old, with diabetes duration of 10.0 ± 4.6 years, and A1c of 8.7 ± 1.7%. The text messaging intervention was rated highly and proved to be acceptable to participants. Self-efficacy, glycemic control, and body mass index did not change over the course of the short, 1-month pilot study. Positive, daily, motivational text messages may be effective in increasing motivation for small goal changes in the areas of nutrition and physical activity. These interventions may be used in the future in youth with diabetes to improve diabetes care. Utilizing more targeted text messages is an area for future research.

EHealth and mHealth initiatives in Bangladesh: a scoping study.

BackgroundThe health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.MethodsThis scoping study applies a combination of research tools to explore 26 eHealth and mHealth initiatives in Bangladesh. A screening matrix was developed by modifying the framework of Arksey & O’Malley, further complemented by case study and SWOT analysis to identify common traits among the selected interventions. The WHO health system building blocks approach was then used for thematic analysis of these traits.ResultsFindings suggest that most eHealth and mHealth initiatives have proliferated within the private sector, using mobile phones. The most common initiatives include tele-consultation, prescription and referral. While a minority of projects have a monitoring and evaluation framework, less than a quarter have undertaken evaluation. Most of the initiatives use a health management information system (HMIS) to monitor implementation. However, these do not provide for effective sharing of information and interconnectedness among the various actors. There are extremely few individuals with eHealth training in Bangladesh and there is a strong demand for capacity building and experience sharing, especially for implementation and policy making. There is also a lack of research evidence on how to design interventions to meet the needs of the population and on potential benefits.ConclusionThis study concludes that Bangladesh needs considerable preparation and planning to sustain eHealth and mHealth initiatives successfully. Additional formative and operational research is essential to explore the true potential of the technology. Frameworks for regulation in regards to eHealth governance should be the aim of future research on the integration of eHealth and mHealth into the Bangladesh health system.

MHealth resources to strengthen health programs.

A suite of resources provides implementation guidance for mHealth initiatives, particularly in less developed countries. The suite includes an eLearning course, online guide, evidence database, and a High-Impact Practices brief, along with the mHealth Working Group and website.

Considerations for Community-Based mHealth Initiatives: Insights From Three Beacon Communities

Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs.

A Review of Ghana’s E-health Strategy

Background and Purpose: Ghana has been faced with weak health systems leading to preponderance of communicable diseases, under-nutrition, and poor reproductive health resulting in difficulties in meeting some of the targets of the MDGs. There are also increasing incidence of non-communicable and chronic diseases, and severe inequities in access to health services resulting in large disparities in health outcomes across the country. In light of these, the Ministry of Health and Ghana Health Service in 2007 developed a National Health Policy which has three broad objectives. These are: (a) To ensure that people live long, healthy and productive lives and reproduce without an increased risk of death. (b) To reduce the excessive risk and burden of morbidity, mortality and disability, especially in the poor and marginalized groups (c) To reduce inequalities in access to health, reproduction and nutrition services. However, achieving these objectives require a change in the way health business is run and that the health sector must find new and innovative ways of reaching more people with information and resources to help them make informed decisions. Under these circumstances the Ministry of Health and its agencies have identified e-health as the best means to achieve the above objectives and hence formulation of Ghana’s e-health strategy in 2010. The research seeks to: give an overview of the 2010 Ghana e-health strategies as a driving force in achieving the health sector goals; enumerate success chalked from implementation of e-health strategies; identify the barriers to the implementation of e-health strategies in Ghana. Methods: Ghana’s e-health policies and strategies since 2003 have been reviewed. Situational analysis approach was used in this review. Several stakeholders such as the Ministry of health, Ghana health service, Development partners, National Information Technology Agency, Academia, Telcos etc were consulted and they made very valuable contributions to this review. Results: Within 10 years Ghana has seen the development of five documents on e-health policies and strategies: ICT for Accelerated Development (ICT4AD) Policy; Proposals for Ghana eHealth Strategy; Health Sector’s ICT Policy and Strategy; ehealth plan: 2007-2011 and Ghana E-health strategy 2010. Ghana’s 2010 e-health strategy seeks to: streamline the regulatory framework for health data and information management; build sector capacity for wider application of e-health solutions in the health sector; increase access and bridging equity gap in the health sector through the use of ICT and develop strategies towards paperless records and reporting systems. Ghana has chalked some success since the implementation of e-health strategies which are categorised as (1) Capacity building – Msc in Health Informatics ; C ertificate and Diploma in Health Informatics; e-learning project in all Health training institution. (2) mHealth initiatives - Sene smart phone project, MoTeCH, MVP Project – telemedicine, SMS for life, EWS, Fio-GHS and RDT smart reader. (3) Health Management Information Systems – LMIS, HIS, iHost (GHS), NHIA – eClaims, eRegister and DHIMS2. Conclusions: Full execution of this strategy is expected to lead to developing a robust ICT system to capture, store, exchange health information thereby improve patient care services throughout the country and facilitating the achievement of the health sector goals. Keywords: E-health strategy, National Health Policy, Ministry of Health, Ghana Health Service

Mobile technology-enabled healthcare service delivery systems for community health workers in Kenya: a technology-to-performance chain perspective

Mobile technology-enabled healthcare service delivery systems for community health workers in Kenya: a technology-to-performance chain perspective

A Pilot Study of an mHealth Application for Healthcare Workers: Poor Uptake Despite High Reported Acceptability at a Rural South African Community-Based MDR-TB Treatment Program

IntroductionAs the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDR-TB) epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs), trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize) for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.ObjectiveWe assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period.MethodsAll five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs’ usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment.ResultsMobile HCWs submitted nine of 33 (27%) expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care.DiscussionThis pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations of HCWs and technologic enhancements prior to scaling new mHealth initiatives in resource poor settings.

MHealth: Technology for nursing practice, education, and research

Mobile health (mHealth) is a rapidly growing field providing the potential to enhance patient education, prevent disease, enhance diagnostics, improve treatment, lower health care costs and increase access to health care services, and advance evidence-based research. For the field of nursing the potential capabilities of mHealth are not only for patient care but for delivery of nursing education to our future practicing nurses, providing a means of communication between healthcare professionals located close and at greater geographic distances, and provides access to information and personal monitoring for geographically isolated clients. Although mHealth capabilities’ value appears significant for training, and practice, there remains a significant need for research and evaluation of the devices that now appearing in the health care marketplace. The National Institute of Nursing Research’s strategic plan includes supporting research to develop and test the flood of health apps to assist clients in the management of their health. The purposes of this paper are to: 1) discuss the importance of mHealth in nursing practice, education, and research, and 2) describe the mHealth initiatives underway at the University of Pittsburgh School of Nursing as exemplars to stimulate mHealth research and promote nursing role in providing health care to patients in this age of information technology.

Introduction: Real Time Monitoring for the Most Vulnerable - Investing in Common Guidance for Equity and Quality

Growth in the use of real-time digital information for monitoring has been rapid in developing countries across all the social sectors, and in the health sector has been remarkable. Commonly these Real Time Monitoring (RTM) initiatives involve partnerships between the state, civil society, donors and the private sector. There are differences between partners in understanding objectives, and further divergence often occurs due to adoption of specific technology-driven approaches and because profit-making is a part of the equation for some partners. With the swarming, especially of pilot mHealth initiatives, in many countries there is risk of chaotic disconnects, of confrontation between rights and profits, and of overall failure to encourage appropriate alliances to build sustainable and effective national RTM systems. What is needed is a country-led process for strengthening the quality and equity sensitivity of real-time monitoring initiatives. This article proposes the development of an effective learning and action agenda centred on the adoption of common guidance.

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.

Operational challenges in the Cambodian mHealth revolution

The use of mobile phones to deliver health programs (mHealth) has great potential in developing countries and mHealth initiatives such as the NightWatch malaria prevention program are becoming increasingly popular. However even when an mHealth intervention is known to be effective the structure of the telecommunications industry combined with user behaviours can make it extremely difficult to implement in some countries. This article describes the case of Cambodia where more than 90% of the population have access to a mobile phone due to limited accessibility of landlines but operational challenges plague even the simplest mobile interventions. The impact of this is already apparent with commercial mobile banking services. In Kenya the M-Pesa mobile banking system grew to around nine million users (21% of the population) within three years of launch. Despite Cambodians having a similar need for financial services an equivalent mobile banking product (Wing) has only reached around 250000 Cambodian users (2% of the population) in its first three years. Four significant operational challenges facing mHealth programs in Cambodia have been identified through the author’s own experiences implementing mHealth initiatives with the Cambodian Health Education Media Service (CHEMS). These challenges are potentially relevant to other countries with similar telecommunication markets: Switching Subscriber Identification Module (SIM) cards; Lack of functionality and Khmer language capability; Sharing mobiles; Competition with commercial spam.

Remote Usability Study on mHealth app VirTelMed in a South African Setting

mHealth initiatives are becoming a growing solution for healthcare provision in developing countries. With the purpose of helping people from underserved areas to access physicians, the University of California Irvine has designed the mobile application VirTelMed. The objective of the study was to implement a usability study of VirTelMed in South Africa, with a focus in its design, usefulness and intuitiveness. The study is based on observing how the respondents attempt to perform a series of tasks, complemented with a semistructured interview. Namely, 16 persons were asked to test VirTelMed. In average, the respondents expressed satisfaction with its intuitiveness, usefulness and design. Remote usability studies that use methods such as participant observation and interviews allow software developers to test mHealth applications in diverse contexts, and obtain useful contributions. Participatory tools have to be featured to allow the testers to contribute remotely to the design of the applications. General Terms Mobile health, Software Testing, Mobile Applications.

Developing a Full-Cycle mHealth Strategy

Healthcare executives today must balance an increasing number of operational dimensions, many of which were not factors as recently as ten or even five years ago. The advent of mobile healthcare, or mHealth--the emergence of handheld devices in the healthcare continuum--is one of those dimensions. All major stakeholders in care delivery are concerned and engaged with the topic of mHealth, as physicians, nurses, administrative staff, and patients increasingly depend on mobile devices to communicate at home as well as at work. The increased presence of mHealth in organizations is undeniable, although it tends to advance without the benefit of tactical or strategic design. In response, many organizations, in the course of updating their strategic plans, are now incorporating mHealth strategies or initiatives. In mHealth we are dealing with a phenomenon that has intrinsic organizational value, that can be a market differentiator, and that can lead to increased physician engagement and satisfaction. Security, device management, support, and interoperability all must be purposefully evaluated and planned for as an organization crafts an mHealth strategy. Yet, by all accounts, mHealth proliferation is proceeding, with purposeful design or without it.

The RTBP – Collective Intelligence Driving Health for the User

The Real Time Biosurveillance Program (RTBP) Pilot, is an active collaboration between multipartners that is utilizing collective intelligence to improve rural health outcomes, in Sri Lanka and Tamil Nadu, India. This paper presents how the RTBP is detecting, preventing, and therefore, improving the health systems of these two nations through the use of ICT to strengthen health reporting systems. It puts forth the challenges that the RTBP pilot has faced initially, and how they have been addressed. The RTBP is also differentiated from other mHealth initiatives by acknowledging how it is not disease specific and how it engages all stakeholders, from the receipients, the health workers, and the government.

Enabling superior m-health project success: a tricountry validation

The healthcare industry is facing increasing pressures to embrace new technologies that support greater patient access to, and higher quality of (but at the same time offer cost-effective), healthcare delivery. This pressure has spawned a plethora of initiatives to embrace the possibilities and potentials of technologies to develop and then diffuse new devices, new pharmaceutical products and support minimal invasive surgical techniques that will facilitate superior healthcare delivery. Pursuing such initiatives from idea generation to commercialisation and adoption, however, also necessitates new alliances between academe and industry to ensure rigorous research followed by rapid diffusion to support the realisation of these initiatives so that the patient becomes the ultimate beneficiary. This in turn requires new research methodologies for such applied research scenarios. The Accelerated Mapping-to-Realisation (AMR) methodology is used as an appropriate knowledge-based methodology to ensure academic rigour and validation and also facilitate rapid diffusion and commercialisation of m-health initiatives.