MobileActive.org

The application of mobile computing and communication technology is rapidly expanding in the fields of health care and public health. This systematic review will summarise the evidence for the effectiveness of mobile technology interventions for improving health and health service outcomes (M-Health) around the world.

To be included in the review interventions must aim to improve or promote health or health service use and quality, employing any mobile computing and communication technology. This includes:

(1) interventions designed to improve diagnosis, investigation, treatment, monitoring and management of disease;

(2) interventions to deliver treatment or disease management programmes to patients, health promotion interventions, andinterventions designed to improve treatment compliance; and

(3) interventions to improve health care processes e.g. appointment attendance, result notification, vaccination reminders.

A comprehensive, electronic search strategy will be used to identify controlled studies, published since 1990, and indexed in MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, the Cochrane Library, or the UK NHSHealth Technology Assessment database. The search strategy will include terms (and synonyms) for the following mobile electronic devices (MEDs) and a range of compatible media: mobile phone; personal digital assistant (PDA); handheld computer (e.g. tablet PC); PDA phone (e.g. BlackBerry, Palm Pilot); Smartphone; enterprise digital assistant; portable media player (i.e. MP3 or MP4 player); handheld video game console. No terms for health or health service outcomes will be included, to ensure that all applications of mobile technology in public health and healthservices are identified.

Bibliographies of primary studies and review articles meeting the inclusion criteria will besearched manually to identify further eligible studies. Data on objective and self-reported outcomes and study quality will be independently extracted by two review authors. Where there are sufficient numbers of similar interventions, we will calculate and report pooled risk ratios or standardised mean differences using meta-analysis.

This systematic review will provide recommendations on the use of mobile computing and communication technology in health care and public health and will guide future work on intervention development and primary research in this field.

Access to basic health  service is limited in rural areas of Bangladesh, where 80% of the total population lives. For instance, 35% of doctors and 30% of nurses are located in four metropolitan districts where only 14.5% of the population lives. Most of the rural people are physically remote from the qualified health care providers. Two major mobile phone service providers in Bangladesh have initiated mobile health care help line service s nationwide as a remedy in this case. Since there is much hope of mobile phones to be used for basic health care services for populations living in rural areas, this research aims to evaluate how far such interventions reached  for the improvement of health care in those communities. Through an interpretive case-based research strategy, our field studies uncover enthusiasm from the rural people towards availing health help line services and the intervention's contribution to improved health-seeking behavior.

This report takes a journalistic rather than an academic approach. It aims to pique interest, provoke debate, and explore the ideas that emerged from a groundbreaking relationship. It also hopes both to accentuate the Technology Partnership’s many positive results while providing a sense of self-reflection that might benefit other potential partnerships.
Over half a decade of experimentation, the Technology Partnership encountered many challenges and saw a variety of outcomes – some successful, others less so. Some of those outcomes might have been improved by different design, but many were also an unavoidable consequence of a complex world of many players and the fast rate of
technological change.

What emerges clearly, however, is a moment of extraordinary and continued opportunity in which both the humanism of the UN and the action-oriented culture of the private sector will be essential. The potential of this cross-sector collaboration is demonstrated by the work of the UN Foundation and Vodafone Foundation. Public-private alliances of this kind require sacrifice and hard work but promise a significant boost to global efforts to improve human wellbeing.

Uganda suffers from a severe shortage of professional healthcare workers. Thus, programs aimed at prevention of disease are an important complement to the limited healthcare delivery system.

We analyze two deployments of an SMS-based HIV/AIDS education system that uses a quiz format to assess people’s knowledge of the disease, including its causes and methods of prevention. The deployments were to two groups in Uganda, one a sample of mobile phone users who live in a town in northwest Uganda; the other, workers at three factories in central and southeastern Uganda. The two samples had accuracy rates above chance levels and workers at the three factories had higher rates of participation (more individuals and more questions) than the sample selected from the cell tower service area. An analysis of incorrect answers suggested that while participants had some difficulty in matching the formatting required by the quiz, literacy did not appear to be a significant problem.

We discuss the results in terms of implications for using SMS as a user interface mechanism and explore the possibility of using social ties among participants as a way to promote the scalability and sustainability of this quiz-based education method.

Both mHealth and MFS (Mobile Financial Services) are nascent industries and fragmented along multiple dimensions. The aim of this paper is to help reduce some of these uncertainties and reinforce dialogue on how the mobile communications platform can be leveraged to strengthen mutually positive outcomes related to both financial inclusion and health. With user-centric solutions that leverage common technologies, new efficiencies and capabilities can be created that serve to accelerate global scale.

Unlocking this potential will require the following questions to be addressed: 1. What will be the best method to drive awareness and adoption of the self-reinforcing dynamics of “wealth and health”? Who will lead these efforts? 2. How will the integration and interoperability of disparate technologies across multiple industry and public sector domains occur? 3. Who will build and manage the common infrastructure and distribution networks? 4. How will the various points of policy coordination work across sector domains?

Still in its infancy, mHealth, the use of mobile technologies for health, runs the risk of not realizing its full potential due to small-scale implementations and pilot projects with limited reach. To help shed light on these issues, the mHealth Alliance commissioned an in-depth exploration of the policy barriers and research gaps facing mHealth. The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.

As illustrated throughout the literature, the current single-solution focus of mHealth needs to be replaced by using mHealth as an extension and integrator of underlying health information systems along the continuum of care. Creating a strong collaborative foundation will be instrumental in driving and positioning public and private investment in mHealth in a way that contributes to achieving improved access to health information and services, health outcomes, and efficiencies.

Within such structured paradigms, planning for infrastructure investment and human resources capacity strengthening and identifying public and private stakeholders within the ecosystem to take leadership for the development, testing, implementation, and evaluation of mHealth activities can be appropriately mapped and planned and mHealth services more effectively extended to support the health of citizens and the work of health professionals and administrators.

Rural health workers in India do not always have the training, credibility or motivation to effectively convince clients to adopt healthy practices. To help build their efficacy, we provided them with messages on mobile phones to present to clients. We present a study which compared three presentations of persuasive health messages by health workers using a phonebased lecture-style message, a phone-based dialogic message that elicits user responses, or no additional aids.

We found that dialogic messages significantly improve the quality of counseling sessions and increase discussion between health workers and clients; however, we did not statistically measure an effect of either phone-based message on health behavioral outcomes. We analyze these results in light of the challenges we faced and compromises we made through the research process due to the interplay of social, cultural and environmental realities, and discuss how these factors affect ICTD projects at large.

Patient data collection and emergency health service is the primary challenge in developing countries. Risk assessment of pregnant mother and healthcare based on priority is almost impossible in present health service of Bangladesh.

A pilot study was done in three urban slums of Dhaka where BRAC health workers were provided with mobiles. A smart algorithm was incorporated in the mobiles. The mobile solution came up with useful findings. The health workers now could send data directly to central MIS system which reduced previous time lag. A secure web page contained all the patient data which was accessible by BRAC Personnel from anywhere any time. An automated risk assessing decision tree categorized the patients depending on their risk levels for timely treatment.

The mobile solution proposed a pro-active, cost-effective platform for rapid health service for pregnant mothers and neonates with reduced manpower.

Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.

This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.

Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009

All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.

MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.

Mobile phones are currently used by millions of people around the world. In Africa, mobile phone ownership and use has dispersed at a surprisingly rapid rate across the continent. Recently, there have been multiple and diverse efforts to exploit mobile technologies for purposes of health communication, including collection of health data and provision of health information. Using mobile phones to provide family planning information, however, is a new area that has received almost no attention from health workers.

Recognizing this as a gap and an opportunity, the Mobile for Reproductive Health (m4RH) project was born. The m4RH project is conceptualized as an automated, text-based system that is compatible with any and every mobile phone to maximize reach and access to family planning information via mobile phone. Since this is a new project and mobile phones are a novel method of delivering family planning information, formative research to obtain feedback on the project was carried out in countries where the m4RH project will be piloted in 2010.

Handheld computers have untapped potential to improve HIV/AIDS programs in sub-Saharan Africa, particularly in the collection of survey data. We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior.

Participants were asked about their HIV/AIDSrelated knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition. These results suggest that using handheld computers in data collection in sub-Saharan Africa may lead to biased reports of HIV/AIDS-related risk behaviors.

The overall goal of the PDAs for Malaria Monitoring in Maputo and Gaza Provinces, Centre was to improve the management of public health dat using handheld computers in order to provide the malaria program the Lubombo Spatial Development Initiative (LSDI) with appropriate assessment tools and the ability to make informed decisions.

The specific objectives of the project that would contribute to the achievement of the overall goal were

1. to enable personnel from District level of the health service to collect data and provide it to the Provincial level in a timely fashion;
2. to develop training courses and appropriate collection tools designed for use with handheld computers; and
3. to evaluate the utility of handheld computers for the malaria control program to provide data rapidly and accurately to allow better targeting of interventions and resources.

AED-SATELLIFE developed and successfully deployed electronic data collection tools which catalog drug and rapid diagnostic test stocks; spray operators daily work performance; weekly health facility data; localization of individual households with GPS, including demographic data on household members, house structure and divisions; and health facility surveys linked to GPS positioning. Training materials were developed inPortuguese.

Independent evaluation confirmed that the electronic data collection/transmission tools proved to be a useful, adoptable, and result in higher user satisfaction compared to paper based approaches. Some challenges need to be addressed before there can be widespread adoption of the technology, such as limited infrastructure, especially cellular coverage.

Mobile phones are becoming prolific in society, both in industrialized and non-industrialized countries. Of all of the developments in new media, mobile is the only one that seems to be narrowing the digital divide rather than widening it, making it a crucial tool in improving the health of poor and hard-to-reach populations. Organizations around the world are beginning to implement mobile technology into their health behavior interventions and are seeing rising success. In diabetes and other chronic disease management, mobile phones are being used for medication alerts and health reporting. The technology is being used to send sexual health and HIV/AIDS information in places like downtown San Francisco and rural Africa, as part of ongoing testing, counseling and prevention services. In the US, applications involving GPS technology, video games, and persuasive technology are all being tested for their effectiveness in influencing health behavior and applicability on mobile phones.

Through published research and interviews with key leaders in the mobile health field, this paper outlines the benefits of mobile technology and the barriers to integrating mobile fully into public health campaigns. Despite the enormous work already being done and a host of new technologies on the rise, most experts will agree that mobile phones on their own will not serve as primary tools for influencing health behavior.  A comprehensive and integrated campaign that incorporates mobile will be most effective, but mobile alone faces too many barriers to fostering social norms on the wide-scale. In fact, many argue that the ways in which public health advocates are able to place health messages in broadcast media cannot be applied on cell phones because of society’s growing resistance to mobile marketing.

The paper asks: What are some examples of how organizations around the world have harnessed mobile technology to improve the health behavior of disease-specific and target populations? What lies in the future for mobile technology and health? Is mobile the answer we have been looking for?

The number of mobile subscribers globally is estimated to have reached four billion in 2008 (ITU, 2008), with mobile penetration reaching 61%. Around 58% of subscribers are in developing countries, and subscriber growth in Africa – more than 50% per year – is the highest in the world. Studies have shown that this rapid increase in mobile penetration has contributed significantly to economic growth. Fuss, Meschi and Waverman (2005) looked at 92 countries, both developed and developing, to estimate the impact of mobile phones on economic growth for the period 1980 to 2003. They found that a 10% difference in mobile penetration levels over the entire sample period implies a 0.6% difference in growth rates between otherwise identical developing nations. The effect of mobiles was twice as large in developing countries as in developed ones (Waverman, 2005).

Mobile phones have brought three kinds of benefits (id21, 2007). First, incremental benefits, improving what people already do – offering them faster and cheaper communication, often substituting for costly and risky journeys. Fishermen in India, for example, can earn more money and waste less fish by phoning coastal markets to see which market has a shortage of supply. Second, transformational benefits that offer something new. Innovative applications, such as m-banking and m-commerce, are bringing banking services to millions for the first time, and enabling people to use mobile phones to pay for goods and services. Third, production benefits that result from the creation of new livelihoods, not only through professional telecommunications jobs but also through activities like re-selling air-time or phone cards. Since the liberalisation of Nigeria’s telecommunications sector in 2000, the industry has become a key source of new jobs in the economy, employing about 5,500 professionals, and responsible, indirectly, for another 450,000 jobs.

With the continued expansion of mobile technology around the globe, and the persistent lack of universal Internet connectivity, the use of mobile phones in public health presents a new opportunity to improve health services delivery. This intersection of mobile technology and public health, known as m-health, offers four distinct applications for international development, including drug adherence and remote monitoring, remote dissemination of information, data collection and disease outbreak surveillance, and diagnostic treatment and support.

Several programs have addressed these m-health applications, but those that are most effective utilize open-source coding, are not reliant upon the Internet, and have great potential for scalability.