mHealth in developing countries has mixed effectiveness, modest benefits
At a time when mobile healthcare is being embraced by the United Nations to improve health outcomes in developing countries, two studies published in PLoS Medicine show that while mHealth has tremendous potential, it has resulted in mixed effectiveness and modest benefits.
The problem is that nearly all trials demonstrating the success of mHealth have been conducted in developed countries and have been low quality, according to a Guardian article. The first study on "The Effectiveness of Mobile-Health Technology-Based Health Behavior Change or Disease Management Interventions for Health Care Consumers: A Systematic Review" highlighted the need for additional high-quality controlled mHealth trials, particularly in low- and middle-income countries.
Of the 75 controlled trials reviewed in the study, the only two mHealth applications with sufficient evidence of benefit were ones related to adherence to antiretroviral therapy and smoking cessation. Yet, only the trial leveraging text messages for antiretroviral adherence took place in a low-income country.
"The demonstration that text messaging interventions increased adherence to antiretroviral therapy in a low-income setting and increased smoking cessation in a high-income setting provides some support for the inclusion of these two interventions in health-care services in similar settings," states the editors' summary of the study. "However, the effects of these two interventions need to be established in other settings and their cost-effectiveness needs to be measured before they are widely implemented."
Similarly, the second study on "The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis" concluded that high quality trials measuring clinical outcomes are needed. Researchers identified 42 controlled trials that investigated mobile technology-based interventions designed to improve health-care service delivery processes, but none of the trials were of high quality and nearly all were undertaken in high-income countries.
Meta-analyses of the results of these trials indicated that using SMS appointment reminders significantly but modestly increased patient attendance compared to no reminders. However, SMS reminders were no more effective than postal or phone call reminders, and texting reminders to patients who persistently missed appointments did not significantly change the number of cancelled appointments.
"These findings indicate that some mHealth interventions designed to improve health-care service delivery processes are modestly effective, but they also highlight the need for more trials of these interventions," states the editors' summary of the study. "Specifically, these findings show that although some interventions designed to provide support for health-care providers modestly improved some aspects of clinical diagnosis and management, other interventions had deleterious effects."
A recent FierceMobileHealthcare article on the topic argues that while developing countries have been using mobile phones, miniature laptops and diagnostic devices in the health sector for years now, there are many issues that hamper the provision of mHealth systems in these environments. Healthcare providers should consider several factors for designing successful mHealth projects in such areas.
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