The effectiveness of mobile-health technology-based health behaviour change or disease management for health care consumers: A systematic review

Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Medicine (Impact Factor: 14). 01/2013; 10(1):e1001362. DOI: 10.1371/journal.pmed.1001362
Source: PubMed

ABSTRACT Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers.
We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72-0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature.
Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes. Please see later in the article for the Editors' Summary.

Download full-text


Available from: Leandro Galli, Jul 30, 2015
1 Follower
  • Source
    • "Data suggest explosive technology growth in South Africa (Central Intelligence Agency, 2013; Smith, 2013). Technology-based interventions lack many of the structural challenges noted in traditional interventions and are less costly to scale up (Cole-Lewis & Kershaw, 2010; Free et al., 2013; Noar, Black, & Pierce, 2009; Perry et al., 2012; Ybarra & Eaton, 2005). Nonetheless , technology is under-utilized to promote HIV preventive behavior in developing countries. "
    [Show abstract] [Hide abstract]
    ABSTRACT: One in three new cases of HIV in South Africa is among adolescents. Given that adolescents are particularly affected, scalable and cost-effective prevention programs are urgently needed. This study aims to identify opportunities to integrate technology into youth HIV prevention efforts. In 2012, 1,107 8th – 11th graders completed a paper-and-pencil survey. Respondents were enrolled in one of three public high schools in Langa, a lower income community in Cape Town, South Africa. Eighty-nine percent of respondents have used text messaging (SMS) and 86% have gone online. If an HIV prevention program was offered online, 66% of youth would be somewhat or extremely likely to access it; slightly fewer (55%) felt the same about SMS-based programming. In comparison, 85% said they would be somewhat or extremely likely to access a school-based HIV prevention program. Interest in Internet- (60%) and SMS-based (54%) HIV prevention programming was similar for youth who had a selfappraised risk for HIV compared to youth who appraised their risk to be lower, as it was for youth who were tired of hearing messages about HIV prevention. Technology use is common – even among high school students who live in lower income communities. At the same time, these data reveal that it is not uncommon for youth to be tired of hearing messages about HIV prevention, and many of the typical topics key to HIV prevention have low interest levels among youth. HIV prevention researchers need to be mindful of the extent of existing programming that youth are exposed to. Technology-based programming may be especially amenable to meeting these requirements because of its novelty especially in developing countries, and because interactive functionality can be easily integrated into the program design. Given the preference for school- and Internet-based programming, it seems that a hybrid approach is likely feasible and acceptable.
    AIDS Care 12/2014; DOI:10.1080/09540121.2014.936814 · 1.60 Impact Factor
  • Source
    • "Even among the more rigorous evaluations, the intervention is often bundled with other inputs, such as web-based information, assistance hotlines, office visits, or free/subsidized medicine (Franklin, Waller, Pagliari, & Greene, 2006; Hurling et al., 2007; Ostojic, Cvoriscec, Ostojic, Reznikoff, Stipic-Markovic, & Tudjman, 2005; Rodgers et al., 2005). Only a few studies have attempted to isolate the impact of text messaging on health behavior or other outcomes (Free et al., 2013). Almost all of the existing evaluations have been " reminder " studies that used text messages as reminders for disease control or health management. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is little evidence showing whether health information transmitted via text messages can change health and educational outcomes. We conducted a randomized field experiment involving 900 primary students in rural China to study whether a health education campaign conducted via text message could affect caregiver knowledge or student outcomes. When caregivers received both weekly health messages and monthly quiz questions (testing retention of the information conveyed in the weekly messages), caregiver knowledge improved and students experienced gains in both health and academic performance. When caregivers received weekly health messages only, there was no impact on caregiver knowledge or student outcomes.
    World Development 12/2014; 64:766-780. DOI:10.1016/j.worlddev.2014.07.015 · 1.73 Impact Factor
  • Source
    • "In addition, telecommunications and social media have transformed the delivery of health message. " More than two-thirds of the world's population owns a mobile phone, which can be used to deliver health messages to people anywhere and anytime " (Edwards et al., 2013, p. 2). This is why research on persuasive information through mobile gadgets and applications designed to change health behaviors is showing the potential to improve healthy living, to lower health care costs (Chatterjee & Price, 2009), and to feel ownership and/or control of the intervention (Ainsworth et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The major causes of death in the world are heart attack, stroke, and cancer. The main contributing factors for chronic diseases complications are unhealthy behaviors; so, health behavior change has become imperative in the world today. There are several models and theories for health behavior change. They are, however, far from public reach because they are not easy for people to understand and apply in their daily lives. The seven-step model (7SM) is the result of integrating key constructs from different theories and models and putting them in a way that the public may understand and apply. The model has seven steps that individuals, families, and small groups can use to change behavior, and three more tools for maintenance. An exploratory study done in the Philippines and Peru with graduate students from 30 different countries shows the potential of the 7SM in changing different unhealthy behaviors and installing new healthy behaviors.
Show more