A comparative study on the benefits and challenges of the application of mobile technology in health

Abstract

Background: The application of mobile technology in the health domain i.e mobile health (mhealth) commonly refers to the use of mobile telecommunication and multi-media technologies for providing health services and public health systems. Some scholars consider mobile health as a subsystem of health technology which, due to the existing conditions, has become more significant compared to other interventions in this field. The present study intends to investigate the global approach on mobile health technology on the one hand, and its benefits and challenges on the other. Materials and Methods: As a comparative-descriptive study conducted in 2011, the present study has tried to explore mhealth technology strategies in public health domain, different types of mhealth interventions and benefits of using mhealth as well as its challenges and obstacles. The data were collected through informational sources such as articles, books, magazines and valid websites. Then, the status of the countries were compared and analyzed as far as the development of this technology is concened. Results:Based on the findings of the study, one of the criteria affecting the development of mhealth is the high penetration of mobile phone. By October, 2011, the estimated number of mobile users has been over 5 billion showing a penetration coefficient of % 76. The review of the research on the obstacles and challenges experienced in moving towards the development of this technology by World Health Organization revealed that prioritization and increasing knowledge level are the most significant obstacles in the way to develop this technology. Discussions: Mhealth technology has been provided in most countries with the aim of promoting public health and accelerating the supply of health services. Having a penetration coefficient of over %90 in Iran, it can be predicted that this country can take effective steps towards development of this technology.

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A Comparative Study on the Benefits and Challenges of the Application of Mobile Technology in Health
Razieh Mirzaeian1, Mahmoud Mobasheri2, Borzoo Khaledifar3
1. Deputy of research and technology Shahrekord University of Medical Sciences. Shahrekord, Iran.
2. Department of epidemiology and bio-statistics, Faculty of health, Shahrekord University of Medical Sciences,
Shahrekord, Iran.
3. Department of Surgery, Shahrekord University of Medical Sciences,Shahrekord,Iran.
mobasheri@skums.ac.ir
Abstract: Background: The application of mobile technology in the health domain i.e mobile health (mhealth)
commonly refers to the use of mobile telecommunication and multi-media technologies for providing health services
and public health systems. Some scholars consider mobile health as a subsystem of health technology which, due to
the existing conditions, has become more significant compared to other interventions in this field. The present study
intends to investigate the global approach on mobile health technology on the one hand, and its benefits and
challenges on the other. Materials and Methods: As a comparative-descriptive study conducted in 2011, the present
study has tried to explore mhealth technology strategies in public health domain, different types of mhealth
interventions and benefits of using mhealth as well as its challenges and obstacles. The data were collected through
informational sources such as articles, books, magazines and valid websites. Then, the status of the countries were
compared and analyzed as far as the development of this technology is concened. Results:Based on the findings of
the study, one of the criteria affecting the development of mhealth is the high penetration of mobile phone. By
October, 2011, the estimated number of mobile users has been over 5 billion showing a penetration coefficient of
%76. The review of the research on the obstacles and challenges experienced in moving towards the development
of this technology by World Health Organization revealed that prioritization and increasing knowledge level are the
most significant obstacles in the way to develop this technology. Discussions: Mhealth technology has been
provided in most countries with the aim of promoting public health and accelerating the supply of health services.
Having a penetration coefficient of over %90 in Iran, it can be predicted that this country can take effective steps
towards development of this technology.
[[Mirzaeian R, Mobasheri M, Khaledifar B. A Comparative Study on the Benefits and Challenges of the
Application of Mobile Technology in Health. Life Sci J 2013;10(4):3625-3629] (ISSN:1097-8135).
http://www.lifesciencesite.com. 485
Keywords: Mhealth, Benefits; Challenges; Health
1. Introduction
Mhealth term which was first introduced by
Professor Robert Stepanian in 2003 generally refers
to providing health services through portable
communication tools and network technologies.
Since then, this technology has had a great
development in the public health and wellfare
domians. Due to the unexpected expansion of
telecommunication infrastructures and mobile phone
services, it has created a remarkable movement all
around the world especially among low-income
nations (Mechael, 2010). The abbreviated term
mhealth in fact covers a wide spectrum of products
and services ranging from blood, cholesterol and
blood pressure controlling and on-line physical
fitness plans to medical plan networks developed for
chronic patients (Sarasohn, 2009). Moreover,
“mhealth” as one technological capability has
experienced increasingly development during the
recent years (Mechael, 2010). It is predicted that
mhealth will turn into a $5 billion-industry in 2014
(Ollivier, 2009). Today, mobile phone is used for
making standard contacts, short message services
(SMS) and multimedia services (MMS) and in some
cases check mail and electronic mail (Gomez, 2008).
Besides the advantages that mobile phone has in
business and data accessibility, the researchers are
now studying the possibility of using mobile
technology in the public health services enabling the
patient to take benefits from mobile services for
purposes such as satisfying health information
requirements, management of health and care data
registration and remote monitoring under the
conditions of chronic disease like Diabetes, Asthma
and high blood pressure. Many scholars regard this
change as a revolution in the health services
(Chatterjee, 2009). Among the advantages of mhealth
project throughout the world, the following cases can
be enumerated: an increase in the access to the
health care-related information for various purposes
such as population control, an increase in
productivity, a decrease in the expenditures of health
services provision, an enhancement in the capability
of diagnosis, treatment and discovery of the disease,

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timely use of public health information, widespread
access to medical continuous education for health
care providers, supporting physicians’ and
prescribers’ orders (Mechael, 2010). Although
mobile technology is still at early stages of its
development, the existing signs are indicative of the
start of transferring this technology to the health
system so that health services and data have also
come into use for population control and a move has
been made towards population-based health care and
treatment (Nakajima, 2007). Throughout the world,
there is an inclination towards using advancements in
telecommunications and rapid absorption of portable
communicative technologies in the health domain.
Given the high interest in implementing this
technology especially in developing countries, there
seems to be a need to a conduct a deep analysis on
the results of the research performed or explore the
issues that are required to be studied. Lak of such
data impedes making effort for investment for the
development of telecommunication networks
hindering achievement in the pilot mhealth projects
(Sarasohn, 2009). The first survey on the mhealth
projects entitled “World Perspective on the
Electronic Health in 2007” was conducted by World
Health Organization and studies carried out in 2009-
2010 were reviewed and published in the public
council of mobile union so as to provide researchable
and up-to-date information regarding the application
of mhealth (Hayn,2009).
2. Materials and Methods:
In the present study which was descriptive-
comparative in nature, mhealth concepts including its
definition and description, objectives, capabilities as
well as its applications in the nations in question and
some challenges facing its development were studied
and compared. Data collection instrument was data
collecting papers which had content and face validity
and confirmed by the experts. Data resources
included documents, articles, textbooks and
magazines. Study data were gathered by studying
texts provided from the libraries and health-related
web-sites, US Food and Drug Administration, health
association and Health Electronic Transformation
National Agency. First, search strategy was designed
based on keywords and MESH system. Then, the
search was done through search engines such as
Google, Embase, Magiran, and ScienceDirect. The
used articles were in English belonging to 2003-
2010. Gathering the data, the researcher studied the
capabilities and interventions of this technology in
the health services and its challenges.
3. Results:
A total of 205 articles were found.
Following the Quality Assessment Framework was
conducted with 114 articles of which 98 papers were
foreign and other domestic articles. Articles were
classified based on the aims of researches about
various advantages of application of mobile
technology in health and the present challenges about
that. Number of articles on application of mobile
technology in preventing disease and Health
measures such as Vaccination, network coverage in
line with informing about regional communicable
diseases was 36 cases. The numbers of articles
related to the effect of this technology on reminding
the time of drug use and warn against the type of
drug consumption to control drug intervention and to
avoid wrong consumption of drug especially in
elderly was 41 cases. Articles about the role of
mobile technology in tele-consultation, supporting
the patients after their discharge from the hospital,
emergency conditions interventions and unexpected
accidents, telemedicine and telesonography were 21
cases.The findings of the study obtained from the
comparative comparison of the status of mhealth
have been classified as follows:
Table 1. Comparative Comparison of the Status of Mhealth in the Nations in Question
England
Thailand
Philipines
Uganda
South Africa
Peru
The Comparison of the Nations in
Question
*
*
*
Preventing disease
*
*
*
Reminding the time of drug use
*
*
*
Vaccination
*
*
Tele
-
consultation
*
Medical Advanced Cares
*
*
Emergency Conditions Interventions and
Unexpected Accidents
*
Supporting the patients after their
discharge from the hospital

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Table 2. A Comparison of the Challenges and Obstacles Facing Mhealth Technology
Challe
nges and Obstacles Facing Mhealth Technology
Cost
-
benefit analysis for implementing mhealth
The increase in the aged population of the societies
Accessibility and transfer of the main health priorities
Continuous check of health parameters
IT technolo
gy infrastructures architecture
Shortage of financial resources
Network coverage
The shortage of expert forces and inappropriate
diversity
The integrity of health information systems
The limitation of space and facilities
Development of mobile informati
on system in the rural
areas The security of data and preservation of data privacy
4. Discussion
According to the findings of the studies
carried out in the developed and developing nations,
mobile technology can promote health care efficiency
making it more effective. Based on the long-term
goal and expectations, mhealth projects may have
considerable effects on the clinical outcomes
including a lower infant mortality, a longer longevity,
a lower disease load. An investigation into the
performance of different nations regarding mobile
application in the health domain in Peru, using
mobile phones for sending short messages about the
symptoms of the disease has been accompanied by
the capability of rapid response to disease symptoms
(Curioso, 2010). In South Africa, sending Massey
Lulack’s short messages with the aim of providing
information about AIDS has resulted in a triple
increase in the volume of the contacts to the local
informing center. Sending short messages about
AIDS virus in Uganda has increased the number of
the visitors for AIDS test as much as %40 (Curioso2,
2010). In Philippines and Thailand in 2007, daily
contacts were made with the patients with Pneumonia
so as to remind them of the time of using their drug.
%90 of the patients in these two countries used their
drugs based on this technology. The same trend was
observed in South Africa, i.e. %90 of the patients
used their drugs by receiving these messages.
Compared to the patients who did not receive such
messages, the efficiency of drug use was promoted
by %30-%68 among these patients. Research
conducted in Spain, Australia, Finland and South
Korea on the advantages of using mobile technology
for following vaccination and Asthma or Diabetes
proved that the results of using this method are
considerable as far as improving the patients’ status
is concerned. In China, during a period of sending
textual messages for reminding the visit time, the rate
of visits was increased with the costs reduced to 1/3.
Researchers in England found that the reduction in
the visits to the hospitals due to meeting health
service requirements by using mHealth technology is
accompanied by an annual £575,000,000 saving in
the health expenditures (Vital Wave Consulting,
2009). Hence, the common capabilities of mHealth
can be divided into 7 distinct domains:
1. Notification and informing: Public
notification regarding Poliomyelitis with the
help of mobile operators was performed in
India.
2. Reminder services: This is used for those
patients who have to use medicine for a long
time at given time with time interval
between drug useage being of high
significance. Providing such services by
mobile operators will increase effective
medication therapy and decrease thinking
concerns of the family members regarding
timely use of drugs by the aged parent.
3. Distance-consultation: Online consultation
entitled help-line consultation attempts to
deliver such services.
4. Remote-control: Controlling life symptoms
and heart pulse pattern is very helpful and
effective at the time of a sudden heart attack.
5. Diagnosis: Placing a micro-chip in the
mobile phone can analyze one’s blood
sample and report the results with an image
from the sample.
6. Fighting against the accidents and
epidemics: data exchange in crisis
circumstances such as mental crises, trauma,
poisoning, informing about members
transplant, informing about the suffered
individuals, informing about blood bank all
deserve giving a thought.
7. Distance-data collection(Puccio, 2009)
8. Supporting the patients after discharge from
hospital: One recent study by Grimsman
(2007) showed that medication therapy
changes at the time of discharge for %98 of
the inpatients with at least 5 cases of change
registered for % 60 of them. Currently,
medication-related data are exchanged
through discharge paper which of course are
satisfied with some delay and do not

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necessarily include physicians’ required data
(karapinar, 2010).
9. Using Personal Digital Assistant (PDA):
PDA is the abbreviated term for personal
digital assistant referring to the first version
of mobile phone with some modern
capabilities such as web check, e-mail and
facilitating writing using light pen.
Intelligent phone is the newest
communication technology including an
integration of the functions of a mobile
phone and PDA that provide capabilities
such as access to Internet, picture and video.
Although this type of mobile phones has
gained a high popularity in the nations of
high income, they are expensive for low-
income nations (Mechael, 2010). However,
it is noteworthy that the distance between
intelligent mobile phone and ordinary
mobile phones is increasingly decreasing
(Mechael, 20101). The applications of
mobile in the developing nations have been
established in some domains such as
banking and agriculture. The move towards
taking benefits from this technology in the
health domain is slow, while the results of
the surveys by the Health World
Organization and World Bank have
provided some evidence on the development
of the mobile applications in the health
domain (Krishnamurthy, 2006). In Uganda,
PDA plan using wireless phones has been
used for checking, collecting and reporting
the illnesses resulting in a saving as much as
%24 in the expenditures. %87 of the health
care providers participating in the plan
announced that it has led to a rapid and
accurate diagnosis prompting public
awareness and enhancing illnesses
management. On recent study carried out in
USA on the use of wireless PDA by patients
suffering from Diabetes type 2 revealed that
those patients who used it regularly
experienced a higher promotion in their
blood sugar indices as opposed to those who
did not use it. Despite such benefits,
implementing this technology suffered some
challenges such as widespread coverage in
the rural areas, using equipments of efficient
performance, training , providing financial
resources and efficient check and evaluation.
Data security in data exchange and data
storing is one critical issue which may endanger
individuals’ data if it is not given due consideration.
Parameters such as data protection by password,
connecting to the network if necessary, assimilating
the files in the computer and getting a supportive file
and installing file improver and other similar
software all are a part of mobile security policy. To
prevent the removal of the data and getting polluted
by the viruses, the system must also be equipped with
a strong anti-virus program and firewall capability
(Cocosila, 2004).
5. Conclusions:
It is generally concluded that most nations
have made some provisions for the use of mobile
phones in health domain with the aim of individuals’
accessibility to their health data. Using new
informational technologies can promote the quality of
medical services. As it is evident, with mhealth for
both individual and social health purposes being one
form of them, the possibility of using such
technologies in the health domain is in increase day
by day. Taking all these into account, hence, it is
necessary for Iran to provide necessary preliminaries
for using mobile services in the health domain based
on other nations’ experiences.
Corresponding Author:
Dr. Mahmoud Mobasheri
Department of epidemiology and bio-statistics,
Faculty of health, Shahrekord
University of Medical Sciences,
Shahrekord, Iran.
E.mail: mobasheri@skums.ac.ir
Tel: 0381-3342414
Fax: 0381-3349506
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