Article

Scaling Up mHealth: Where Is the Evidence?

Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
PLoS Medicine (Impact Factor: 14.43). 02/2013; 10(2):e1001382. DOI: 10.1371/journal.pmed.1001382
Source: PubMed

ABSTRACT

Mark Tomlinson and colleagues question whether there is sufficient evidence on implementation and effectiveness to match the wide enthusiasm for mHealth interventions, and propose a global strategy to determine needed evidence to support mHealth scale-up.

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    • "mHealth applications have tremendous potential for chronic disease support. However, these software applications have not been tested in rigorous trial designs with clinically meaningful outcomes363738 39]. The strength of this study is the use of a rigorous randomized controlled trial (RCT) design, measurement of intervention usage and fidelity, intervention delivery that is present both within the hospital and at followup , evaluation of clinically important outcomes and ITT analysis [40]. "
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    ABSTRACT: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers. Movies4Stroke will be a randomized control, outcome assessor blinded, parallel group, single center superiority trial. Participants with an acute stroke, medically stable, with mild to moderate disability and having a stable primary caregiver will be included. After obtaining informed consent the stroke survivor-caregiver dyad will be randomized. Intervention participants will have the movie program software installed in their phone, desktop, or Android device which will allow them to receive, view and repeat 5-minute videos on stroke-related topics at admission, discharge and first and third months after enrollment. The control arm will receive standard of care at an internationally accredited center with defined protocols. The primary outcome measure is medication adherence as ascertained by a locally validated Morisky Medication Adherence Scale and control of major risk factors such as blood pressure, blood sugar and blood cholesterol at 12 months post discharge. Secondary outcome measures are post-stroke complications and mortality, caregiver knowledge and change in functional outcomes after acute stroke at 1, 3, 6, 9 and 12 months. Movies4Stroke is designed to enroll 300 participant dyads after inflating 10 % to incorporate attrition and non-compliance and has been powered at 95 % to detect a 15 % difference between intervention and usual care arm. Analysis will be done by the intention-to-treat principle. Movies4Stroke is a randomized trial testing an application aimed at supporting caregivers and stroke survivors in a LMIC with no rehabilitation or chronic support systems. Trial registration NCT02202330 (28 January 2015)
    Full-text · Article · Dec 2016 · Trials
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    • "This research concluded Smartphone applications for pregnant women will be an effective educational tool compared to other existing mediators even though frequency or scope of using it would be varied according to the user's age. Frequently mentioned challenges of research on APE using Smartphone are methodological issues and lack of strong evidence for the use of mHealth [26], [27]. Accordingly, Educational use of Smartphones in the real world has to be studied closely to seek advanced ways of antenatal parent education using ICTs. "

    Preview · Article · Jan 2016
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    • "mHealth (the use of mobile technology for health) has become an established area of research and practice. The significant focus so far, though, has been on technical development, piloting, and more recently on finding and understanding the evidence of its efficacy (Labrique et al., 2013;Tomlinson et al., 2013;WHO, 2011). However, even when technological innovations are developed and are found to be efficacious, a challenge often remains as to how they can be implemented and institutionalized successfully, especially in " real world " organizational settings (Klein and Sorra, 1996). "
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    ABSTRACT: Health Management Information Systems (HMIS) in developing countries have yet to live up to expectations because of the significant proportion of implementation failures. Mobile health (mHealth) technologies are being adopted increasingly in Ministries of Health (MoHs) to address aspects of HMIS implementation failure, such as the timeliness and ease of data collection from the lowest levels of healthcare. However, networked technologies such as mobile technologies used in mHealth data collection can introduce a network logic into the organization. This network logic, which often favors open, non-hierarchical modes of communication, must work with the traditional hierarchical bureaucratic logic of the HMIS and the MoH in which they become embedded. This paper conceptualizes the interaction between these two logics. It draws on succinct, empirical vignettes from two action-research projects involving the use of mHealth technology to improve data collection for the HMIS in Nigeria. Based on these findings and an institutional logics lens, this paper argues that the interaction between these logics potentially leads to a conflict where the logic embedded in networked technologies (such as mHealth) disrupts and challenges the existing hierarchical logic in the bureaucracy (such as in the MoH). It threatens not only to unsettle existing practices and norms in the organization, but also to restructure (flatten) the organization, due to resistance, loss, or changes in some pre-existing roles. Practitioners and implementation researchers need to be sensitive to potential hierarchical and network-centric forces that are involved in implementing mHealth in traditional hierarchical settings, particularly with regards to the unintended side effects that may arise in the process.
    Full-text · Article · Jan 2016
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